Lower trapezius tendon transfer for irreparable rotator cuff tears: Achilles allograft versus hamstring autograft

Arthroscopic-assisted lower trapezius tendon transfer (SALTT) utilizes an interpositional graft between the lower trapezius tendon and the greater tuberosity. We hypothesized that SALTT with achilles allograft or semitendinosus autograft would result in similar patient outcomes and complication rates.

Patients undergoing SALTT with semitendinosus autograft from 2019 to 2023 were case matched to patients with achilles allograft based on age, preoperative subjective shoulder value (SSV), and sex. Active forward elevation (aFE), external rotation (ER) lag, and SSV were assessed pre- and postoperatively.

Sixteen patients (17 shoulders) with semitendinosus autograft (Auto) were case matched to 17 patients with achilles allograft (Allo). SSV improved with no significant difference between groups (Auto: 71.8 ± 7.3, Allo: 72.5 ± 19.4, P = 0.9). ER lag also improved, with a similar rate of a persistent ER lag (Auto: 5.9%, Allo: 11.8%, P = 1). aFE was greater in the Allo cohort (151 ± 16°, 135 ± 20°, P = 0.015). On linear regression analysis, a subscapularis tear requiring repair (β = -0.61, P = 0.008) and male sex (β = -0.48, P = 0.032) were negatively associated with final SSV. There was one surgical site infection in the Auto cohort and one traumatic graft rupture in the Allo cohort.

SALTT with either achilles allograft or semitendinosus autograft delivers similar improvements in SSV and ER lag with minimal complication rates.

Level III, case-controlled study.