Abstract
PurposeThe purpose of this study was to investigate the anatomical feasibility of a middle trapezius transfer below the acromion for treatment of irreparable supraspinatus tendon tears.MethodsThis study involved 20 human cadaveric shoulders in 10 full-body specimens. One shoulder in each specimen was dissected and assessed for muscle and tendon extent, force vectors, and distance to the neurovascular structures. The opposite shoulder was used to evaluate the surgical feasibility of the middle trapezius transfer via limited skin incisions along with an assessment of range of motion and risk of neurovascular injury following transfer.ResultsThe harvested acromial insertion of the middle trapezius tendon showed an average muscle length of 11.7 ± 3.0 cm, tendon length of 2.7 ± 0.9 cm, footprint length of 4.3 ± 0.7 cm and footprint width of 1.4 ± 0.5 cm. The average angle between the non-transferred middle trapezius transfer and the supraspinatus was 33 ± 10° in the transversal plane and 34 ± 14° in the coronal plane. The mean distance from the acromion to the neurovascular bundle was 6.3 ± 1.3 cm (minimum: 4.0 cm). During surgical simulation there was sufficient excursion of the MTT without limitation of range of motion in a retracted scapular position but not in a protracted position. No injuries to the neurovascular structures were noted.ConclusionTransfer of the acromial portion of the middle trapezius for replacement of an irreparable supraspinatus seems to be feasible in terms of size, vector, excursion, mobility and safety. However, some concern regarding sufficiency of transfer excursion remains as scapula protraction can increase the pathway length of the transfer.Level of evidenceBasic Science Study/Anatomical Study
Highlights
Irreparable supraspinatus tendon tears (ISTT) with associated pain and loss of function are difficult to treat especially in a younger and high-demanding patientMoroder et al J EXP ORTOP (2021) 8:5 by the cuff and interposition grafting depends on the still available rotator cuff muscle tissue
While several replacement options have been described for anterosuperior and posterosuperior irreparable rotator cuff tendon tears (IRCTT) [9, 10, 12, 15, 18, 19, 27, 28, 36], currently, no tendon transfer option other than the deltoid-flap procedure [2, 34] is available for replacing a ISTT
While trapezius transfers have been previously used for paralytic patients due to brachial plexus palsies and deltoid muscle inactivity [1, 3–5, 13, 20, 22, 25, 29, 30], a transfer of the middle trapezius to treat patients with ISTT has so far not been described
Summary
Irreparable supraspinatus tendon tears (ISTT) with associated pain and loss of function are difficult to treat especially in a younger and high-demanding patientMoroder et al J EXP ORTOP (2021) 8:5 by the cuff and interposition grafting depends on the still available rotator cuff muscle tissue. Irreparable supraspinatus tendon tears (ISTT) with associated pain and loss of function are difficult to treat especially in a younger and high-demanding patient. Tendon transfers are common salvage procedures for irreparable rotator cuff tendon tears (IRCTT) featuring a dynamic biomechanical component and independence from residual muscle and tendon tissue of the torn musculotendinous unit. While several replacement options have been described for anterosuperior and posterosuperior IRCTTs [9, 10, 12, 15, 18, 19, 27, 28, 36], currently, no tendon transfer option other than the deltoid-flap procedure [2, 34] is available for replacing a ISTT. While trapezius transfers have been previously used for paralytic patients due to brachial plexus palsies and deltoid muscle inactivity [1, 3–5, 13, 20, 22, 25, 29, 30], a transfer of the middle trapezius to treat patients with ISTT has so far not been described. The purpose of this study was to investigate the anatomical feasibility of a middle trapezius transfer below the acromion to substitute the supraspinatus
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