Outcomes After Arthroscopic-Assisted Lower Trapezius Transfer with Achilles Tendon Allograft.

MedStar author(s):
Citation: Journal of Shoulder & Elbow Surgery. 2023 Jul 25PMID: 37499785Institution: MedStar Union Memorial Hospital | MedStar Union Memorial HospitalDepartment: Orthopaedic Surgery | OrthopedicsForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2023Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:2004 - 2007ISSN:
  • 1058-2746
Name of journal: Journal of shoulder and elbow surgeryAbstract: BACKGROUND: Lower trapezius tendon transfer is one option to improve pain and function with massive irreparable rotator cuff tears. Magnetic resonance imaging (MRI) evaluation of tendon healing with the procedure has not yet been reported. The purpose of this study was to evaluate early tendon transfer healing using postoperative MRI scans and to assess early clinical outcomes in patients after arthroscopic-assisted lower trapezius tendon transfer (AALTT) for massive irreparable rotator cuff tears.CONCLUSION: In this series, AALTT showed a high rate of healing of the transferred tendon on MRI by 6 months postoperatively. The current findings of a high rate of early tendon transfer healing are consistent with the good early and mid-term outcomes that have been observed in AALTT and provide support for surgeon and patient expectations, postoperative rehabilitation, and return to work following AALTT for massive posterior superior rotator cuff tears. Copyright © 2023. Published by Elsevier Inc.METHODS: This was a single institution retrospective review of consecutive patients with massive irreparable rotator cuff tears who underwent AALTT with a single surgeon from January 2017 to July 2020 with minimum 6-month follow-up. Patient information including age, sex, follow-up, prior surgical history, and type of work (sedentary or labor-intensive) was recorded. Preoperative and postoperative range of motion, external rotation strength, presence of a lag sign, and pain visual analogue scale (VAS) data were extracted from medical records. Patient-reported outcomes were extracted from patient charts. Six-month postoperative MRIs were reviewed for tendon transfer healing at both the greater tuberosity and the trapezius-allograft interface.RESULTS: A total of 19 patients met inclusion criteria with average age 56.7 (range, 29-72 years). Of these patients, 17 (89.5%) were male. The average follow-up was 14.6 (range, 6-45) months. Fifteen (78.9%) patients had unsuccessful previous rotator cuff repair. Six-month MRI demonstrated complete healing of the transferred tendon in 17 of 19 patients (89.5%). There were significant improvements in postoperative pain VAS (5.9+/-2 vs. 1.8+/-2), ASES score (44.6+/-18 vs. 71.2+/-24), and PROMIS Physical (46.3+/-6 vs. 51.3+/-11) and in external rotation motion (10.5+/-17degree vs. 40.5+/-13degree) and strength (2.8/5 +/-1 vs. 4.7/5 +/-0.5) at final follow-up. All patients with a preoperative external rotation lag sign had reversal of their lag sign at final follow-up (15/15). Of 17 work-eligible patients, 13 (76.4%) were able to return to work.All authors: Chopra A, Murthi AM, Wright MAFiscal year: FY2024Digital Object Identifier: Date added to catalog: 2023-10-04
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 37499785 Available 37499785

Available online from MWHC library: 1995 - present, Available in print through MWHC library:2004 - 2007

BACKGROUND: Lower trapezius tendon transfer is one option to improve pain and function with massive irreparable rotator cuff tears. Magnetic resonance imaging (MRI) evaluation of tendon healing with the procedure has not yet been reported. The purpose of this study was to evaluate early tendon transfer healing using postoperative MRI scans and to assess early clinical outcomes in patients after arthroscopic-assisted lower trapezius tendon transfer (AALTT) for massive irreparable rotator cuff tears.

CONCLUSION: In this series, AALTT showed a high rate of healing of the transferred tendon on MRI by 6 months postoperatively. The current findings of a high rate of early tendon transfer healing are consistent with the good early and mid-term outcomes that have been observed in AALTT and provide support for surgeon and patient expectations, postoperative rehabilitation, and return to work following AALTT for massive posterior superior rotator cuff tears. Copyright © 2023. Published by Elsevier Inc.

METHODS: This was a single institution retrospective review of consecutive patients with massive irreparable rotator cuff tears who underwent AALTT with a single surgeon from January 2017 to July 2020 with minimum 6-month follow-up. Patient information including age, sex, follow-up, prior surgical history, and type of work (sedentary or labor-intensive) was recorded. Preoperative and postoperative range of motion, external rotation strength, presence of a lag sign, and pain visual analogue scale (VAS) data were extracted from medical records. Patient-reported outcomes were extracted from patient charts. Six-month postoperative MRIs were reviewed for tendon transfer healing at both the greater tuberosity and the trapezius-allograft interface.

RESULTS: A total of 19 patients met inclusion criteria with average age 56.7 (range, 29-72 years). Of these patients, 17 (89.5%) were male. The average follow-up was 14.6 (range, 6-45) months. Fifteen (78.9%) patients had unsuccessful previous rotator cuff repair. Six-month MRI demonstrated complete healing of the transferred tendon in 17 of 19 patients (89.5%). There were significant improvements in postoperative pain VAS (5.9+/-2 vs. 1.8+/-2), ASES score (44.6+/-18 vs. 71.2+/-24), and PROMIS Physical (46.3+/-6 vs. 51.3+/-11) and in external rotation motion (10.5+/-17degree vs. 40.5+/-13degree) and strength (2.8/5 +/-1 vs. 4.7/5 +/-0.5) at final follow-up. All patients with a preoperative external rotation lag sign had reversal of their lag sign at final follow-up (15/15). Of 17 work-eligible patients, 13 (76.4%) were able to return to work.

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