Advancement of Rotator Cuff With Trapezius Reinforcement: An Alternative Surgical Technique for Treatment of Massive Irreparable Posterosuperior Rotator Cuff Tears

Abstract

Massive irreparable rotator cuff tears represent a marked challenge for shoulder surgeons, particularly in younger patients with a high level of activity, when a reverse shoulder arthroplasty is not a valuable option. Since massive tears have traditionally been attributed to high retear rates, numerous alternative procedures have been proposed such as partial repair, various tendon transfers, superior capsular reconstruction, or repair with different patch augmentation techniques. In recent years, muscle advancement of the rotator cuff, which used to be a historical procedure, has been emphasized again, with several studies reporting promising clinical and structural outcomes for the treatment of irreparable rotator cuff tears. In this technical note, we describe an alternative technique: advancement of the rotator cuff with trapezius reinforcement. This technique includes muscle advancement of the supraspinatus and infraspinatus muscles and an additional augmentation of the infraspinatus muscle using the lower trapezius tendon to enhance the muscular component of the final repair construct and to achieve higher postoperative strength outcomes in massive irreparable posterosuperior rotator cuff tears.