Arthroscopic-Assisted Lower Trapezius Tendon Transfer With Autologous Semitendinosus Tendon and Long Head of Biceps Superior Capsule Reconstruction for Massive Irreparable Posterosuperior Rotator Cuff Tears

Arthroscopic-Assisted Lower Trapezius Transfer Augmented by Peroneus Longus Autograft in Irreparable Posterior Superior Rotator Cuff Tears: Functional Outcomes at 24 Months of Follow-up

Background

Massive irreparable rotator cuff tears are a devastating problem, especially for the middle-aged active population. Tendon transfer seems to be a feasible treatment option for this age group. Biomechanical studies have shown that lower trapezius tendon transfer, rather than latissimus dorsi tendon transfer, could restore the kinematics of the shoulder.

Purpose

To evaluate the functional outcome, efficacy, and safety of arthroscopy-assisted lower trapezius transfer with peroneus longus augmentation for irreparable posterior superior rotator cuff tears.

Study Design

Case series; Level of evidence, 4.

Methods

This study included 20 patients who had massive rotator cuff tears, symptomatic global shoulder pain, and the inability to move their upper limbs actively. The patients were examined by manual testing using a goniometer, and the study had a follow-up period of at least 24 months.

Results

The mean age of the patients was 53.4 ± 4.3 years (range, 40-60 years). Thirteen patients had associated biceps pathology. The mean American Shoulder and Elbow Surgeons score improved from 22.88 ± 7.25 preoperatively to 84.44 ± 4.54 postoperative (P < .001). The mean visual analog scale improved from 7.9 ± 1.33 preoperatively to 2.7 ± 1.3 postoperatively (P < .001). All patients regained a good functional range of shoulder motion at the end of the follow-up without major shoulder complications.

Conclusion

Arthroscopy-assisted lower trapezius transfer with peroneus longus augmentation for irreparable rotator cuff tear is advisable because it shows marked improvement in the functional outcome and range of motion without major complications.

Restoring the Anteroposterior Shoulder Force Couple: Arthroscopic-Assisted Lower Trapezius Tendon Transfer With Partially Augmented Rotator Cuff Repair for Irreparable Massive Rotator Cuff Tears

Lower trapezius transfer presents a highly encouraging therapeutic approach for addressing posterosuperior irreparable massive rotator cuff tears. Based on studies on the balance of force couples of the rotator cuff, more scholars believe that attention should be paid to the reconstruction of the force couples of the rotator cuff. This study proposes a modified surgical approach that integrates an arthroscopic-assisted lower trapezius transfer with autologous hamstring tendon and partially augmented rotator cuff repair for irreparable massive rotator cuff tears, with a focus on restoring the anterior-posterior shoulder force couple.

Combined Lower Trapezius and Middle Trapezius Tendon Transfer for Posterior Superior Irreparable Rotator Cuff Tears: A Case Report

Introduction

Irreparable rotator cuff tears (IRCTs) often deteriorate shoulder function, necessitating careful consideration of treatment approaches. While reverse total shoulder arthroplasty (RTSA) is the first line of treatment in patients with arthropathy, preserving the joint is crucial for highly demand patients without arthritis. For those patients, various tendon transfer techniques have been established to address different types of IRCTs, including lower trapezius tendon (LTT) transfer for posterior superior IRCTs (PSIRCTs) and middle trapezius tendon (MTT) transfer for isolated supraspinatus IRCTs (ISIRCTs).

Case Report

A 66-year-old male with persistent right shoulder pain and weakness for 2 years, diagnosed with PSIRCTs, sought an alternative to RTSA due to occupational concerns as a restaurant owner. Preoperatively, patients showed limited range of motion (ROM) and weakness, especially in forward elevation (FE) and external rotation (ER). Radiography and magnetic resonance imaging (MRI) scan indicated superior humeral head translation without advanced arthritis and concurrent tears in the supraspinatus and infraspinatus with atrophy. After the consultation, patients underwent a combined transfer of LTT and MTT with a split Achilles tendon allograft in Y-configuration. By postoperative 1 year, the patient exhibited notable improvement, including reduced pain (VAS 4-2), enhanced function (ASES 50-83, Constant 42-78), and increased ROM (FE, 120°-160° and ER, 10°-40°). Radiographic assessments demonstrated an increased in acromiohumeral distance without arthritic progression. Post-operative MRI confirmed tendon integrity, and the patient successfully resumed work at 6 months.

Conclusion

A combined transfer of the MTT and LTT with a split Achilles tendon allograft in Y-configuration has been shown to alleviate pain, enhance functional scores, and improve the ROM in patients with PSIRCTs without arthritis.

Arthroscopic-Assisted Lower Trapezius Tendon Transfer Using a Fasciae Lata Autograft in Treatment of Posterior Superior Irreparable Rotator Cuff Tears in Lateral Decubitus Position

The optimal treatment for patients with posterior superior irreparable rotator cuff tears (PSIRCTs) is still a topic of ongoing debate. Lower trapezius tendon transfer is one of the effective surgical treatments for PSIRCTs in younger patients and elderly patients with high activity levels without arthritis. In this report, we describe an arthroscopic-assisted technique for lower trapezius transfer using a fascia lata autograft for patient with PSIRCTs in lateral decubitus position.

Arthroscopic Lower Trapezius Tendon Transfer for a Patient with Axillary Nerve Injury and Concomitant Rotator Cuff Tear: A Case Report and Technical Notes

Introduction: Concomitant nerve injuries with musculoskeletal injuries present a challenging problem. The goals of nerve reconstruction for the shoulder include shoulder abduction and external rotation. When patients fail to achieve acceptable shoulder external rotation and shoulder abduction, tendon transfers such as trapezius transfer offer a reliable option in the subsequent stage. Case Presentation: A 32-year-old male presented with weak external rotation in his left shoulder, after previous axillary nerve reconstruction. He received the ipsilateral lower trapezius transfer with the aim of improving the external rotation. Discussion: The lower trapezius restores a better joint reaction force in both the compressive-distractive and anterior-posterior balancing and provides a centering force through the restoration of the anterior-posterior force couple. Conclusion: We believe that the ipsilateral lower trapezius transfer to the infraspinatus is a good outcome and is effective in improving overall shoulder stability and the shoulder external rotation moment arm or at least maintaining in neutral position with the arm fully adducted in patients with post axillary nerve injuries post unsatisfactory nerve reconstruction to increase the quality of life and activities of daily living.

Combined Arthroscopic-Assisted Lower Trapezius Tendon Transfer and Superior Capsule Reconstruction for Massive Irreparable Posterior-Superior Rotator Cuff Tears: Surgical Technique

Primary or revision irreparable rotator cuff tears remain a challenge. Clear algorithms do not exist. Several joint-preserving options are available, but no technique has been definitely proven to be better than another. Although superior capsule reconstruction has been shown to be effective in restoring motion, lower trapezius transfer can provide strong external rotation and abduction moment. The aim of the present article was to describe an easy and reliable technique to combine both options in 1 surgery, aiming to maximize the functional outcome by getting motion and strength back.

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.