Lower Trapezius Tendon Transfer Improves Range of Motion, Function, and Restores External Rotation in Patients With Massive, Irreparable, Posterosuperior Rotator Cuff Tears

Massive, irreparable rotator cuff tears can cause severe pain and weakness. In younger, more active patients, joint salvage interventions are the preferred treatment. Over the last decade, lower trapezius tendon transfer (LTTT) has increasingly been used to reduce pain and improve function in patients with massive posterosuperior rotator cuff tears. Few studies have reported outcomes following LTTT or examined risk factors for failure and poor patient reported outcomes The objective of this study was to report on failure rate, patient reported outcomes, and possible risk factors up to 2-years post-operative in those undergoing LTT in the management of massive, irreparable, posterosuperior rotator cuff tears. This was a prospective longitudinal observational study conducted between 2018 and 2023. Patients undergoing arthroscopic assisted LTTT by two fellowship-trained upper extremity surgeons from two sites were screened for study inclusion. Inclusion criteria were patients with massive (2+ tendons), irreparable rotator cuff tears in the primary or revision setting. Irreparable was defined as two or more of the following: grade 3 or higher fatty infiltration, patte grade 3, tendon length < 1 5mm, previous rotator cuff repair surgery. Exclusion criteria were prisoners, military, non-English speakers, patients < 1 8 years of age. Patients completed the Single Assessment Numeric Score (SANE), 4-point satisfaction scale (poor, fair, good, excellent), and ASES at baseline, and 12- and 24-months post-operative. Clinical assessment was conducted at all intervals including range of motion, and lag sign. Surgical failure was defined as reoperation, LTTT failure, SANE score of < 5 0%, or forward flexion of less than 90°. Descriptive statistics were generated and independent t-tests were performed between time-points for patient reported outcomes. Exploratory logistic regression was conducted to evaluate risks of failure with age, sex, WCB, primary or revision surgery, subscapularis status, and subscapularis repair as possible predictors. Linear regression was conducted to evaluate possible predictors of 12-month post-operative SANE scores including WCB status, and revision or primary surgery. Seventy-four patients completed 12-months follow-up and 51 of those have reached the 24-month interval. Table 1 outlines patient demographics and baseline characteristics. Patient reported outcomes and active range of motion (AROM) scores pre- and post-operatively are provided in Table 2. Ten (14%) LTTT surgeries were considered failures by 24-months post-operative, of which 5 had a subscapularis repair during their LTTT procedure, and 5 had a normal subscapularis. Lag sign was positive in 42 of 74 patients pre-operatively, with 29 corrected with surgery, 7 remaining positive, and 6 that did not attend in-person post-operative follow-up. Of the 7 that remained positive, 4 were failures and 3 were not. A subscapularis tear of 50% or greater was predictive of failure (p=0.009). WCB status was predictive of 12-month SANE score (p=0.006). Other variables were not predictive. The majority of patients experience improved range of motion, functional outcomes, and restoration of external rotation at up to two years post-LTTT surgery. However, those with a subscapularis tear of 50% or greater may be at greater risk of failure, and WCB patients may have lower SANE scores at 12-months post-operative. For any figures or tables, please contact the authors directly.