修復不可能な後上部腱板断裂に対するアキレス腱骨同種移植片と細胞除去真皮基質増強を用いた改良型下部僧帽筋腱移行術

Lower trapezius (LT) transfer has shown promising clinical outcomes in the treatment of posterior-superior rotator cuff tears. Numerous surgical modifications of LT transfer have been developed, including variations in interpositional graft choices, fixation methods, and graft anastomosis techniques. The most widely adopted method involves the use of an Achilles tendon allograft to bridge the gap between the humerus and the LT. Unlike conventional tendon-only grafts, the technique described in this article retains the calcaneal bone block to facilitate bone-to-bone healing at the humeral footprint. The bony portion is shaped to approximately 5 mm in thickness for optimal fit and is secured using a triple-row suture anchor configuration. To enhance the subacromial spacer effect and reduce friction on the bursal side, an acellular dermal matrix patch is applied over the graft. This technical note outlines a step-by-step approach to arthroscopically assisted LT transfer using an Achilles tendon-bone allograft augmented with an acellular dermal matrix patch for the treatment of irreparable posterior-superior rotator cuff tears.