1
|
Baek CH, Kim BT, Kim JG, Kim SJ. Mid-term outcomes of arthroscopically assisted lower trapezius tendon transfer using Achilles allograft in treatment of posterior-superior irreparable rotator cuff tear. J Shoulder Elbow Surg 2024; 33:1293-1305. [PMID: 37852430 DOI: 10.1016/j.jse.2023.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Arthroscopically assisted lower trapezius tendon (aLTT) transfer is one of the treatment options for posterior-superior irreparable rotator cuff tears (PSIRCTs). Although short-term clinical outcomes have shown promising results, there are currently no reported clinical outcomes over a longer follow-up period. This study evaluated the mid-term outcomes of aLTT transfer in patients with a diagnosis of PSIRCT. METHODS This retrospective case-series study included patients who underwent aLTT transfer between May 2017 and May 2019. The clinical outcome assessment included the visual analog scale (VAS) pain score, Constant score, American Shoulder and Elbow Surgeons score, University of California-Los Angeles score, Activities of Daily Living Requiring Active External Rotation (ADLER) score, active range of motion, Single Assessment Numeric Evaluation score, and return-to-work rate. The radiographic analysis included the acromiohumeral distance, Hamada grade, and integrity of the transferred tendon at final follow-up. Subgroup analyses were performed based on the integrity of the transferred tendon and the trophicity of the teres minor (Tm). RESULTS This study enrolled 36 patients with a mean age of 63.4 years who met the inclusion criteria and were followed up for a mean of 58.2 ± 5.3 months. At final follow-up, the patients showed significant improvement in mean VAS score, Constant score, American Shoulder and Elbow Surgeons score, University of California-Los Angeles score, ADLER score, and active range of motion in all directions except internal rotation. A decrease in the acromiohumeral distance and an increase in the Hamada grade were observed at final follow-up (P = .040 and P = .006, respectively). Retears of the transferred tendon occurred in 7 patients, and postoperative infections developed in 2 individuals. An interesting finding was that the retear group still demonstrated improvement in the VAS score but did not show improvement in external rotation at the side by the final follow-up. Compared with the Tm non-hypertrophy group, the Tm hypertrophy group showed significantly better improvement in external rotation at 90° of abduction and at the side, as well as the ADLER score. Of the study patients, 30 (83.3%) were able to successfully resume their previous work. CONCLUSION In this study, aLTT transfer in patients with PSIRCTs demonstrated significant improvements in clinical and radiologic outcomes by the final follow-up. These findings provide support for the mid-term safety and effectiveness of aLTT transfer as a viable joint-preserving treatment option for PSIRCTs. However, larger and longer-term studies are still needed to further validate these findings.
Collapse
Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
| |
Collapse
|
2
|
Simão DT, Heise CO, Rodrigues JC, Yamauti LS, Villegas RI, Cho AB, Mattar Junior R. Functional and morphological evaluation of the trapezius muscle after spinal accessory nerve transfer to brachial plexus nerves. Microsurgery 2024; 44:e31152. [PMID: 38363113 DOI: 10.1002/micr.31152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/05/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION The main innervation of the trapezius muscle is provided by the spinal accessory nerve. Several studies describe the contributions of cervical plexus roots to the trapezius muscle innervation, either directly or through connections with the spinal accessory nerve. There is no adequate understanding of how the trapezius muscle is affected after using the spinal accessory nerve in nerve transfer procedures with the usual technique, preserving at least 1 branch for the upper trapezius. METHODS We evaluated 20 patients with sequelae of traumatic brachial plexus injury who underwent surgical procedures for brachial plexus repair or free muscle transfer, which included the spinal accessory nerve transfer technique and were followed for a minimum of 1 year. The three portions trapezius muscle were evaluated by physical examination, magnetic resonance imaging (analysis of fatty degeneration) and electromyography. RESULTS In all evaluation methods, the middle and lower portions of the trapezius muscle showed more significant morphological and/or functional impairment than the upper portion, in most cases. There was a statistically significant difference in all the complementary exams results, between the affected side (with sacrifice of the nerve) versus the normal side, in the middle and lower portions of the trapezius muscle. CONCLUSIONS Physical examination alone is not sufficient to determine the residual functionality of the trapezius muscle. Magnetic resonance imaging and electromyography are useful tools to assess both morphological involvement of the trapezius muscle and nerve conduction impairment of the trapezius muscle, respectively. The results suggest that the middle and lower portions of the trapezius muscle are affected by previous SAN transfer and should be considered with caution for further muscle transfer procedures.
Collapse
Affiliation(s)
- Danielle Tiemi Simão
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Carlos O Heise
- Division of Neurology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - João C Rodrigues
- Department of Imaging Diagnostic, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Radiology Department, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Lucas S Yamauti
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Robin I Villegas
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Alvaro B Cho
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
- Division of Hand Surgery and Microsurgery, Coordinator of the Hand Surgery and Microsurgery Fellowship Program, ABC Medical School, Santo André, Brazil
| | - Rames Mattar Junior
- Division of Hand Surgery and Microsurgery, Institute of Orthopedics and Traumatology, "Hospital das Clínicas" of the School of Medicine of the University of São Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Loren J, Lu CY(J, Yang CP, Hsu KY, Cheng YH, Sheu H, Chen CY, Tang HC, Chuang CA, Chiu CH(J. Arthroscopic Lower Trapezius Tendon Transfer for a Patient with Axillary Nerve Injury and Concomitant Rotator Cuff Tear: A Case Report and Technical Notes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1817. [PMID: 37893536 PMCID: PMC10608587 DOI: 10.3390/medicina59101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Introduction: Concomitant nerve injuries with musculoskeletal injuries present a challenging problem. The goals of nerve reconstruction for the shoulder include shoulder abduction and external rotation. When patients fail to achieve acceptable shoulder external rotation and shoulder abduction, tendon transfers such as trapezius transfer offer a reliable option in the subsequent stage. Case Presentation: A 32-year-old male presented with weak external rotation in his left shoulder, after previous axillary nerve reconstruction. He received the ipsilateral lower trapezius transfer with the aim of improving the external rotation. Discussion: The lower trapezius restores a better joint reaction force in both the compressive-distractive and anterior-posterior balancing and provides a centering force through the restoration of the anterior-posterior force couple. Conclusion: We believe that the ipsilateral lower trapezius transfer to the infraspinatus is a good outcome and is effective in improving overall shoulder stability and the shoulder external rotation moment arm or at least maintaining in neutral position with the arm fully adducted in patients with post axillary nerve injuries post unsatisfactory nerve reconstruction to increase the quality of life and activities of daily living.
Collapse
Affiliation(s)
- Jeff Loren
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
- Department of Orthopedics & Traumatology, Royal Prima General Hospital, Medan 20118, Indonesia
| | - Chuieng-Yi (Johnny) Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (K.-Y.H.); (Y.-H.C.)
| | - You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (K.-Y.H.); (Y.-H.C.)
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Chao-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (H.-C.T.); (C.-A.C.)
| | - Chieh-An Chuang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (H.-C.T.); (C.-A.C.)
| | - Chih-Hao (Joe) Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
| |
Collapse
|
4
|
Checchia CS, da Silva LA, do Val Sella G, Checchia SL, de Moraes Barros Fucs PM, Miyazaki AN. Allograft-enhanced latissimus dorsi transfer is better than the conventional technique for irreparable posterosuperior rotator cuff tears. A retrospective matched cohort. INTERNATIONAL ORTHOPAEDICS 2023; 47:1527-1534. [PMID: 36951977 DOI: 10.1007/s00264-023-05775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Latissimus dorsi tendon (LDT) transfer (LDTT) to the greater tuberosity to treat irreparable posterosuperior rotator cuff tears (RCTs) in young active patients has been shown to have up to 36% of clinical failures, most of them happening because of either deltoid origin disruption or post-operative transfer rupture from the greater tuberosity. In an attempt to simultaneously prevent both complications, a modified technique includes the following adaptations to the original technique: reinforcement and augmentation of the LDT with a tendinous allograft, enabling the use of a single deltopectoral approach. The aim of this study is to compare mid-term outcomes of the traditional LDTT technique with this modified transfer. METHODS Retrospective cohort study comparing two groups who underwent either the traditional (group 1; n = 19) or the modified technique (group 2; n = 27). Group homogenization was assured by statistical comparison of 24 baseline independent variables. The outcome variables were the gains to active shoulder range of motions (ROM) and UCLA scores (and all its subscores, independently), at a minimum follow-up of two years. A p value < .05 was considered to be statistically significant. RESULTS At a mean follow-up of 25 months, both groups have shown improvements to most variables. However, group two (modified technique) achieved greater improvements to UCLA score (p = .009), active external rotation (p = .006) and internal rotation (p = .008). CONCLUSION At mid-term follow-up, improvements to outcomes of the modified (single approach, allograft-enhanced) latissimus dorsi transfer were greater than those of the original technique.
Collapse
Affiliation(s)
- Caio Santos Checchia
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil.
- Hospital Sírio-Libanês, São Paulo, Brazil.
| | | | | | - Sergio Luiz Checchia
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | | | - Alberto Naoki Miyazaki
- Department of Orthopaedics, Santa Casa School of Medicine, São Paulo, Brazil
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| |
Collapse
|
5
|
Desai V, Stambulic T, Daneshvar P, Bicknell RT. Lower trapezius tendon transfer for irreparable rotator cuff injuries: a scoping review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:1-9. [PMID: 37588064 PMCID: PMC10426520 DOI: 10.1016/j.xrrt.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Rotator cuff tears are a common source of shoulder pain and dysfunction. An irreparable rotator cuff tear poses a particular treatment challenge. There have been few studies reporting the outcomes of lower trapezius tendon (LTT) transfer for irreparable rotator cuff injuries. Therefore, the purpose of this review is to summarize the postoperative functional outcomes and complications of patients undergoing a LTT transfer for massive irreparable rotator cuff injuries. Methods A scoping review was performed using the Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases with the search terms "trapezius" AND "transfer." Of 362 studies included for initial screening, 37 full-text citations were reviewed, with 5 studies meeting all the inclusion criteria to be included in the review. Two reviewers extracted data on study design, patient demographics, surgical technique, functional outcomes, range of motion (ROM), and complications for each study according to the predefined criteria. Results Improvements in the preoperative to postoperative functional status, identified using the Disabilities of the Arm, Shoulder, and Hand (50.34 to 18), The American Shoulder and Elbow Surgeons Score (48.56 to 80.24), Visual Analog Scale (5.8 to 1.89), Single Assessment Numeric Evaluation (34.22 to 69.86), and Subjective Shoulder Value (52.24 to 77.66), were evident across all 5 studies. Preoperative to postoperative increases in ROM were seen for flexion (85 to 135), external rotation (18 to 52), and abduction (50 to 98). The overall complication rate was 18%, with seroma formation (8%) as the most common postoperative complication. Discussion/Conclusion Our analysis showed that LTT transfer improved postoperative function, ROM, and pain for patients with irreparable rotator cuff tears with an overall complication rate of 18%. Future controlled studies are required to directly compare LTT transfer to other tendon transfers and other surgical techniques for irreparable rotator cuff tears.
Collapse
Affiliation(s)
- Veeral Desai
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Thomas Stambulic
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Parham Daneshvar
- Department of Othopaedic Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Ryan T. Bicknell
- Department of Othopaedic Surgery, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
6
|
Miyazaki AN, Checchia CS, Fonseca Filho JM, Rosa JRP, Val Sella GD, Silva LAD. Resultados da transferência do grande dorsal alongado com enxerto tendíneo homólogo por via delto-peitoral para lesões póstero-superiores irreparáveis do manguito rotador. Rev Bras Ortop 2022; 57:590-598. [PMID: 35966441 PMCID: PMC9365491 DOI: 10.1055/s-0041-1724073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022] Open
Abstract
Objective
The primary aim of the present study is to evaluate the functional results of a modification to the latissimus dorsi (LD) transfer around the shoulder for irreparable posterosuperior rotator cuff tears. The secondary aim is to evaluate variables that might influence the outcomes.
Surgical Technique
Through a single deltopectoral approach, the LD tendon is detached, reinforced, and elongated with a tendinous allograft, transferred around the humerus, and fixed superolaterally to the greater tuberosity and anteriorly to the subscapularis.
Methods
Retrospective functional evaluation of 16 cases. The average follow-up was 21 months (12–47). The postoperative results (at last follow-up) were compared with the preoperative ones, as well as to other pre, intra, and postoperative variables.
Results
All (but one) patients were satisfied. Average University of California, Los Angeles (UCLA) score increased from 11.6 (8–16) to 27.3 (17–30) (
p
< 0.001). Improvements of shoulder pain, function, and strength achieved statistical significance (
p
< 0.001). Nonetheless, normal strength was never restored. Average active range of motion improved as follows: forward elevation, from 106° (60–140°) to 145° (130–160°) (
p
< 0.001); external rotation from 30° (0° to 60°) to 54° (40–70°) (
p
< 0.001); and internal rotation from L1 (gluteus to T7) to T10 (T12–T3) (
p
< 0.05). No complication has occurred. Preoperative pseudoparesis was reverted in all the six cases in which it was present. None of the variables analyzed influenced the outcomes, including pseudoparesis.
Conclusions
At early follow-up, this technique is safe and effective at recovering from pseudoparesis and at improving shoulder pain, function, and strength.
Collapse
Affiliation(s)
- Alberto Naoki Miyazaki
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Caio Santos Checchia
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - João Manoel Fonseca Filho
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
- Departamento de Cirurgia Ortopédica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - João Roberto Polydoro Rosa
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
- Departamento de Cirurgia Ortopédica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Guilherme do Val Sella
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Luciana Andrade da Silva
- Grupo de Cirurgia em Ombro e Cotovelo, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
7
|
López-Zamora I, Campos-Varela I, Luzardo-González A, Justes-Solé A. [Early physiotherapy in lower trapezius transfer for massive and irreparable rotator cuff injuries. A case report]. Rehabilitacion (Madr) 2022; 57:100748. [PMID: 35803750 DOI: 10.1016/j.rh.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 10/17/2022]
Abstract
Massive and irreparable lesions of the rotator cuff are frequent between people over 60 years old. Recently, inferior trapezium transference with Achilles tendon allograft has demonstrated very good results to restore shoulder's function. For this kind of surgery, it is recommended an absolute immobilization in shoulder abduction at 90° and maximal external rotation between 6-8 weeks. A 57-year-old woman underwent surgery with a lower trapezius transfer to repair the rotator cuff due to a massive and irreparable tear. She started aquatic physiotherapy 15 days after surgery and conventional physiotherapy treatment at 25 days, with a follow-up of 12 months. Good functional results of the operated shoulder were obtained, which were maintained in the postoperative follow-up. In this case early physiotherapy did not result in any risk of suture dehiscence, loosen or distressing of the allograft.
Collapse
Affiliation(s)
- I López-Zamora
- Unidad de Fisioterapia, Servicio de Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - I Campos-Varela
- Unidad de Fisioterapia, Servicio de Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A Luzardo-González
- Unidad de Fisioterapia, Servicio de Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A Justes-Solé
- Unidad de Fisioterapia, Servicio de Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| |
Collapse
|
8
|
Ye L, Han D, Zhang Q, Yang X, Tung TH, Zhou X. Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears. Front Surg 2022; 8:796359. [PMID: 35071315 PMCID: PMC8782238 DOI: 10.3389/fsurg.2021.796359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/08/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: To explore the indications and surgical techniques for arthroscopic lower trapezius transfer (LTT) with tendon autograft in managing massive irreparable posterosuperior rotator cuff tears (PSRCTs); to validate the feasibility, safety, and efficacy of this technique. Methods: This study retrospectively enrolled 23 patients with massive irreparable PSRCTs, admitted to and followed up by the Taizhou Hospital of Zhejiang province between July 2020 and April 2021, and treated with ipsilateral LTT and ipsilateral hamstring tendon autograft. The control group consisted of 23 patients with massive RCTs receiving conventional repair procedures within the same frame. Follow-up data at the preoperative visit, and postoperative month 3 were collected to assess the active range of motion, Constant–Murley Score (CMS),American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University of California, Los Angeles (UCLA)shoulder score, visual analog scale (VAS)and the post-operative MRI results, all of which could provide a comprehensive postoperative early efficacy assessment. Results: Three months follow-up visits were completed for all patients, revealing improvements in all aspects compared to the preoperative state, with no complications, such as postoperative infection of surgical sites and nerve injuries of infection and nerve injury. The distribution of active shoulder range of motion of patients and function scores with two types of operation was as follow: angles of flexion and lifting (130.00° ± 31.55° vs. 90.78° ± 19.85°), abduction (123.26° ± 30.47°vs. 85.87° ± 18.74°), external rotation at side (101.74° ± 14.74° vs. 91.74° ± 11.92°), external rotation at 90° abduction (41.52° ± 21.97° vs. 24.57° ±12.60°), VAS (0.74± 0.81 vs. 1.87 ±0.87), CMS(56.3 ± 13.01 vs. 48.30 ± 8.38), UCLA shoulder score (24.04 ± 2.88 vs.20.96 ± 3.47), ASES (72.91 ± 9.99 vs.60.74 ± 8.84). Significantly better improvements were found in the study group on month 3.19 of 23 patients in the study group and 17 of 23 patients in the control group underwent MRI on the 3 months follow up. Retear was found in only one patient who had grade 4 subscapularis tendon injury, However, revision was not performed due to postoperative pain relief and functional improvement. Conclusion: Compared to conventional repair procedures, in the early postoperative period, LTT with tendon autograft could achieve better pain relief, more rapid motor functional recovery, and higher functional scores for massive irreparable PSRCTs.
Collapse
Affiliation(s)
- Lingchao Ye
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Dawei Han
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Qingguo Zhang
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Xiangdong Yang
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Tao-Hsin Tung
- Public Laboratory, Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
| | - Xiaobo Zhou
- Department of Sports Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China
- *Correspondence: Xiaobo Zhou
| |
Collapse
|
9
|
Houdek MT, Wagner ER, Rose PS, Barlow JD, Elhassan BT, Sanchez-Sotelo J. Allograft prosthetic composite reconstruction using a reverse total shoulder arthroplasty for failed oncologic proximal humerus reconstruction. J Surg Oncol 2021; 125:775-781. [PMID: 34913481 DOI: 10.1002/jso.26772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Endoprosthetic or allograft reconstruction are the preferred reconstruction techniques for proximal humeral bone tumors. Failure of these reconstructions may occur, but historically revision is performed rarely due to the lack of reliable options. Reverse shoulder arthroplasty with an allograft prosthetic composite (rAPC) may provide a revision option. The purpose of the current study was to evaluate our institutional outcome of these procedures. METHODS Eleven (6 male, 5 female) patients (mean age 51 ± 17 years) underwent revision of a failed oncologic reconstruction of the proximal humerus utilizing a rAPC. The most common indication for revision was subluxation (n = 6) and the most common previous implant was an endoprosthesis (n = 5). RESULTS Revision resulted in improvements in shoulder elevation (39° vs. 62°, p = 0.02), external rotation (13° vs. 25°, p = 0.04), American Shoulder and Elbow Surgeons score (39 vs. 58, p = 0.004) and Musculoskeletal Tumor Society Scores (51% vs 69%, p = 0.002). There were 2 re-revision procedures performed. One for an allograft fracture and one for allograft resorption and loosening. CONCLUSIONS Revision with a rAPC can effectively restore patient function. Due to the complexity of the cases, we advocate for these procedures to be performed by subspecialty upper extremity surgeons trained in complex revision shoulder arthroplasty.
Collapse
Affiliation(s)
- Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric R Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia, USA
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bassem T Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | |
Collapse
|
10
|
Cartaya M, Canales P, Werthel JD, Hovsepian JM, Valenti P. Feasibility of lower trapezius and rhomboid minor transfer for irreparable subscapularis tears: an anatomic cadaveric study. JSES Int 2021; 5:447-453. [PMID: 34136852 PMCID: PMC8178634 DOI: 10.1016/j.jseint.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Previously reported outcomes after tendon transfers to reconstruct the subscapularis are unpredictable and often unsatisfactory, especially in the presence of anterior humeral head subluxation. We studied the anatomic feasibility of the lower trapezius and the rhomboid minor transfer to reconstruct irreparable tendon tears of the subscapularis. The aim of this study was to determine the feasibility of lower trapezius and rhomboid minor transfer to reconstruct irreparable subscapularis tendon tears. Materials and methods We measured the tendons dimensions, muscles excursions, distances to pedicles, and dissection needed to complete a successful lower trapezius and/or rhomboid minor transfer to the subscapularis footprint in 10 cadaveric shoulders. The transferred muscles were detached distally, augmented with a semitendinosus and gracilis autograft, and passed anteriorly between the scapula and the subscapularis remnant through a small serratus window to reach the lesser tuberosity. The risk of pedicle compression was subjectively assessed in all cases. Results The trapezius and rhomboid tendons were asymmetric with an average length of 37.6 mm and 21.7 mm, an average width of 63 mm and 33.4 mm, respectively. The mean distances from each distal insertion to the lesser tuberosity were 109 mm for the trapezius and 144 mm for the rhomboid. Mean distances from tendon to pedicle were 57.9 mm and 33.1 mm, respectively. The mean size of the necessary serratus window was 49.4 mm, which was measured at maximal excursion achieved at maximal external rotation 90° representing two digitations. All of the tendon transfers were feasible, and the risk of pedicle compression was 20% for the trapezius and 10% for the rhomboid. Superior migration of the transfer was observed during passive external rotation if the insertion point was too high. Conclusions Transfer of the lower trapezius and rhomboid minor to the lesser tuberosity to reconstruct an irreparable subscapularis tear is feasible without extensive dissection and with a low risk of nerve compression. We recommend not to transfer the rhomboid minor routinely, owing to the risk of tendon luxation after external rotation of the shoulder.
Collapse
Affiliation(s)
| | | | | | - Jean Michel Hovsepian
- Department of Orthopaedic Sports Medicine, Chirurgisches Klinikum München Süd, Munich, Germany
| | | |
Collapse
|
11
|
Clouette J, Leroux T, Shanmugaraj A, Khan M, Gohal C, Veillette C, Henry P, Paul RA. The lower trapezius transfer: a systematic review of biomechanical data, techniques, and clinical outcomes. J Shoulder Elbow Surg 2020; 29:1505-1512. [PMID: 32169465 DOI: 10.1016/j.jse.2019.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lower trapezius (LT) transfers were originally described to restore external rotation (ER) in the management of brachial plexus palsy; however, there is recent interest in the role of this transfer to restore shoulder function, specifically ER, in patients with a massive irreparable rotator cuff tear (RCT). The purpose of this systematic review is to summarize the current literature pertaining to LT transfers, including biomechanics, techniques, and clinical outcomes for patients with brachial plexus palsy and massive RCTs. METHODS MEDLINE, EMBASE, and PubMed were searched for biomechanical and clinical studies, as well as technique articles. Four biomechanical studies reported on moment arms, range of motion (ROM), and force vectors. Seven clinical studies reported postoperative ROM and functional outcomes, and weighted mean improvements in ROM were calculated. RESULTS Overall, 18 studies were included, and then subdivided into 3 themes: biomechanical, technique, and clinical. Biomechanical studies comparing LT and latissimus dorsi (LD) transfers observed an overall larger moment arm in abduction and ER in adduction for the LT transfer, with similar results in forward elevation. Clinical studies noted significant improvement in shoulder function following the LT transfer, including ROM and functional outcome scores. There were several described techniques for performing the LT transfer, including arthroscopically assisted and open approaches, and the use of both allograft and autograft augmentation. CONCLUSION This study suggests that the LT transfer is generally safe, and the clinical and biomechanical data to date support the use of the LT transfer for restoration of function in these challenging patient populations.
Collapse
Affiliation(s)
- Julien Clouette
- The Arthritis Program, University Health Network, Toronto, ON, Canada
| | - Timothy Leroux
- The Arthritis Program, University Health Network, Toronto, ON, Canada.
| | | | - Moin Khan
- Department of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Chetan Gohal
- Department of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | | | - Patrick Henry
- Department of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ryan A Paul
- The Arthritis Program, University Health Network, Toronto, ON, Canada
| |
Collapse
|
12
|
Stoll LE, Codding JL. Lower Trapezius Tendon Transfer for Massive Irreparable Rotator Cuff Tears. Orthop Clin North Am 2019; 50:375-382. [PMID: 31084840 DOI: 10.1016/j.ocl.2019.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The treatment of the massive irreparable rotator cuff tear poses a challenging problem. Tendon transfers offer a solution for irreparable posterosuperior rotator cuff tears. The lower trapezius tendon transfer with incorporation of an Achilles tendon allograft has emerged as an effective way to restore strength and function in select patients. Both open and arthroscopic-assisted techniques have been described.
Collapse
Affiliation(s)
- Laura E Stoll
- Division of Orthopaedic Surgery and Sports Medicine, Virginia Mason Medical Center, 1100 Ninth Avenue, X6-ORT, Seattle, WA 98101, USA.
| | - Jason L Codding
- Department of Orthopaedic Surgery, The Everett Clinic, 3901 Hoyt Avenue, Everett, WA 98201, USA
| |
Collapse
|