Comparative outcomes of middle trapezius tendon transfer using Achilles tendon allograft vs. fascia lata autograft for isolated supraspinatus tendon tears.

Abstract

Irreparable supraspinatus tendon tears pose significant challenges in surgical management, particularly when conventional arthroscopic repair methods are inadequate. Middle trapezius tendon (MTT) transfer has emerged as a potential salvage procedure, but the comparative efficacy of different interpositional grafts-such as Achilles tendon allografts and fascia lata autografts-remains unclear. This retrospective case series evaluated patients who underwent MTT transfer with either an Achilles tendon allograft (group A) or fascia lata autograft (group F) from December 2019 to March 2022. Included patients had persistent pain after conservative treatment, minimal glenohumeral arthritis, and severe supraspinatus retraction with high fatty infiltration. Clinical outcomes were assessed preoperatively and postoperatively using visual analog scale for pain, along with patient-reported outcome measures including the Constant, American Shoulder and Elbow Surgeons, University of California, Los Angeles, and Single Assessment Numeric Evaluation scores. Radiological assessments evaluated the integrity of the transferred tendon and glenohumeral arthritis progression. A total of 33 patients (20 in group A and 13 in group F) were included. Both groups showed significant improvements in visual analog scale scores and patient-reported outcomes (P < .001) with no notable differences between them. Shoulder range of motion and strength also improved significantly in both groups. There was no significant progression of glenohumeral arthritis and no significant difference in rate of complications between the groups. MTT transfer is an effective surgical option for patients with irreparable supraspinatus tendon tears, yielding substantial improvements in pain and shoulder function regardless of the interpositional graft used. Both Achilles tendon allografts and fascia lata autografts demonstrated similar outcomes, offering flexibility in surgical approach based on individual patient considerations.