Abstract
Objectives: To explore the indications and surgical techniques for arthroscopic lower trapezius transfer (LTT) with tendon autograft in managing massive irreparable posterosuperior rotator cuff tears (PSRCTs); to validate the feasibility, safety, and efficacy of this technique.Methods: This study retrospectively enrolled 23 patients with massive irreparable PSRCTs, admitted to and followed up by the Taizhou Hospital of Zhejiang province between July 2020 and April 2021, and treated with ipsilateral LTT and ipsilateral hamstring tendon autograft. The control group consisted of 23 patients with massive RCTs receiving conventional repair procedures within the same frame. Follow-up data at the preoperative visit, and postoperative month 3 were collected to assess the active range of motion, Constant–Murley Score (CMS),American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University of California, Los Angeles (UCLA)shoulder score, visual analog scale (VAS)and the post-operative MRI results, all of which could provide a comprehensive postoperative early efficacy assessment.Results: Three months follow-up visits were completed for all patients, revealing improvements in all aspects compared to the preoperative state, with no complications, such as postoperative infection of surgical sites and nerve injuries of infection and nerve injury. The distribution of active shoulder range of motion of patients and function scores with two types of operation was as follow: angles of flexion and lifting (130.00° ± 31.55° vs. 90.78° ± 19.85°), abduction (123.26° ± 30.47°vs. 85.87° ± 18.74°), external rotation at side (101.74° ± 14.74° vs. 91.74° ± 11.92°), external rotation at 90° abduction (41.52° ± 21.97° vs. 24.57° ±12.60°), VAS (0.74± 0.81 vs. 1.87 ±0.87), CMS(56.3 ± 13.01 vs. 48.30 ± 8.38), UCLA shoulder score (24.04 ± 2.88 vs.20.96 ± 3.47), ASES (72.91 ± 9.99 vs.60.74 ± 8.84). Significantly better improvements were found in the study group on month 3.19 of 23 patients in the study group and 17 of 23 patients in the control group underwent MRI on the 3 months follow up. Retear was found in only one patient who had grade 4 subscapularis tendon injury, However, revision was not performed due to postoperative pain relief and functional improvement.Conclusion: Compared to conventional repair procedures, in the early postoperative period, LTT with tendon autograft could achieve better pain relief, more rapid motor functional recovery, and higher functional scores for massive irreparable PSRCTs.
Highlights
In the 21st century, with the accelerated aging of the Chinese population, cases of rotator cuff injuries are increasing, as with patients with irreparable rotator cuff tears (RCTs)
Various treatments have been developed for massive RCTs, including conservative treatment, arthroscopic debridement, transfer and fixation of the long head of biceps, superior capsular reconstruction (SCR), latissimus dorsi transfer, lower trapezius transfer (LTT), subacromial balloon spacer implantation, and reverse shoulder replacement [3, 4]
The selection of procedures and their efficacies have been questioned by many experts due to the high failure rate of the massive RCT repair procedures, which is probably caused by intramuscular fat infiltration and severe atrophy of the rotator cuff resulting from the chronic course of the disease
Summary
In the 21st century, with the accelerated aging of the Chinese population, cases of rotator cuff injuries are increasing, as with patients with irreparable rotator cuff tears (RCTs). Various treatments have been developed for massive RCTs, including conservative treatment, arthroscopic debridement, transfer and fixation of the long head of biceps, superior capsular reconstruction (SCR), latissimus dorsi transfer, lower trapezius transfer (LTT), subacromial balloon spacer implantation, and reverse shoulder replacement [3, 4]. As for the treatment of irreparable posterosuperior rotator cuff tears, an increasing number of studies focused on latissimus dorsi transfer (LDT) and lower trapezius transfer (LTT), as well as their efficacy in comparison to one another, with results showing that LTT possessed advantages such as better aid in synergistic movement, application of force on humeral head in a direction more consistent with infraspinatus muscle, etc. This study explored attempts of LTT with tendon autograft in the treatment of massive irreparable PSRCTs and summarized clinical follow-up data
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