Feasibility of lower trapezius transfer extended by the infraspinatus fascia for restoration of external rotation in irreparable posterosuperior rotator cuff tears: an anatomical study

Return to Work and Sports After Lower Trapezius Tendon Transfer for Posterosuperior Irreparable Rotator Cuff Tears

BACKGROUND

Lower trapezius tendon (LTT) transfer has demonstrated promising results for patients with posterosuperior irreparable rotator cuff tears (PSIRCTs). However, there has been no study evaluating return to work (RTW) and return to sports (RTS) after LTT transfer.

PURPOSE/HYPOTHESIS

The purpose of this study was to assess the rates of RTW and RTS and identify associated factors among patients who have undergone LTT transfer for PSIRCTs. It was hypothesized that LTT transfer would result in favorable functional outcomes and high rates of RTW and RTS.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A retrospective review was conducted on patients who underwent LTT transfer for symptomatic PSIRCTs with minimal glenohumeral arthritis. The clinical assessment included patient-reported outcome measures, testing of active range of motion, and a radiological evaluation of arthritis. Patients were surveyed on occupation, sports activity, RTW or RTS status, time to return, and degree of resumption of previous work and sports levels. Exclusion criteria included a follow-up period of <1 year, revision surgery, postoperative infections, loss to follow-up, and unavailability of data.

RESULTS

A total of 110 patients (mean age, 63.0 ± 6.9 years; mean follow-up, 35.3 ± 15.7 months) were included. Clinical scores and active range of motion significantly improved at the final follow-up, with no significant differences between the different work levels. For RTW, 93.6% (n = 103) returned to work (63.1% completely, 36.9% partially), with a mean time to return of 5.2 ± 1.7 months; 6.4% (n = 7) did not return. Patients with lighter work levels had higher return rates and quicker times to return than those with heavier work levels. For RTS, 90.7% (n = 86) returned to sports (70.5% completely, 29.5% partially), with a mean time to return of 5.7 ± 1.3 months. For patients who participated in shoulder sports, 89.9% returned, and 10.1% failed to return. Multivariable logistic regression showed significant associations of higher RTW rates with lighter work levels (odds ratio [OR], 2.72; P = .005) and lower retear rates (OR, 5.41; P = .021). A lower retear rate was also significantly associated with a higher RTS rate (OR, 7.66; P = .010).

CONCLUSION

LTT transfer for PSIRCTs yielded favorable functional outcomes with high rates of RTW and RTS. Patient-related factors, notably work level and retears, influenced successful RTW and RTS.

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.

Rotator cuff irreparability or failure of repair (re-tear): technical note on middle trapezius tendon transfer for reproduction of supraspinatus function

PURPOSE

Based 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.

METHODS

While 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.

RESULTS

Transfer 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.

CONCLUSION

For 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.