Summary

This case series analyze the functional outcomes, pain relieve and range of motions with one year follow of patients with an irreparable tear of rotator cuff without glenohumeral arthrosis, who were treated with a lower trapezius transfer with semitendinosus and gracilis autologous tendon with an arthroscopic assistance.

Abstract

Purpose

To analyze the functional outcomes and postsurgical pain of patients who underwent a lower trapezius transfer with semitendinosus and gracilis tendon graft, using arthroscopic assistance to treat irreparable posterosuperior tear of rotator cuff without glenohumeral arthrosis; at 3, 6 and 12 months postoperative.

Methods

A single surgeon retrospective chart review of prospectively collected data was completed of ten patients with an irreparable posterosuperior rotator cuff tear without glenohumeral arthrosis who underwent a lower trapezius transfer with semitendinosus and gracilis autologous tendon graft fixed to humerus with knotless suture anchors, using arthroscopic assistance. ASES (American Shoulder and Elbow Surgeons) score, Constant score, pain (Analogue scale of pain) and ranges of motion was evaluated pre and post-operatively at 3, 6 and 12 months postoperative.

Results

A total of 10 patients (7 males, 3 females) with a mean age of 57,6 (53,2 - 65,1) years for males and 64,3 (56,2 – 70,1) years for females were included, 60% were right-handed. No intraoperative complications, neurovascular injuries, adverse events, bleeding, or infections were reported. At 3, 6 and 12 months follow-up, there was statistically significant improvement of the ASES score (preoperative=27,2 [23,3 – 35,0; SD: 4,0]; at 3 months= 43,9 [36,6 – 56,6; SD: 8,8]; at 6 months=76,3 [64,9 – 86,6; SD: 6,2]; at 12 months=92,8 [88,3 – 96,6; SD: 2,9]; p<0.001); Constant score (preoperative=32,3 [26,0 – 38,0; SD: 3,9]; at 3 months=41,6 [30,0 – 55,0; SD: 6,5]; at 6 months=70,7 [63,0 – 83,0; SD: 3,9]; at 12 months=87,0 [84,0 – 90,0; SD: 2,1]; p<0.001) and pain (preoperative=7 [5 – 9; SD: 1,2]; at 3 months=5 [3 – 6; SD: 0,9]; at 6 months=2,2 [1 – 3; SD: 0,6]; at 12 months=0,8 [0 – 2; SD: 0,8]; p<0.001). The ranges of motion had a statistically significant improvement at 6 and 12 months: Flexion (preoperative=82,5 [60-140; SD: 26,4]; at 3 months=58,5 [40 – 70; SD: 58]; at 6 months=125,5 [80 – 150; SD: 23,6]; at 12 months=143,5 [120 – 160; SD: 12]; p<0.001), Abduction (preoperative=76 [60-100; SD: 13,7]; at 3 months= 46,0 [30 – 63; SD: 11,5]; at 6 months=154, [130 – 170; SD: 10,8]; at 12 months=160,0 [140 – 170; SD: 9,7]; p<0.001), Externa rotation (preoperative=10,5 [0 - 20; SD: 10,5]; at 3 months=9,0 [5 - 15; SD: 3,9]; at 6 months=52,0 [25 – 80; SD: 18,0]; at 12 months=65,0 [50 – 80; SD: 9,1]; p<0.001) and internal rotation (preoperative=2,3 [1 - 4; SD: 0,9]; at 3 months=3,2 [2 - 4; SD: 0,8]; at 6 months=3,6 [3 – 4 ; SD: 0,5]; at 12 months=3,8 [3 – 4; SD: 0,4]; p<0.001).

Conclusion

Lower trapezius transfer with semitendinosus and gracilis autologous tendon graft fixed to humerus with knotless suture anchors, using arthroscopic assistance to treat irreparable posterosuperior tear of rotator cuff without glenohumeral arthrosis has an improve of functionality and pain relieve at 3, 6 and 12 months follow-up, with an excellent outcome at year of surgery. Ranges of motion decrease at 3 months postoperative but improve at 6 and 12 months.