Arthroscope-Assisted Lower Trapezius Tendon Transfer Using Achilles Tendon Allograft for Irreparable Rotator Cuff Tears Demonstrates Excellent Short-Term Outcomes in the Setting of Concomitant Subscapularis Repair

Abstract

Purpose

To quantify the improvement of patients undergoing scope-assisted lower trapezius tendon transfer (SALTT) for irreparable rotator cuff tears (IRCTs) and whether intraoperative subscapularis management affected these outcomes.

Methods

From 2015 to 2023, patients undergoing primary SALTT for IRCTs without osteoarthritis or brachial plexopathy with serial follow-up at 6 months and a minimum of 12 months postoperatively were identified. Subjective shoulder value (SSV) scores, active forward elevation (FE), external rotation (ER) lag, and cuff strength were recorded. Continuous variables were analyzed with 1-way or repeated-measures analysis of variance, and a multivariate linear regression was performed evaluating demographic, radiographic, and intraoperative variable effects on SSV and ER lag.

Results

Seventy-six (mean age: 56.5 ± 8.1 years; body mass index: 29.0 ± 4.3; 73% male) patients, operated on by 4 surgeons (A: 66%; B: 15%; C: 13%; D: 4%), had significant improvement in baseline SSV scores (mean: 23.9 ± 13.1) to 6-month (mean: 73.5 ± 10.6, 91% minimal clinically important difference achievement, P < .001) and final (mean: 43.5 ± 29.5 months) follow-up scores (mean: 79.9 ± 16.5, 92% minimal clinically important difference achievement, P < .001; n = 45/122: 37% 2-year inclusion rate). Regression analysis for final SSV showed age (β: 0.8, P = .017) to have a positive effect and subscapularis fatty infiltration (β: –10.6, P < .001) to have a negative effect. Active FE improved from 6-month (139° ± 23.8°) to final (146° ± 23.0°, P = .013) follow-up while ER lag (17° ± 17°) improved as well (6-month mean: 3° ± 7.8°, P < .001; final: 3° ± 5.6°, P < .001). Regression analysis revealed subscapularis fatty infiltration (β: –11.6, P = .003) had a negative effect on final active FE, while infraspinatus fatty infiltration (β: –1.2, P = .048) and concomitant subscapularis repair (β: –5.0, P = .023) had a negative effect on final ER lag. Presence of subscapularis tears alone (β: 4.5, P = .030) had a positive effect on ER lag. Overall, 5 (7%) patients underwent reoperations.

Conclusions

Patients with IRCT undergoing SALTT with or without subscapularis tears requiring repair achieve excellent short-term clinical outcomes while improving from an examination standpoint.

Level of Evidence

Level III, retrospective case series.