Arthroscopic Assisted Lower Trapezius Transfer for the Treatment of Irreparable Posterosuperior Rotator Cuff Tears with Non-Functional Teres Minor: Are the Results Sustained After More Than 7.5 Years?

Abstract

Lower trapezius transfer has been demonstrated to restore external rotation in patients with brachial plexus palsies. In certain cases of cuff tear arthropathy, patients exhibit preserved forward elevation but lack active external rotation. This study evaluates the clinical outcomes of lower trapezius transfer, augmented with a semitendinosus tendon autograft and anchored to the infraspinatus insertion using an arthroscopically assisted technique and, to determine whether pain relief and functional improvement are maintained at minimum 7.5-year follow-up compared to the 11-month follow-up. Between March 2014 and February 2024, 23 patients (15 men, 8 women; mean age 55 years, range 32-75) underwent surgical reconstruction of irreparable posterosuperior rotator cuff tears involving the supraspinatus, infraspinatus, and non-functional teres minor. A 6 cm horizontal incision was made just inferior to the scapular spine to harvest the lower trapezius tendon, which was augmented with the semitendinosus tendon. The extended tendon was fixed laterally to the greater tuberosity at the infraspinatus insertion via arthroscopy. The proximal stump was fixed medially into the lower trapezius muscle belly with the arm in maximum external rotation. Clinical outcomes were assessed using the Constant-Murley score, Visual Analog Scale (VAS), active Range of Motion and, Subjective Shoulder Value (SSV). Twenty-three patients were included, with a first mean follow-up of 11 months (range: 5-19 months). Twelve patients had a second mean follow-up of nine years and four months (range: 92-128 months). At the first follow-up, the average increase in external rotation in adduction was 40°, and 70° at ninety degrees of abduction (p<.001). The Constant-Murley score improved from 46 to 82 points (p<.001), the SSV increased from 40% to 67% (p<.001), and VAS pain decreased from 5 to 1 (p<.001). Both the lag sign and Hornblower sign were negative post-transfer. The subgroup with a follow-up of at least 7.5 years showed slight improvements in functional outcomes, including active range of motion (aROM), Constant score, VAS, and SSV, but no statistically significant differences compared to the 11-month follow-up. Complications included two hematomas, only one requiring revision due to infection. Lower trapezius transfer is an effective treatment for irreparable posterosuperior rotator cuff tears with external rotation deficiency. This procedure results in significant improvement in pain and active external rotation in adduction and at 90° of abduction. Functional results remain stable over a long-term follow-up of minimum 7.5 years.