Lower trapezius transfer for massive posterosuperior rotator cuff defects

• Published in: Operative Orthopädie und Traumatologie Vol. 34; no. 1; pp. 34 - 44
• Main Authors: Rodríguez-Vaquero, Gia, López-Fernández, Vanesa, Calvo, Emilio
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Medizin 01.02.2022
• Subjects: Anatomy; Hand Surgery; Humans; Medicine; Medicine & Public Health; Operative Techniken; Orthopedics; Plastic Surgery; Rotator Cuff - surgery; Rotator Cuff Injuries - surgery; Superficial Back Muscles - surgery; Surgical Orthopedics; Tendon Transfer; Traumatic Surgery; Treatment Outcome; Irreparable rotator cuff tears; Arthroskopischer Transfer des unteren M. trapezius; Arthroscopic lower trapezius transfer; Schwerer Rotatorenmanschettendefekt; Rekonstrukion der Schulter; Shoulder reconstruction; Massive rotator cuff tear; Irreparable Rotatorenmanschettendefekte; Lower trapezius; Sehnentransfer an der Schulter; Shoulder tendon transfer
• ISSN: 0934-6694; 1439-0981; 1439-0981
• DOI: 10.1007/s00064-021-00756-1

Objective To present the arthroscopically assisted lower trapezius transfer technique that restores shoulder external rotation and forward elevation, with low complication rates and fast recovery. Indications Massive irreparable posterosuperior rotator cuff tears in active young patients with fatty infiltration ≥ III, osteoarthrosis Hamada ≤ 3, normal function of lower trapezius, and without glenohumeral stiffness. Contraindications Absolute: Active soft tissue infection and trapezius muscle paralysis. Relative: medical comorbidities, inability to follow postoperative recommendations, advanced age, advanced degenerative changes (Hamada > 3), deltoid deficiency, and forward elevation < 60º. Surgical technique Beach chair position. Lower trapezius harvesting, allograft preparation, arthroscopic evaluation and rotator cuff partial repair, allograft passage, allograft intraarticular arthroscopic attachment, lower trapezius-allograft open attachment and wound closure. Postoperative management Avoidance of internal rotation with an external rotation brace for 6 weeks. At 6 weeks progressively appropriate physical therapy. Unrestricted activity at 6 months. Results At mean follow-up of 14 months, good results were reported (pain, range of motion, and Subjective Shoulder Value and Disabilities of the Arm and Shoulder and Hand scores). Long-term symptoms, Hamada 3 rotator cuff arthropathy, and true pseudo paralysis were associated with negative clinical outcomes, but subscapularis pathology and teres minor fatty atrophy were not. A low complication rate was described. Arthroscopically assisted lower trapezius transfer may restore motion and strength in external rotation. Good results with low complication rates have been reported. It has become the authors’ procedure of choice in young active patients with irreparable massive rotator cuff tears.