Arthroscope-Assisted Lower Trapezius Tendon Transfer Using Achilles Tendon Allograft for Irreparable Rotator Cuff Tears Demonstrates Excellent Short-Term Outcomes in the Setting of Concomitant Subscapularis Repair.

• Tác giả: Berkcan Akpinar, Bassem ElHassan, Matthew N Galati, Sarah M Koljaka, Ryan Lohre, Jon J P Warner
• Ngôn ngữ: eng
• Thông tin xuất bản: United States : Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association , 2025
• Bộ sưu tập: NCBI
• ID: 487369

Tóm tắt

 PURPOSE: The purpose of this study was to quantify the improvement patients undergoing scope-assisted lower trapezius tendon transfer (SALTT) for irreparable rotator cuff tears (IRCT) have and whether intra-operative subscapularis management affected these outcomes. METHODS: From 2015 to 2023, patients undergoing primary SALTT for IRCT without osteoarthritis or brachial plexopathy with serial follow-up at 6- and minimum 12-months post-operatively were identified. Subjective Shoulder Value (SSV) scores, active forward elevation (aFE), external rotation (ER) lag, and cuff strength was recorded. Continuous variables were analyzed with one-way or repeated measures analysis of variance, and a multivariate linear regression was performed evaluating demographic, radiographic, and intra-operative variable effects on SSV and ER lag. RESULTS: Seventy-six (mean age: 56.5±8.1 years
  BMI: 29.0±4.3
  73% male) patients operated on by 4 surgeons (A: 66%
  B: 15%
  C: 13%
  D: 4%) demonstrated significant improvement in baseline SSV scores (mean: 23.9±SD:13.1) to 6-month (mean: 73.5±10.6, 91% MCID achievement P<
 0.001) and final (mean: 43.5±29.5 months) follow up scores (mean: 79.9±16.5, 92% MCID achievement P<
 0.001
  n=45/122:37% 2-year inclusion rate). Regression analysis for final SSV demonstrated age (beta: 0.8, P=0.017) to have a positive effect and subscapularis fatty infiltration (beta: -10.6, P<
 0.001) to have a negative effect. Active FE improved from 6-month (139±SD:23.8°) to final (146±23.0°, P=0.013) follow-up while ER lag (17±SD:17°) improved as well (6-month mean: 3±7.8°, P<
 0.001
  final: 3±5.6°, P<
 0.001). Regression analysis demonstrated subscapularis fatty infiltration (beta:-11.6, P=0.003) had a negative effect on final aFE while infraspinatus fatty infiltration (beta:-1.2, P=0.048) and concomitant subscapularis repair (beta:-5.0, P=0.023) had a negative effect in final ER lag. Presence of subscapularis tears alone (beta:4.5, P=0.030) had a positive effect on ER lag. Overall, five (7%) patients underwent re-operations. CONCLUSION: Patients with IRCT undergoing SALTT with or without subscapularis tears requiring repair achieve excellent short-term clinical outcomes while improving from an exam standpoint.