Outcomes after arthroscopically assisted lower trapezius transfer for irreparable posterosuperior rotator cuff tears

The preferred surgical management for massive irreparable posterosuperior rotator cuff tears remains undecided. Treatment options include primary partial repair with allograft augmentation, balloon spacer, tendon transfers, and reverse total shoulder arthroplasty (rTSA). For younger and more active patients where rTSA is not preferred, tendon transfers may be an appropriate option. This study evaluates the outcomes of patients who underwent an arthroscopically assisted lower trapezius tendon transfer (AaLTT) for irreparable posterosuperior rotator cuff tears.

A total of 54 patients (42 male and 12 female) with an average age of 59 years (range: 36-76 years) were evaluated. All patients were treated with an AaLTT as treatment for a massive irreparable posterosuperior rotator cuff tear and had a minimum follow-up of 12 months. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale (VAS), and range of motion (ROM) were compared to evaluate improvement in ROM and function after the procedure.

At a minimum follow-up of 12 months, patients demonstrated a significant improvement in forward flexion (average 20°, P value < .0001) and external rotation ROM (average 10°, P value < .0001). A preoperative external rotation lag sign was reversed in 36 of 38 (94.7%) patients. There were significant improvements in postoperative ROM and patient-reported outcome measurement scores (ASES and VAS) with a median improvement of 53 points for the ASES score and a median improvement of 4 points on the VAS. There is no literature describing the minimal clinically important difference for VAS and ASES change after AaLTT. However, our values do exceed the minimal clinically important difference cited in prior reports for arthroscopic rotator cuff repair of 27.13 and 2.37 for ASES and VAS, respectively.

This study demonstrates that AaLTTs with allograft augmentation for irreparable rotator cuff tears provide patients with a significant improvement in ROM, specifically forward flexion and external rotation, as well as patient-reported outcome measures. Future studies should focus on follow-up beyond 12 months as well as creating standardization of surgical technique in order to improve procedure adoption.