Outcomes of arthroscopic-assisted middle trapezius tendon transfer for isolated irreparable supraspinatus tendon tears: minimum 2-year follow-up

Short-term clinical results of middle trapezius tendon transfer with Achilles tendon allograft for irreparable supraspinatus tears

BACKGROUND

Among emerging options, middle trapezius tendon (MTT) transfer has shown promise, particularly in isolated supraspinatus irreparable rotator cuff tears (ISIRCTs) and nonarthritic shoulders unsuitable for reverse total shoulder arthroplasty. This study aims to assess clinical and radiological results of MTT transfer utilizing an Achilles tendon allograft for ISIRCTs.

METHODS

We retrospectively reviewed patients who received MTT transfer using Achilles tendon allograft for ISIRCTs between May 2020 and August 2021. Clinical assessments using pain visual analog scale, Constant, American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Single Assessment Numeric Evaluation score were assessed preoperatively and postoperatively. Active range of motion was obtained, and radiologic assessments included acromiohumeral distance, Hamada grade, and MTT integrity.

RESULTS

Eighteen patients were involved with mean age of 63.8 ± 7.1, followed for an average of 25.4 ± 4.4 months. Significant improvements were observed in pain relief (visual analog scale: 4.7 ± 1.5 to 1.6 ± 0.9, P < .001), shoulder function (Constant: 53.1 ± 11.1 to 70.0 ± 15.1, American Shoulder and Elbow Surgeons: 57.7 ± 13.5 to 78.2 ± 17.0, University of California-Los Angeles: 13.6 ± 4.5 to 22.0 ± 6.4; all P < .001), and patient satisfaction (Single Assessment Numeric Evaluation: 51.3 ± 14.1 to 73.7 ± 15.0, P < .001). Active range of motion significantly improved in forward elevation and abduction. Radiologic assessments showed no significant change in acromiohumeral distance and Hamada grade, with P values of 0.503 and 0.260, respectively.

CONCLUSION

MTT transfer using Achilles tendon allograft showed improvement in pain relief, clinical scores, and active forward elevation and abduction in patients with ISIRCTs. However, the validation of its effectiveness necessitates multicenter and long-term studies.

Comparative outcomes of middle trapezius tendon transfer using Achilles tendon allograft vs. fascia lata autograft for isolated supraspinatus tendon tears

BACKGROUND

Irreparable supraspinatus tendon tears pose significant challenges in surgical management, particularly when conventional arthroscopic repair methods are inadequate. Middle trapezius tendon (MTT) transfer has emerged as a potential salvage procedure, but the comparative efficacy of different interpositional grafts-such as Achilles tendon allografts and fascia lata autografts-remains unclear.

METHODS

This retrospective case series evaluated patients who underwent MTT transfer with either an Achilles tendon allograft (group A) or fascia lata autograft (group F) from December 2019 to March 2022. Included patients had persistent pain after conservative treatment, minimal glenohumeral arthritis, and severe supraspinatus retraction with high fatty infiltration. Clinical outcomes were assessed preoperatively and postoperatively using visual analog scale for pain, along with patient-reported outcome measures including the Constant, American Shoulder and Elbow Surgeons, University of California, Los Angeles, and Single Assessment Numeric Evaluation scores. Radiological assessments evaluated the integrity of the transferred tendon and glenohumeral arthritis progression.

RESULTS

A total of 33 patients (20 in group A and 13 in group F) were included. Both groups showed significant improvements in visual analog scale scores and patient-reported outcomes (P < .001) with no notable differences between them. Shoulder range of motion and strength also improved significantly in both groups. There was no significant progression of glenohumeral arthritis and no significant difference in rate of complications between the groups.

CONCLUSIONS

MTT transfer is an effective surgical option for patients with irreparable supraspinatus tendon tears, yielding substantial improvements in pain and shoulder function regardless of the interpositional graft used. Both Achilles tendon allografts and fascia lata autografts demonstrated similar outcomes, offering flexibility in surgical approach based on individual patient considerations.

Efficacy of latissimus dorsi and teres major tendon transfer in anterosuperior irreparable rotator cuff tears and posterosuperior irreparable rotator cuff tears

BACKGROUND

There are various options of tendon transfer according to the different types of irreparable rotator cuff tears (IRCTs). However, there were no clear treatment options for the IRCTs involving the anterior, superior and posterior rotator cuff tears (global IRCTs). Latissimus dorsi and teres major (LDTM) could be transferred anteriorly or posteriorly in global IRCTs. The purpose of this study is to evaluate the efficacy of LDTM transfer in anterosuperior IRCTs (ASIRCTs) and posterosuperior IRCTs (PSIRCTs).

METHODS

The patients who underwent anterior LDTM (aLDTM) transfer (aLDTM group, n = 35) for ASIRCTs or pLDTM transfer (aLDTM group, n = 33) for PSIRCTs between January 2017 and December 2020 were reviewed retrospectively. Clinical and functional outcomes were evaluated based on pain, patient-reported outcome scores, active range of motion (aROM) and strength of aROM. Radiological outcomes were evaluated using arthritic changes in the glenohumeral joint and transferred tendon integrity. Arthritic changes in the glenohumeral joint were evaluated using the acromiohumeral distance (AHD) and Hamada classification on the true anteroposterior radiograph.

RESULTS

No significant intergroup difference was confirmed in patient demographics except for preoperative fat infiltration grade of subscapularis and infraspinatus. The postoperative Constant score, and University of California and Los Angeles (UCLA) score of aLDTM group were significantly higher than that of pLDTM group (p < 0.001 and < 0.001, respectively). Moreover, the achievement of minimal clinically important difference (MCID) for American Shoulder and Elbow Surgeons score and UCLA score showed a significant difference between two groups (p = 0.021 and 0.042, respectively). The postoperative forward elevation (FE) was significantly higher in aLDTM group (p = 0.046). The postoperative FE strength and abduction strength were significantly higher in aLDTM group (p = 0.001 and 0.025, respectively). Moreover, the mean improvement of internal rotation strength in aLDTM group was significantly higher than mean improvement of external rotation strength in pLDTM group (p = 0.011). The progression of arthritic change was significantly higher in pLDTM group (p = 0.002).

CONCLUSION

Although LDTM transfer is an effective and safe treatment option for ASIRCTs and PSIRCTs, LDTM transfer is more effective for ASIRCTs than PSIRCTs due to its biomechanical advantage and tendon transfer principles.

LEVEL OF STUDY

Level III.

Arthroscopic-Assisted Middle Trapezius Transfer Using an Achilles Tendon Allograft in Treatment of Isolated Supraspinatus Irreparable Rotator Cuff Tears in Lateral Decubitus Position

The optimal treatment for patients diagnosed with isolated supraspinatus irreparable rotator cuff tears continues to be a subject of debate. Joint-preserving methods, including partial repair, superior capsule reconstruction, balloon spacers, and tendon transfer, have been introduced. Among these options, the middle trapezius tendon (MTT) transfer has garnered attention for its potential to replace the irreparable portion of the supraspinatus tendon and provide dynamic stability to the joint. Although some reports have highlighted promising clinical outcomes of MTT, there remains a dearth of literature regarding the techniques and methods involved in the surgical procedure. This Technical Note introduces an arthroscopic-assisted technique for MTT transfer using an Achilles tendon allograft for patients diagnosed with isolated supraspinatus irreparable rotator cuff tears in lateral decubitus.

Middle trapezius tendon transfer using Achilles allograft for irreparable isolated supraspinatus tendon tears effectively restores the superior stability of the humeral head without restricting range of motion: a biomechanical study

BACKGROUND

Middle trapezius tendon (MTT) transfer has been suggested for promising treatment of irreparable isolated supraspinatus tendon tears (IISTTs). However, there have been no attempts to assess the biomechanical efficacy of MTT transfer. This study aims to evaluate the biomechanical efficacy of MTT transfer in the setting of IISTTs.

METHODS

Eight fresh frozen cadaveric shoulders were tested in 3 conditions: (1) intact rotator cuff, (2) IISTT, and (3) MTT transfer using Achilles allograft for IISTTs. Total humeral rotational range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were measured at 0°, 20°, and 40° glenohumeral abduction (representing 0°, 30°, and 60° shoulder abduction). Superior translation and subacromial contact pressures were measured at 0°, 30°, 60°, and 90° external rotation (ER). Two different MTT muscle loading conditions were investigated. A linear mixed effects model and Tukey post hoc test were used for statistical analysis.

RESULTS

Total ROM was significantly increased after IISTT at 20° abduction (P = .037). There were no changes in total ROM following MTT transfer compared to the IISTT condition (P > .625 for all comparisons). The IISTT condition significantly increased superior translation compared to the intact rotator cuff condition in 0° and 20° abduction with all ER angles (P < .001), 40° abduction-30° ER (P = .016), and 40° abduction-60° ER (P = .002). MTT transfer significantly decreased superior translation of the humeral head at all abduction angles compared to the IISTT condition (P < .026). MTT transfer significantly decreased peak contact pressure by 638.7 kPa (normal loading) and 726.8 kPa (double loading) at 0° abduction-30° ER compared to the IISTT condition (P < .001). Mean contact pressure was decreased by 102.8 kPa (normal loading) and 118.0 kPa (double loading) at 0° abduction-30° ER (P < .001) and 101.0 kPa (normal loading) and 99.2 kPa (double loading) at 0° abduction-60° ER (P < .001). MTT transfer at 20° abduction-30° ER with 24 N loading significantly decreased contact pressure by 91.2 kPa (P = .035).

CONCLUSIONS

The MTT transfer biomechanically restored the superior humeral head translation and reduced the subacromial contact pressure in a cadaveric model of IISTT, while not restricting total ROM. These findings suggest that MTT transfer may have potential as a surgical treatment for IISTTs.

Superior Capsular Reconstruction Versus Middle Trapezius Tendon Transfer for Isolated Irreparable Supraspinatus Tendon Tears: Static Versus Dynamic Reconstruction

BACKGROUND

Both superior capsular reconstruction (SCR) and middle trapezius tendon (MTT) transfer can be performed in nonarthritic young and active patients with isolated irreparable supraspinatus tendon tears (IISTTs). However, to our knowledge, no comparative clinical studies have been conducted on these procedures.

PURPOSE

To evaluate and compare the clinical and radiological outcomes of SCR and arthroscopic-assisted MTT transfer in patients with IISTTs.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

A total of 60 patients with IISTTs were categorized into 2 groups according to the surgical procedure-Group S underwent SCR (n = 34); Group M underwent MTT transfer (n = 26). The clinical outcomes included the visual analog scale score for pain, active shoulder range of motion, American Shoulder and Elbow Surgeons score, and University of California, Los Angeles, shoulder score. Radiological outcomes included the assessment of the acromiohumeral distance, progression of cuff tear arthropathy (Hamada grade), subacromial bone erosion, and graft failure.

RESULTS

The mean follow-up time was 39.3 ± 5.2 months (range, 26-59 months) and 37.6 ± 9.8 months (range, 27-54 months) in Group S and Group M, respectively. Significant improvements in clinical outcomes were observed in both groups, while the active forward flexion (148.2°± 24.1° vs 165.9°± 8.7°; P = .003) and abduction (131°± 37.3° vs 152.5°± 17.9°; P = .035) were significantly higher in Group M at the final follow-up. No significant differences were found in the postoperative Constant, American Shoulder and Elbow Surgeons, and University of California, Los Angeles, shoulder scores between the 2 groups. Radiologically, although no difference was found in the Hamada grade at the final follow-up between the 2 groups (P = .143), the rates of acromial wear (58.8% vs 15.4%; P < .001) and graft retear (47.1% vs 7.7%; P < .001) were significantly higher in Group S than in Group M.

CONCLUSION

Both SCR and MTT transfer improved the overall clinical outcomes of IISTTs postoperatively, whereas MTT transfer was superior to SCR in terms of active forward flexion and abduction range of motion. Although higher rates of graft failure and subacromial bone erosion were observed in Group S, no difference was found in the clinical scores between the 2 groups at the short-term follow-up. However, further well-structured, prolonged comparative trials should be conducted in the future.

Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed

Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.