Comparison between allograft and autograft in lower trapezius tendon transfer in irreparable rotator cuff tears: a...

Recently, lower trapezius tendon transfer (LTT) has gained attention as an effective treatment option for irreparable rotator cuff tears. Although the use of interpositional graft is an inevitable process in LTT, there was no study to compare the allograft and autograft as an interpositional graft in LTT. The purpose of this systematic review is to compare the clinical outcome, graft retear and complications according to the interpositional graft using allograft and autograft in LTT.

This systematic review was prepared with the guidelines of the preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. The inclusion criteria of this systematic review were a full-length article written in English, peer-reviewed articles, level of evidence IV or higher articles, and articles reporting the clinical outcome of LTT. A comprehensive search was performed in PubMed, Cochrane Library, and Ovid-Embase. The quality of selected articles was assessed with Methodological Index for Non-Randomized studies score. The postoperative range of motion, patient-reported clinical outcome scores, graft retear, complications, and reoperations were systematically analyzed.

A total of 299 patients of 12 articles were included in this systematic review. Among them, 230 patients of 8 articles reported the results of allograft, and 69 patients of 4 articles reported the results of autograft. The mean Methodological Index for Non-Randomized studies score of 3 comparative studies and 9 case series were 17.3 ± 0.6 (72.1% of total score) and 10.6 ± 0.9 (66.3% of total score), respectively. Both allograft group and autograft group had a tendency of improvement in range of motion, and patients-reported clinical outcomes. Total graft retear rate was reported in 20 of 214 (9.3%) patients from 6 articles with a range from 4.3% to 10.5%. Total complication rate was reported in 33 of 299 (11.0%) patients from 12 articles with range from 8.6% to 26.8%. For allograft group and autograft group, the graft retear rate was 13 of 169 (7.7%) from 4 articles and 3 of 45 (6.7%) from 2 articles, respectively. The complication rate was 27 of 230 (11.7%) from 8 articles in allograft group and 6 of 69 (8.7%) from 4 articles in auto graft group.

LTT may lead to significant improvement in clinical outcomes in patients with irreparable rotator cuff tears, regardless of whether allograft or autograft is used for interpositional grafts. Although the graft retear rate was slightly higher in the allograft group, the difference of graft retear rate between allograft and autograft was not significant. However, other complications, and reoperations were higher in allograft group.