Abstract
PurposeBased on its close anatomic features and nearly-collinear force vector to those of supraspinatus muscle, the current article describes a technique of middle trapezius tendon transfer for reproduction of supraspinatus function in the context of rotator cuff irreparability/re-tear management.MethodsWhile seating the patient in beach-chair position, arthroscopic gleno-humeral examination and sub-acromial decompression are initially performed. Hamstring tendons are harvested and fashioned as flattened quadruple sheet. Through McKenzie approach, infraspinatus and subscapularis tendons are repaired. Then, medial half of middle trapezius insertion tendon is harvested from most medial 5-6 cm of the scapular spine. Through McKenzie approach, hamstring sheet is retrieved via a sub-trapezius/sub-acromial corridor from the scapular wound. Hamstring sheet is re-attached to cuff footprint by double row/suture bridge repair configuration. While retracting the scapula and placing gleno-humeral joint in 45O-abduction/45O-external rotation, hamstring sheet is re-attached to released middle trapezius tendon by non-absorbable sutures. Finally, tendon reconstruct is dynamically-tested in different positions of range of motion.ResultsTransfer of medial portion of middle trapezius insertion tendon (lengthened by interposition hamstring tendon sheet) to cuff footprint was technically feasible. Dynamic testing showed smooth sub-acromial gliding motion of the tendon reconstruct.ConclusionFor reproduction of supraspinatus function, hamstring tendon augmented-middle trapezius tendon transfer to cuff footprint heralds a number of technical and biomechanical advantages; thus offering a potential effective modality of cuff irreparability/re-tear management in relatively young patients of high functional demands. However, current description should be investigated in further biomechanical and clinical studies to validate its long-term outcomes.
Highlights
In current orthopedic practice, postero-superior rotator cuff (RC) irreparability and re-tear remain challenging conditions for which tendon transfer of latissimus dorsi represented, over decades, a commonly-exercisedKandeel Journal of Experimental Orthopaedics (2021) 8:105 management modality, notably, in young active patients of high functional demands [6]..In 2009, Elhassan et al described the technique of lower trapezius tendon transfer (LTTT) for management of traumatic brachial plexus palsy
For reproduction of SSP function; middle trapezius tendon transfer (MTTT) might offer a number of potential biomechanical, biological and technical advantages which in turn are to result in almost re-normalized gleno-humeral (GH) kinematics and satisfactory clinical outcomes especially with regard to restoration of active GH elevation [8, 13, 14, 18]
In a novel cadaveric technical description, Moroder et al released the middle trapezius tendon from its acromial attachment in order to be transferred to the footprint of a simulated SSP tear; concluding that insufficient length and dynamic mechanical block of the transferred tendon remain questionable possibilities in protracted-scapular position [13]
Summary
Postero-superior rotator cuff (RC) irreparability and re-tear remain challenging conditions for which tendon transfer of latissimus dorsi represented, over decades, a commonly-exercisedKandeel Journal of Experimental Orthopaedics (2021) 8:105 management modality, notably, in young active patients of high functional demands [6]..In 2009, Elhassan et al described the technique of lower trapezius tendon transfer (LTTT) for management of traumatic brachial plexus palsy. Later in 2016, LTTT was investigated; in management of irreparable postero-superior RC deficiency yielding satisfactory outcomes in terms of shoulder functional scoring and restoration of external rotation (ER) provided that preoperative active forward flexion (FF) was more than 80O. The latter perquisite can be attributed to inability of this transfer to reproduce supraspinatus (SSP) function [3, 5].
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