Outcomes After Arthroscopic Assisted Lower Trapezius Transfer for Irreparable Posterosuperior Rotator Cuff Tears.

IF 2.9 2区医学 Q1 ORTHOPEDICS

Journal of Shoulder and Elbow Surgery Pub Date : 2025-06-26 DOI:10.1016/j.jse.2025.05.018

Brent A Geers, Jacob Archutowski, Clarence Cabatu, Jacob Best, Michael Ayad, David Donnelly, Jalen Warren, Paul J Favorito, David Kummerfeld, Shariff K Bishai

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引用次数: 0

Abstract

Background: The preferred surgical management for massive irreparable posterosuperior rotator cuff tears remains undecided. Treatment options include primary partial repair with allograft augmentation, balloon spacer, tendon transfers, and reverse total shoulder arthroplasty (rTSA). For younger and more active patients where rTSA is not preferred, tendon transfers may be an appropriate option. This study evaluates the outcomes of patients who underwent an arthroscopic assisted lower trapezius tendon transfer (AaLTT) for irreparable posterosuperior rotator cuff tears.

Methods: A total of 54 patients, 42 males and 12 females, with an average age of 59 (range 36 - 76 years) were evaluated. All patients were treated with an AaLTT as treatment for a massive irreparable posterosuperior rotator cuff tear and had a minimum follow-up of 12 months. Pre- and postoperative American Shoulder and Elbow Surgeon (ASES) scores, Visual Analog Scale (VAS), and range of motion (ROM) were compared to evaluate improvement in ROM and function after the procedure.

Results: At a minimum follow-up of 12 months, patients demonstrated significant improvement in forward flexion (average 20º, p-value < 0.0001) and external rotation ROM (average 10º, P value < .0001). A preoperative external rotation lag sign was reversed in 36/38 (94.7%) patients. There were significant improvements in postoperative ROM and patient reported outcome measurement scores (ASES and VAS) with median improvement of 53-points for the ASES score and median improvement of 4-points on the VAS scale. There is no literature describing the Minimal clinically important difference (MCID) for VAS and ASES change following aLTT. However, our values do exceed the MCID cited in prior reports for arthroscopic rotator cuff repair of 27.13 and 2.37 for ASES and VAS respectively.

Conclusion: This study demonstrates that arthroscopic assisted lower trapezius tendon transfers with allograft augmentation for irreparable rotator cuff tears provides patients with significant improvement in range of motion, specifically forward flexion and external rotation, as well as patient reported outcome measures. Future studies should focus on follow-up beyond 12 months as well as creating standardization of surgical technique in order to improve procedure adoption.

Level of evidence: Level IV; Case Series; Treatment Study.

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关节镜辅助下斜方肌转移治疗不可修复的后上肩袖撕裂的结果。

背景：对于大量不可修复的后上肩袖撕裂，首选的手术治疗方法仍未确定。治疗方案包括同种异体移植物增强、球囊间隔、肌腱转移和逆行全肩关节置换术（rTSA）的初级部分修复。对于不喜欢rTSA的年轻和更活跃的患者，肌腱转移可能是合适的选择。本研究评估了接受关节镜辅助下斜方肌腱转移（AaLTT）治疗不可修复的后上肩袖撕裂的患者的结果。方法：共54例患者，男42例，女12例，平均年龄59岁（36 ~ 76岁）。所有患者均接受AaLTT治疗，作为大面积不可修复的后上肩袖撕裂的治疗，随访时间至少为12个月。比较术前和术后美国肩关节外科医生（asas）评分、视觉模拟量表（VAS）和活动范围（ROM），以评估手术后ROM和功能的改善。结果：在至少12个月的随访中，患者前屈（平均20º，P值< 0.0001）和外旋ROM（平均10º，P值< 0.0001）均有显著改善。36/38（94.7%）患者的术前外旋转滞后症状得到逆转。术后ROM和患者报告的预后测量评分（ASES和VAS）均有显著改善，asa评分中位改善53分，VAS评分中位改善4分。没有文献描述aLTT后VAS和ASES变化的最小临床重要差异（MCID）。然而，我们的数值确实超过了先前报道的关节镜下肩袖修复术的MCID，分别为27.13和2.37。结论：本研究表明，关节镜辅助下斜方肌腱转移与异体移植物增强治疗不可修复的肩袖撕裂为患者提供了显著的活动范围改善，特别是前屈和外旋，以及患者报告的结果测量。未来的研究应关注12个月以上的随访，并建立标准化的手术技术，以提高手术的采用率。证据等级：四级；系列;治疗研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.