Lower Trapezius Tendon Transfer Using Achilles Tendon Allograft Effectively Restores Function After Failed Superior...

Area of Science:

• Orthopedic Surgery
• Shoulder Reconstruction
• Tendon Transfer Procedures

Background:

• Failed superior capsular reconstruction (SCR) presents a significant challenge in shoulder treatment.
• Identifying effective salvage procedures for patients with failed SCR is crucial for restoring shoulder function.
• Lower trapezius tendon (LTT) transfer is an emerging technique for addressing complex shoulder instability and defects.

Purpose of the Study:

• To evaluate the clinical outcomes of lower trapezius tendon (LTT) transfer using an Achilles tendon allograft in patients who experienced failure of prior superior capsular reconstruction (SCR).
• To assess the efficacy of LTT transfer as a salvage procedure for failed SCR, focusing on pain reduction and functional restoration.

Main Methods:

• A retrospective review of 18 patients who underwent LTT transfer with an Achilles tendon allograft following SCR failure (January 2018 - May 2020).
• Inclusion criteria included structural/functional SCR failure with minimal glenohumeral arthritis and ≥2 years follow-up.
• Clinical outcomes were assessed using VAS, SSV, Constant score, ASES score, and range of motion (ROM) preoperatively and at final follow-up.

Main Results:

• Statistically significant improvements were observed in VAS, SSV, Constant, and ASES scores (P < .001).
• Clinically meaningful improvements (MCID) were noted in 88.9-94.4% of patients across outcome measures.
• Significant gains in forward elevation (73° to 120°), abduction (57° to 93°), and external rotation (-22° to 40°) were achieved.
• 77.8% resumed occupational activities, 61.1% returned to sports; 22.2% required conversion to reverse shoulder arthroplasty.

Conclusions:

• Lower trapezius tendon (LTT) transfer using an Achilles tendon allograft following failed SCR leads to significant improvements in pain, function, and range of motion.
• This procedure represents a potential treatment option for younger, active patients aiming to preserve native shoulder anatomy and function after SCR failure.