Outcome of Arthroscopically Assisted Lower Trapezius Transfer to Reconstruct Massive Irreparable Posterior-Superior Rotator Cuff Tears

Elhassan, Bassem T.; Wagner, Eric R.; Sanchez-Sotelo, Joaquín

doi:10.1016/j.jse.2019.04.021

Cited by 10 publications

(23 citation statements)

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“…When there is a preoperative non-functioning deltoid after aaLLT, the patient may recover their ER but they will not improve ABD or elevation [23]. j Advanced degenerative changes (Hamada > 3) have an effect on outcomes, resulting in less pain improvement, decreased range of motion, and greater need for reoperation with possible conversion to RTSA [17].…”

Section: Disadvantagesmentioning

confidence: 99%

“…9 8 Arthroscopic time: portals placement and joint preparation. The conventional posterior portal is used for visualization at the beginning of arthroscopy, but the lateral portal serves as the main visualization portal during the procedure, using the anterior and the anterolateral as working portals [17,20]. To facilitate tendon to bone healing, the microfractures at the greater tuberosity may also be performed with the aim of providing mesenchymal stem cells.…”

Section: Surgical Techniquementioning

confidence: 99%

“…11 8 Allograft intra-articular attachment. The insertion area is at the anterior and superior aspect of the greater tuberosity, just lateral to the bicipital groove [17]. Use two knotless anchors (Healix Advance Knotless TM anchors, DePuy Mitek Sports Medicine, Raynham, MA, USA), both posterior to the bicipital groove, one anteromedial, just close to the articular surface, and the other anterolateral, just off the ledge of the greater tuberosity [20], using the Orthocord ® sutures (DePuy Synthes, Warsaw, IN, USA).…”

Section: Surgical Techniquementioning

confidence: 99%

“…12 9 Arm position during lower trapezius and allograft fixation. The shoulder should be positioned in maximal external rotation, 30º of flexion and 60º of abduction during the final tendon fixation [17]. An arm holder is very useful for this purpose Lower trapezius muscle Acromion Fig.…”

Section: Surgical Techniquementioning

confidence: 99%

“…After open lower trapezius transfer they showed better abduction (ABD), forward flexion (FF), and ER without affecting internal rotation (IR), specifically in those patients with flexion/ABD of > 60º preoperatively [16]. The arthroscopically assisted lower trapezius transfer (aaLTT), described for the first time in 2016 [4], is less aggressive than the open technique and also shows good results [17].…”

Section: Introductory Remarksmentioning

confidence: 99%

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Lower trapezius transfer for massive posterosuperior rotator cuff defects

Rodríguez-Vaquero¹,

López-Fernández

Calvo

2021

Oper Orthop Traumatol

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Objective: To present the arthroscopically assisted lower trapezius transfer technique that restores shoulder external rotation and forward elevation, with low complication rates and fast recovery. Indications: Massive irreparable posterosuperior rotator cuff tears in active young patients with fatty infiltration ≥ III, osteoarthrosis Hamada ≤ 3, normal function of lower trapezius, and without glenohumeral stiffness. Contraindications: Absolute: Active soft tissue infection and trapezius muscle paralysis. Relative: medical comorbidities, inability to follow postoperative recommendations, advanced age, advanced degenerative changes (Hamada > 3), deltoid deficiency, and forward elevation < 60º. Surgical technique: Beach chair position. Lower trapezius harvesting, allograft preparation, arthroscopic evaluation and rotator cuff partial repair, allograft passage, allograft intraarticular arthroscopic attachment, lower trapezius-allograft open attachment and wound closure.Postoperative management: Avoidance of internal rotation with an external rotation brace for 6 weeks. At 6 weeks progressively appropriate physical therapy. Unrestricted activity at 6 months. Results: At mean follow-up of 14 months, good results were reported (pain, range of motion, and Subjective Shoulder Value and Disabilities of the Arm and Shoulder and Hand scores). Long-term symptoms, Hamada 3 rotator cuff arthropathy, and true pseudo paralysis were associated with negative clinical outcomes, but subscapularis pathology and teres minor fatty atrophy were not. A low complication rate was described. Arthroscopically assisted lower trapezius transfer may restore motion and strength in external rotation. Good results with low complication rates have been reported. It has become the authors' procedure of choice in young active patients with irreparable massive rotator cuff tears. KeywordsIrreparable rotator cuff tears • Massive rotator cuff tear • Arthroscopic lower trapezius transfer • Shoulder tendon transfer • Shoulder reconstruction • Lower trapezius

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Section: Disadvantagesmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%