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Lower Trapezius Transfer Maintains Meaningful Outcomes at 5 Years Based on Procedure-Specific Minimal Clinically
Chang Hee Baek1, Jung Gon Kim1, Bo Taek Kim1
1Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeoseo 1-ro, Republic of Korea.
Purpose:
To quantify patient-reported outcomes at 5 years after arthroscopic-assisted lower trapezius tendon transfer irreparable posterosuperior rotator cuff tears and to establish procedure-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds.
Methods:
From 2017 to 2019, we retrospectively reviewed consecutive lower trapezius tendon transfer cases for irreparable posterosuperior tears with a minimum 5-year follow-up. Patient-reported outcome measures (PROMs) (American Shoulder and Elbow Surgeons [ASES] score, Constant-Murley, Activities of Daily Living and External Rotation [ADLER] score, visual analog pain scale [VAS]) were collected pre- and postoperatively. MCIDs were calculated by a distribution-based approach (.5 SD), and PASS thresholds were derived by receiver operating characteristic-Youden for PROMs with acceptable discrimination (area under the curve (AUC) > .70). Associations of age, sex, body mass index, diabetes, hypertension, and teres-minor trophicity with MCID/PASS attainment were evaluated.
Results:
We analyzed 34 shoulders (23 men/11 women; mean age 63.5 ± 5.5 years) at a mean 76.5 ± 5.7 months (range, 65-89). MCID thresholds were ASES 8.2 (79.4%), Constant 7.4 (70.6%), ADLER 3.0 (76.5%), and VAS 3.0 (70.6%). AUC values were as follows: ASES .97 (95% CI, .92-1.00), Constant .72 (.48-.91), ADLER .74 (.54-.91), and VAS .70 (.54-.92). PASS thresholds were ASES ≥ 83 (61.8%), Constant ≥ 73 (41.2%), and ADLER ≥ 28 (61.8%); VAS showed borderline discrimination and was not retained for PASS reporting. Higher teres minor trophicity correlated with ADLER MCID (ρ = -.743, P < -.001) and PASS (ρ = -.649, P < -.001). Younger age correlated with ASES PASS (ρ = -.427, P = .012) and Constant PASS (ρ = -.504, P = .002). Sex and comorbidities were not associated.
Conclusions:
Arthroscopic-assisted lower trapezius tendon transfer yielded durable, clinically meaningful improvement at least 5 years, and procedure-specific MCID and PASS thresholds were established for ASES, Constant-Murley, and ADLER. Preoperative trophicity of the teres minor was a significant predictor of PASS achievement.
Level Of Evidence:
Level IV, therapeutic retrospective cohort study.