Achilles tendon allograft versus fascia lata autograft as the interpositional graft in arthroscopically assisted lower trapezius tendon transfer for irreparable posterosuperior rotator cuff tear.

Background: Although arthroscopically assisted lower trapezius tendon transfer (aLTT) is an effective treatment option for posterosuperior irreparable rotator cuff tear (PSIRCT), interpositional grafts should be used because of the length limitations of the LTT. This study compared the radiologic and clinical results of an Achilles tendon allograft (ATA) versus a fascia lata autograft (FLA) as the interpositional graft.

Methods: This study included 64 and 26 patients treated with aLTT using an ATA or FLA, respectively. Clinical outcomes were compared using the visual analog scale score, University of California Los Angeles shoulder score, American Shoulder and Elbow Surgeons score, Constant shoulder score, activities of daily living that require active external rotation score, and range of motion. Arthritic changes of the glenohumeral joint were evaluated by acromiohumeral distance (AHD) and Hamada grade. Extent of arthritis was evaluated by magnetic resonance imaging.

Results: Both groups showed significant improvement after the surgery in intra-group analysis, and no significant difference in clinical outcomes were observed between the two groups. AHD and Hamada grades were also comparable. The rate of graft retear was higher in the ATA group than in the FLA group, but without statistical significance.

Conclusions: aLTT may lead to significant improvement in clinical and radiologic outcomes in PSIRCT, regardless of whether an ATA or FLA is used as the interpositional graft. The retear rate of the interpositional bridging graft was not associated with graft status. However, measures to promote graft healing should be considered. Level of evidence: III.