Summary

outcomes

Abstract

Aim

The purpose of this study was to assess the mid-term clinical outcomes of arthroscopy-assisted lower trapezius transfer (aaLTT) in the setting of a functionally irreparable rotator cuff tear. We hypothesized that the aaLTT would provide pain relief and improved functional outcomes and range of movement.

Methods

A multicentric prospective study of patients diagnosed of posterosuperior functionally irreparable cuff tear (FIRCT) who underwent aaLTT, and a minimum 1-year follow-up was conducted. FIRCT was defined as follows: (1) concurrent supra and infraspinatus tears (2) tendon retraction to glenoid or Patte 3 stage (3) Goutallier grade 3 or 4 fatty infiltration and (4) cuff tears considered irreparable during intraoperative assessment. The indications for the aaLTT included (1) posterior-superior FIRCT confirmed by MRI (2) pain and shoulder dysfunction without stiffness, refractory to conservative treatments; (3) loss of active external rotation, external rotation weakness with the arm to the side and/or external rotation lag sign; (4) intact subscapularis or repairable subscapularis tear; (5) no or minimal arthritic changes in the x-ray defined as Hamada <3. Patients with infectious or neurologic disorders, those with trapezius or deltoid palsy and patients with previous surgeries others than rotator cuff repair were not considered for surgery and subsequently for the study. Patient-reported outcomes collected included pain levels measured with visual analog scale (VAS), Constant Murley (CS) and Subjective Shoulder Value (SSV) scores at preoperative and 12 months after surgery. Glenohumeral arthritis progression was also assessed and classified according to Hamada classification by comparing preoperative and postoperative x-rays.

Results

Twenty-two patients, 54.5% men, with a median age of 58 (range 51-70 years old), were included in the study.

At a mean follow-up of 30.1 months (range 12-61 months), all patients showed a significant improvement in VAS, from 7.27 (SD1.45) preoperatively to 1.36 (SD 1.62) postoperatively (p=0.001) and PROs including CS and SSV scores (39.0 (SD 10.4) to 73.4 (SD 13.7) and 39.8 (SD 11.9) to 74.3 (SD 17.7), p=0.001, respectively). ASES score did not significantly change from pre- to postoperative follow-up. Statistically significant improvements in forward flexion, external rotation and abduction averaged 38.6º, 40º and 39.1º (p<.0010)), respectively, were also obtained. External rotation lag sign and pseudoparalysis were reversed in 91.9% (19/22) and 100% (5/5) of patients respectively. At final follow up, all patients but 2 (91%) reported being satisfied with their outcomes. Postoperative MRI was available in 11 (50%) of patients. Lateral avulsion of the graft was identified in 4 (36.4%) cases. Of these, only one patient underwent revision surgery.
Arthritis progressed in only one patient in whom a lateral avulsion of the graft was observed in the MRI.

Conclusion

Arthroscopic-assisted lower trapezius transfer provides satisfactory clinical and functional short-term outcomes in patients with posterosuperior functionally irreparable cuff tears.