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: The purpose of this study was to quantify the improvement patients undergoing scope-assisted lower trapezius tendon transfer (SALTT) for irreparable rotator cuff tears (IRCT) have and whether intra-operative subscapularis management affected these outcomes.

Methods: From 2015 to 2023, patients undergoing primary SALTT for IRCT without osteoarthritis or brachial plexopathy with serial follow-up at 6- and minimum 12-months post-operatively were identified. Subjective Shoulder Value (SSV) scores, active forward elevation (aFE), external rotation (ER) lag, and cuff strength was recorded. Continuous variables were analyzed with one-way or repeated measures analysis of variance, and a multivariate linear regression was performed evaluating demographic, radiographic, and intra-operative variable effects on SSV and ER lag.

Results: Seventy-six (mean age: 56.5±8.1 years; BMI: 29.0±4.3; 73% male) patients operated on by 4 surgeons (A: 66%; B: 15%; C: 13%; D: 4%) demonstrated significant improvement in baseline SSV scores (mean: 23.9±SD:13.1) to 6-month (mean: 73.5±10.6, 91% MCID achievement P<0.001) and final (mean: 43.5±29.5 months) follow up scores (mean: 79.9±16.5, 92% MCID achievement P<0.001; n=45/122:37% 2-year inclusion rate). Regression analysis for final SSV demonstrated age (beta: 0.8, P=0.017) to have a positive effect and subscapularis fatty infiltration (beta: -10.6, P<0.001) to have a negative effect. Active FE improved from 6-month (139±SD:23.8°) to final (146±23.0°, P=0.013) follow-up while ER lag (17±SD:17°) improved as well (6-month mean: 3±7.8°, P<0.001; final: 3±5.6°, P<0.001). Regression analysis demonstrated subscapularis fatty infiltration (beta:-11.6, P=0.003) had a negative effect on final aFE while infraspinatus fatty infiltration (beta:-1.2, P=0.048) and concomitant subscapularis repair (beta:-5.0, P=0.023) had a negative effect in final ER lag. Presence of subscapularis tears alone (beta:4.5, P=0.030) had a positive effect on ER lag. Overall, five (7%) patients underwent re-operations.

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