Is Secondary Lower Trapezius Tendon Transfer After Rotator Cuff Repair Failure Effective? A Comparative Study with Primary Lower Trapezius Tendon Transfer

Abstract

Background: Lower trapezius tendon (LTT) transfer has emerged as a promising surgical intervention for addressing posterosuperior irreparable rotator cuff tears (PSIRCTs) in the absence of glenohumeral arthritis. However, comparative studies evaluating primary versus secondary LTT transfers following rotator cuff repair failure are limited.

Methods: This retrospective study analyzed 103 patients who underwent LTT transfer for PSIRCTs without glenohumeral arthritis. Patients were categorized into Group Primary (no prior shoulder surgeries, n=83) and Group Secondary (previous rotator cuff repairs failure, n=20). Clinical outcomes were assessed using Visual Analog Scale (VAS), Constant score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) score, and Single Assessment Numeric Evaluation (SANE) score. Radiological evaluations included acromiohumeral distance (AHD) and Hamada classification. Incidences of complications such as retears and infections were documented.

Results: The mean age for the Group Primary and the Group Secondary was 63.3 ± 6.3 years and 61.5 ± 4.8 years, respectively, with mean follow-up periods of 37.4 ± 15.7 months and 42.9 ± 16.8 months, respectively. Both Group Primary and Group Secondary demonstrated significant postoperative improvements in VAS, Constant, ASES, UCLA, and SANE scores, with no statistically significant differences observed between the groups. Radiologically, both groups showed a slight progression of glenohumeral arthritis with no significant differences between the groups. Retears of transferred tendon occurred at a similar rate in each group, with 18% in Group Primary and 20% in the Group Secondary CONCLUSION: Secondary LTT transfer following rotator cuff repair failure represents an effective surgical approach for managing PSIRCTs, demonstrating comparable improvements in clinical and radiological outcomes to primary LTT transfer. These findings support the consideration of LTT transfer irrespective of prior rotator cuff repair history. Long-term follow-up studies are essential to evaluate the durability and functional outcomes over extended periods.

Keywords: Irreparable rotator cuff tear; lower trapezius; lower trapezius tendon transfer; posterior superior rotator cuff tear; secondary LTT transfer; tendon transfer.