Lower Trapezius Tendon Transfer Improves Range of Motion, Functional Outcomes, and Pain for Irreparable Rotator Cuff Tears: A Systematic Review.

Abstract

To analyze the available literature on lower trapezius tendon transfer (LTT) for functionally irreparable rotator cuff tears (FIRCTs) and summarize the outcomes of this procedure. A systematic review was conducted on April 4, 2024, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines in the MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, and SPORTDiscus databases to identify clinical outcome studies on LTT for FIRCTs. Peer-reviewed publications with a level of evidence of Level IV or higher were included. Data related to clinical outcomes and complications were recorded. Risk of bias was assessed using the Methodological Index for Non-randomized Studies. The initial search yielded 1,066 studies, resulting in 15 studies for inclusion, including 393 total patients. Mean follow-up ranged from 3 to 58.2 months. All studies reported significant improvements in patient-reported outcomes and range of motion after LTT for FIRCTs. Postoperative American Shoulder and Elbow Surgeons scores ranged from 54.8 to 84.8, with absolute improvements of 21.7 to 48.6, whereas visual analog scale pain scores improved by 1.7 to 5.4. Postoperative external rotation ranged from 35° to 101.7°, with mean improvements of 11° to 32.5°, and forward flexion improved by 7.9° to 66° to a range of 120° to 165.7°. Complications were reported in 12 studies, with LTT retear (range, 0%-19%) and infection (0%-13%) being the most common. Reoperations occurred in 10 studies, most frequently consisting of conversion to shoulder arthroplasty (0%-20%). LTT is a reliable option for FIRCTs, offering significant improvements in clinical and functional outcomes. It is particularly effective in restoring external rotation, with complication and reoperation rates comparable to alternative surgical procedures. Level IV, systematic review of Level III and IV studies.