Clinical results of arthroscopically-assisted lower trapezius transfer using fascia lata autograft for posterior superior irreparable rotator cuff tear

Chang Hee Baek; Bo Taek Kim; Jung Gon Kim; Seung Jin Kim

doi:10.1016/j.jor.2024.02.020

Clinical results of arthroscopically-assisted lower trapezius transfer using fascia lata autograft for posterior superior irreparable rotator cuff tear

J Orthop. 2024 Feb 19:52:78-84. doi: 10.1016/j.jor.2024.02.020. eCollection 2024 Jun.

Authors

Chang Hee Baek¹, Bo Taek Kim¹, Jung Gon Kim¹, Seung Jin Kim¹

Affiliation

¹ Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, 59709, Republic of Korea.

PMID: 38435318
PMCID: PMC10904162 (available on 2025-06-01)
DOI: 10.1016/j.jor.2024.02.020

Abstract

Background: Different interpositional grafts have been proposed to connect between the lower trapezius tendon (LTT) to the humerus during LTT transfer. While studies often mention the successful use of Achilles tendon allograft, there is currently no literature reporting the clinical outcomes of utilizing fascia lata autograft (FLA) in LTT transfer. Therefore, the current study aims to evaluate the clinical and radiologic results of LTT using FLA for posterior superior irreparable rotator cuff tears (PSIRCTs) without arthritis.

Patient and methods: The present study constitutes a retrospective case series involving 22 patients, with a mean follow-up of 35.9 ± 15.9 months. Pain levels were gauged using the Visual Analog Scale (VAS), while shoulder function was comprehensively assessed through the Constant and ASES (American Shoulder and Elbow Society) scores. The evaluation of shoulder activities in daily living employed the ADLER (Activities of Daily Living Requiring Active External Rotation) score. Active ROM (Range of Motion) of all directions were obtained, radiologic assessments included key parameters such as AHD (Acromion Humeral Distance) and the Hamada grade. Finally, the integrity of the transferred LTT was evaluated, and a subgroup analysis was undertaken based on Tm trophicity.

Results: By the final follow-up period, VAS, Constant, ASES, and ALDER demonstrated significant improvement. Active ROM significantly improved in (FE) forward elevation to 155° ± 29°, abduction (Abd) to 140° ± 32°, external rotation (ER) at 90° Abd to 68° ± 19°, and ER at the side to 39° ± 17°. AHD and Hamada grade showed no significant arthritic progression. Tm hypertrophy group experienced superior improvements in ER compared to that of the non-hypertrophy group. Complications included re-tear (n = 2), infection (n = 1) and donor-site morbidity (n = 1).

Conclusion: The study highlighted promising clinical outcomes of LTT transfer using FLA, with no significant complications. Along with Achilles tendon allograft, FLA can be a safe and viable alternative interpositional graft choice.

Keywords: Fascia lata; Irreparable tear; Lower trapezius tendon transfer; Posterior superior rotator cuff tear; Rotator cuff; Tendon transfer.