Summary

The LTT showed significant improvement in active ROM and SSV and outperformed the LDT in these categories

Abstract

Introduction

The aim of this study is the analysis of a cohort of patients who have been treated due to a non-repairable postero-superior rotator cuff (RC) tear with an arthroscopic assisted lower trapezius transfer (LTT). This cohort will be compared to a cohort of patients having been treated for the same pathology with Latissimus dorsi Transfer (LDT). Biomechanical studies have shown a better abduction and external rotation moment arms for the LTT in comparison to the LDT. Therefore, the hypothesis of this study was that the LTT would provide better functional results in comparison to the LDT.

Methods

Between 2013 and 2020 50 patients were treated with LDT and between 2018 and 2020 21 with LTT. For better comparability of the patient groups, a matched pairs analysis was carried out, in which 17 statistical pairs (34 patients: 30 males, 4 females; age (LDT): 55-+6 years, age (aLTT): 55-+7 years) could be included. Matching criteria were same sex, age -+3 years, tear size according to Bateman -+1, and retraction size according to Patte -+1.The LDT was performed in a double incision technique and the LTT was performed arthroscopically assisted unsing an autologous semitendinosis interposition transplant. Clincial evaluation was included passive and active ROM and Constant-Score (CS), DASH, WORC, SSV, ADLEIR, OSS.

Results

At final follow up of 43-+ 18 months (LDT) vs 18-+7 months (LTT) the CS improved in the LDT from 42 to 57 points (p<.01) and in the LTT group from 48 to 63 points (p<.01). Mean Flexion improved in the LDT group from 112° to 134° (n.s.) and mean abduction from 112° to 122° (n.s.); in the LTT group Flexion improved from 119° to 159° ( p<.01) and abduction from 112° to 156° (p<.001). Mean external rotation improved in the LDT group from 19° to 29° (n.s.) and 29° to 44° for the LTT (p=.05). Score results were: CS: 64 (LDT) vs. 70 (LTT) (n.s.); DASH 19 (LDT) vs. 12 (LTT) (n.s.); WORC 77 (LDT) vs. 77 (LTT) (n.s.); SSV 75% (LDT) vs. 77% (LTT) (n.s.); ADLEIR 33 (LDT) vs. 33 (LTT) (n.s.), and OSS 23 (LDT) vs. 19 (aLTT) (n.s.).

Conclusion

Improved score results and functional improvement was seen in both groups. The LTT showed significant improvement in active ROM and outperformed the LDT in these categories. However, longer follow up data and randomized controlled studies are necessary in order to further evaluate the clinical value of both methods.