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Arthroscopic-Assisted Lower Trapezius Tendon Transfer Yields Improved Outcomes Compared to Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears
Haley McKissack, MD1, Hayden L Cooke, BS1, Sameer Khawaja, BS1, Anthony L. Karzon, MD2, Michael B. Gottschalk, MD1 and Eric R. Wagner, MD, MS1, (1)Emory University, Atlanta, GA, (2)Emory University School of Medicine, Atlanta, GA

Introduction: Superior capsular reconstruction (SCR) is utilized to relieve pain and restore function in patients with posterosuperior irreparable rotator cuff tears. Lower trapezius tendon transfer (LTTT) is an alternative procedure which better replicates the line of pull of the infraspinatus, providing a proposed biomechanical advantage and improvement in overall shoulder range of motion and function. This study aimed to compare postoperative outcomes between patients undergoing SCR and LTTT.
Methods: A retrospective review was conducted of our institution’s electronic medical record from 2015-2022. All patients who underwent SCR or LTTT for irreparable rotator cuff tears were identified. Patients with less than 12 months of follow up were excluded; average follow up for SCR was 37 months, and average follow up for LTTT was 30 months. Failure rates, reoperation rates, post-operative range of motion at final follow up, as well as patient reported outcomes including ASES score, SSV score, and pain score, were compared between the two groups.
Results: A total of 39 patients who underwent SCR and 37 who underwent LTTT were included. Failure rate was more than three times greater among patients who underwent SCR in comparison to those who underwent LTTT (38.5% vs 10.8%; p = 0.005). Revision rates were also significantly higher among the SCR group than LTT (25.6% vs 8.1%; p = 0.041). Among patients who underwent LTTT, range of motion at final follow up demonstrated significantly greater forward flexion (161.6° vs 124.7°; p<0.001), abduction (140.3° vs 98.6°; p<0.001), and numerically-scored internal rotation (7.3 vs 5.8, p<0.001) in comparison to patients who underwent SCR. Post-op ASES and SSV scores were significantly higher among patients who underwent LTTT (82.4 vs 74.5, p =0.002 and 82.5 vs 70.2, p =0.003, respectively). Average postoperative VAS pain score was also significantly lower among patients who underwent LTTT (0.73 vs 3.00; p<0.001) at final follow up.
Conclusion: LTTT is associated with significantly lower failure and revision rates than SCR. Additionally, LTTT resulted in superior post-operative patient-reported outcomes, range of motion, and pain scores in comparison to SCR.

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