McKissack Haley M, Cooke Hayden L, Khawaja Sameer R, Hussain Zaamin B, Chopra Krishna N, Gulzar Musab, Gottschalk Michael B, Wagner Eric R
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
J Shoulder Elbow Surg. 2025 Jun 3. doi: 10.1016/j.jse.2025.04.025.
Superior capsular reconstruction (SCR) and arthroscopic-assisted lower trapezius transfer (aLTT) are utilized to augment partial rotator cuff repairs (RCRs) in the treatment of massive irreparable rotator cuff tears (MIRCTs), but indications are poorly characterized. SCR restores coronal glenohumeral stability through static reconstruction of the native superior capsule, while aLTT provides dynamic restoration of the posterosuperior aspect of the axial force couple by replicating infraspinatus function. This study compares outcomes between patients undergoing SCR and aLTT with partial RCR for MIRCT to better elucidate indications for each.
A retrospective review of our institution's electronic medical record from 2015 to 2022 was conducted. Patients who underwent SCR or aLTT in conjunction with partial RCR for MIRCT and had at least 12 months of follow-up were included. Failure rates, reoperation rates, final range of motion (ROM), and patient-reported outcomes were compared between groups. Outcomes were further stratified by Goutallier classification of supraspinatus and infraspinatus fatty infiltration.
Eighty-one patients were included: 45 underwent aLTT, and 36 underwent SCR. The average follow-up was 33 months after SCR and 28 months after aLTT. Failure rates were significantly higher in the SCR group than the aLTT group (38.9% vs. 8.9%). Active ROM including forward flexion (161° vs. 131°), abduction (139.3° vs. 100.9°), and external rotation (60.8° vs. 43.8°) was greater among the aLTT group. Patients with Goutallier scores ≥2 who underwent SCR had significantly worse subjective outcomes, ROM, and failure and revision rates than those who underwent aLTT. Outcomes were comparable between SCR patients with Goutallier scores 0-1 and aLTT patients with Goutallier scores ≥2.
Patients with minimal fatty infiltration of the supraspinatus or infraspinatus are good candidates for SCR augmentation to partial RCR for MIRCT, while patients with high-grade fatty infiltration may benefit from aLTT augmentation. We suggest that a muscle deficit in the form of advanced fatty infiltration is a relative indication for aLTT. If the deficit is more tendinous, however, SCR may be appropriate.
在治疗巨大不可修复性肩袖撕裂（MIRCT）时，上盂唇重建（SCR）和关节镜辅助下下斜方肌转移（aLTT）被用于加强部分肩袖修复（RCR），但适应证尚不明确。SCR通过对天然上盂唇进行静态重建来恢复冠状面盂肱稳定性，而aLTT通过复制冈下肌功能为轴向力偶的后上部分提供动态恢复。本研究比较接受SCR和aLTT联合部分RCR治疗MIRCT的患者的疗效，以更好地阐明每种方法的适应证。
对本机构2015年至2022年的电子病历进行回顾性研究。纳入接受SCR或aLTT联合部分RCR治疗MIRCT且随访至少12个月的患者。比较两组的失败率、再次手术率、最终活动范围（ROM）和患者报告的结果。结果根据冈上肌和冈下肌脂肪浸润的Goutallier分类进一步分层。
纳入81例患者：45例行aLTT，36例行SCR。SCR组平均随访33个月，aLTT组平均随访28个月。SCR组的失败率显著高于aLTT组（38.9%对8.9%）。aLTT组的主动活动范围更大，包括前屈（161°对131°）、外展（139.3°对100.9°）和外旋（60.8°对43.8°）。Goutallier评分≥2且接受SCR的患者的主观结果、ROM、失败率和翻修率明显比接受aLTT的患者差。Goutallier评分为0-1的SCR患者和Goutallier评分≥2的aLTT患者的结果相当。
冈上肌或冈下肌脂肪浸润最少的患者是SCR加强部分RCR治疗MIRCT的良好候选者，而高级别脂肪浸润的患者可能从aLTT加强中获益。我们认为，以高级别脂肪浸润形式存在的肌肉缺陷是aLTT的相对适应证。然而，如果缺陷更多为肌腱性，SCR可能是合适的。
