Rotator cuff irreparability or failure of repair (re-tear): technical note on middle trapezius tendon transfer for reproduction of supraspinatus function

Abstract

Purpose Based on its close anatomic features and nearly-collinear force vector to those of supraspinatus muscle, the current article describes a technique of middle trapezius tendon transfer for reproduction of supraspinatus function in the context of rotator cuff irreparability/re-tear management. Methods While seating the patient in beach-chair position, arthroscopic gleno-humeral examination and sub-acromial decompression are initially performed. Hamstring tendons are harvested and fashioned as flattened quadruple sheet. Through McKenzie approach, infraspinatus and subscapularis tendons are repaired. Then, medial half of middle trapezius insertion tendon is harvested from most medial 5-6 cm of the scapular spine. Through McKenzie approach, hamstring sheet is retrieved via a sub-trapezius/sub-acromial corridor from the scapular wound. Hamstring sheet is re-attached to cuff footprint by double row/suture bridge repair configuration. While retracting the scapula and placing gleno-humeral joint in 45O-abduction/45O-external rotation, hamstring sheet is re-attached to released middle trapezius tendon by non-absorbable sutures. Finally, tendon reconstruct is dynamically-tested in different positions of range of motion. Results Transfer of medial portion of middle trapezius insertion tendon (lengthened by interposition hamstring tendon sheet) to cuff footprint was technically feasible. Dynamic testing showed smooth sub-acromial gliding motion of the tendon reconstruct. Conclusion For reproduction of supraspinatus function, hamstring tendon augmented-middle trapezius tendon transfer to cuff footprint heralds a number of technical and biomechanical advantages; thus offering a potential effective modality of cuff irreparability/re-tear management in relatively young patients of high functional demands. However, current description should be investigated in further biomechanical and clinical studies to validate its long-term outcomes.

Middle Trapezius Tendon Transfer for Augmentation of In Situ Superior Capsular Reconstruction–Reinforced Partial Rotator Cuff Repair: Short-term Outcomes of a Prospective Cohort Study

“… 8 , 24 Therefore, MTT transfer per se might have the potential to recentralize the humeral head over the glenoid via a dynamic mechanism (ie, its reproduction of SSP function), and static mechanisms (ie, the subacromial spacer effect, and the countervailing force of the tensioned hamstring tendon sheet). 15 , 24 , 25 …”

“…In turn, this force couple further counteracts superior translation of the humeral head; hence, a positive feedback loop of GH restabilization mechanisms is established. 15 , 24 , 25 …”

“…In addition, scapular kinematics (ie, trapezius force couple mechanism) remain unviolated, as the upper, lower, and major bulk of the middle segments of the trapezius are kept intact. 15 …”

“…Those anatomic features in conjunction with a horizontally oriented force vector of the medial portion of MTT can overcome the possibility of subacromial block of the transferred tendon, which was reported by Moroder et al 24 in a cadaveric description of transferring the lateral portion of the MTT. 15 , 16 …”

“…Kandeel 15 has recently introduced transfer of the medial portion of the middle trapezius tendon (MTT) as a novel technical note for dynamic reproduction of SSP function in patients with irreparable posterosuperior RC tears. However, as MTT transfer is still a recently evolving technique, valid functional outcomes of this procedure are lacking.…”