Abstract
Objectives:
Massive irreparable rotator cuff tears lead to significant pain and disability. Tendon transfers have been described as one option to improve pain and function for patients, but clinical data are limited. The purpose of this study was to evaluate outcomes in patients after arthroscopically assisted lower trapezius tendon transfer (AALTT) for massive irreparable rotator cuff tears.
Methods:
Twenty-one patients with massive irreparable rotator cuff tears who underwent AALTT with a single surgeon from January 2017 to July 2021 were analyzed. Patient demographics such as age, sex, followup, worker’s compensation claims, and prior surgical history were recorded. Preoperative and one-year postoperative range of motion, external rotation strength, and pain visual analogue scale (VAS) were extracted from medical records. Patient reported outcomes measurements used for comparison included American Shoulder and Elbow Score (ASES), as well as Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function and Mental Function. Six-month postoperative MRIs were reviewed when available. Descriptive and univariate statistical analyses were performed.
Results:
The average patient age was 56.1 (range, 29-72) years and 19 patients (90.5%) were male. The average follow up was 13.2 (range, 4-45) months. Seven patients (33.3%) were involved in worker’s compensation claims and 17 patients (81%) had undergone prior rotator cuff repair. Out of 21 patients who were working at the time of surgery, eleven patients (52.4%) were able to return to their same occupation and 19 patients (86.4%) demonstrated complete tendon healing on postoperative MRI scans (Table 1). There was significant improvement in postoperative pain VAS (5.8±2 vs. 1.7±2) and ASES scores (44.3±18 vs. 71.6±23). No significant changes in PROMIS Physical (47.1±7 vs. 51.4±11) and PROMIS Mental (53.1±8 vs. 53.8±10) were observed. There were significant improvements in external rotation motion (11.0±17 degrees vs. 42.1±13 degrees) and strength (2.9/5 ±1 vs. 4.6/5 ±1) at final followup (Table 2).
Conclusions:
AALTT is a successful treatment option for the massive irreparable rotator cuff tear. Patients demonstrated significant improvements in pain, range of motion, and strength at one year, with complete tendon healing visualized on postoperative MRI scans.
AALTT Patient Demographics
Ranee of Motion and Patient Reported Outcomes after AALTT
