Geers Brent A, Archutowski Jacob, Cabatu Clarence, Best Jacob, Ayad Michael, Donnelly David, Warren Jalen, Favorito Paul J, Kummerfeld David, Bishai Shariff K
Department of Orthopedic Surgery, Henry Ford Macomb Hospital, Clinton Twp, MI, USA.
Department of Orthopedic Surgery, Henry Ford Macomb Hospital, Clinton Twp, MI, USA.
J Shoulder Elbow Surg. 2025 Jun 26. doi: 10.1016/j.jse.2025.05.018.
The preferred surgical management for massive irreparable posterosuperior rotator cuff tears remains undecided. Treatment options include primary partial repair with allograft augmentation, balloon spacer, tendon transfers, and reverse total shoulder arthroplasty (rTSA). For younger and more active patients where rTSA is not preferred, tendon transfers may be an appropriate option. This study evaluates the outcomes of patients who underwent an arthroscopic assisted lower trapezius tendon transfer (AaLTT) for irreparable posterosuperior rotator cuff tears.
A total of 54 patients, 42 males and 12 females, with an average age of 59 (range 36 - 76 years) were evaluated. All patients were treated with an AaLTT as treatment for a massive irreparable posterosuperior rotator cuff tear and had a minimum follow-up of 12 months. Pre- and postoperative American Shoulder and Elbow Surgeon (ASES) scores, Visual Analog Scale (VAS), and range of motion (ROM) were compared to evaluate improvement in ROM and function after the procedure.
At a minimum follow-up of 12 months, patients demonstrated significant improvement in forward flexion (average 20º, p-value < 0.0001) and external rotation ROM (average 10º, P value < .0001). A preoperative external rotation lag sign was reversed in 36/38 (94.7%) patients. There were significant improvements in postoperative ROM and patient reported outcome measurement scores (ASES and VAS) with median improvement of 53-points for the ASES score and median improvement of 4-points on the VAS scale. There is no literature describing the Minimal clinically important difference (MCID) for VAS and ASES change following aLTT. However, our values do exceed the MCID cited in prior reports for arthroscopic rotator cuff repair of 27.13 and 2.37 for ASES and VAS respectively.
This study demonstrates that arthroscopic assisted lower trapezius tendon transfers with allograft augmentation for irreparable rotator cuff tears provides patients with significant improvement in range of motion, specifically forward flexion and external rotation, as well as patient reported outcome measures. Future studies should focus on follow-up beyond 12 months as well as creating standardization of surgical technique in order to improve procedure adoption.
Level IV; Case Series; Treatment Study.
对于巨大且无法修复的肩袖后上部分撕裂，最佳手术治疗方案仍未确定。治疗选择包括同种异体移植增强的一期部分修复、球囊间隔器、肌腱转移和反式全肩关节置换术（rTSA）。对于不适合进行rTSA的年轻且活动较多的患者，肌腱转移可能是一种合适的选择。本研究评估了因无法修复的肩袖后上部分撕裂而接受关节镜辅助下斜方肌下肌腱转移（AaLTT）的患者的治疗结果。
共评估了54例患者，其中男性42例，女性12例，平均年龄59岁（范围36 - 76岁）。所有患者均接受AaLTT治疗巨大且无法修复的肩袖后上部分撕裂，且至少随访12个月。比较术前和术后美国肩肘外科医师（ASES）评分、视觉模拟量表（VAS）和活动范围（ROM），以评估该手术后ROM和功能的改善情况。
在至少12个月的随访中，患者的前屈（平均20°，p值<0.0001）和外旋ROM（平均10°，P值<0.0001）有显著改善。38例术前有外旋滞后征的患者中，36例（94.7%）的该体征得到纠正。术后ROM和患者报告的结局测量评分（ASES和VAS）有显著改善，ASES评分中位数改善53分，VAS量表中位数改善4分。目前尚无文献描述AaLTT后VAS和ASES变化的最小临床重要差异（MCID）。然而，我们的值确实超过了先前报道的关节镜下肩袖修复的MCID，ASES和VAS分别为27.13和2.37。
本研究表明，关节镜辅助下斜方肌下肌腱转移联合同种异体移植增强治疗无法修复的肩袖撕裂，能使患者的活动范围，特别是前屈和外旋，以及患者报告的结局指标得到显著改善。未来的研究应关注12个月以上的随访，并建立手术技术标准化，以提高该手术的应用率。
IV级；病例系列；治疗研究。
