Lower trapezius transfer for massive posterosuperior rotator cuff defects

Author(s):  
Gia Rodríguez-Vaquero ◽  
Vanesa López-Fernández ◽  
Emilio Calvo
Keyword(s):  
2019 ◽  
Vol 28 (7) ◽  
pp. 1257-1264 ◽  
Author(s):  
Akhil Reddy ◽  
Lawrence V. Gulotta ◽  
Xiang Chen ◽  
Alessandro Castagna ◽  
David M. Dines ◽  
...  

2016 ◽  
Vol 25 (8) ◽  
pp. 1346-1353 ◽  
Author(s):  
Bassem T. Elhassan ◽  
Eric R. Wagner ◽  
Jean-David Werthel

2013 ◽  
Vol 25 (1) ◽  
pp. 12 ◽  
Author(s):  
G Bolton ◽  
SJ Moss ◽  
M Sparks ◽  
PC Venter

Background. Shoulder injuries are the most severe injuries in rugby union players, accounting for almost 20% of injuries related to the sport and resulting in lost playing hours.Objective. To profile the thoracic posture, scapular muscle activation patterns and rotator cuff muscle isokinetic strength of semi-professionalrugby union players.Methods. Using the hand-behind-the-neck and -back methods, we manually tested the range of motion (ROM) of the shoulder joints of 91 uninjured semi-professional rugby union players who consented to participate in the study. Profiling and classification of thoracic posture was performed according to the New York Posture Test. Activation patterns of the upper and lower trapezius, serratus anterior and infraspinatus scapular muscles were determined by electromyography. The isokinetic muscle strength of the rotator cuff muscles was determined at 60°/sec by measuring the concentric and eccentric forces during internal rotation (IR) and external rotation (ER).Results. Participants presented with non-ideal or unsatisfactory internal (59%) and external (85%) rotators of the shoulder. A slightly abnormal or abnormal forward head posture was observed in 55% of participants, while 68% had an abnormal shoulder position in the lateral view. The muscle activation sequence of the rotator cuff muscles was: (i) serratus anterior, (ii) lower trapezius, (iii) infraspinatus, and (iv) upper trapezius. The isokinetic ER/IR muscle-strength ratio during concentric muscle contraction was 64% (standard deviation (SD) ±14) for the left shoulder and 54% (SD ±10) for the right shoulder. The ER/IR ratio for eccentric muscle contraction was 67% (SD ±12) and 61% (SD ±9) for the left and right shoulders, respectively.Conclusions. Non-ideal or unsatisfactory flexibility of the external rotators of the shoulder, a forward shoulder posture in the lateral view, and weakness of the external rotators did not result in an abnormal rotator cuff muscle activation pattern in this study. Postural deviations may, however, increase the risk of shoulder injury in rugby union players in the long term, and should be corrected.


Author(s):  
Jarret M Woodmass ◽  
Eric R Wagner ◽  
Michelle J Chang ◽  
Kathryn M Welp ◽  
Florian Grubhofer ◽  
...  

ObjectivesThe purpose of this study is to compare early postoperative recovery following open and arthroscopic-assisted latissimus dorsi tendon (aa-LDT) transfer to arthroscopic-assisted lower trapezius tendon (aa-LTT) transfer for patients with massive irreparable posterosuperior rotator cuff pathology.MethodsA multicentre retrospective analysis comparing the postoperative outcomes after open LDT, arthroscopic-assisted LDT (aa-LDT) or arthroscopic-assisted LTT (aa-LTT) was performed. Active range of motion and patient-reported subjective outcomes were reported preoperatively and postoperatively. Overall, there were 10 patients who underwent open LDT transfer, 16 aaLDT transfers and 8 aa-LTT transfers with mean age of 55±3, 57±6 and 53±13, respectively. Mean follow-up was 22±10 months.ResultsArthroscopic-assisted LDT had significantly improved postoperative forward flexion (85–124, p<0.003) and external rotation (29–38, p<0.005), whereas aa-LTT had significantly improved postoperative forward flexion (101–146, p<0.04). Arthroscopic-assisted LDT and aa-LTT transfers improved American Shoulder and Elbow Surgeons (ASES) Shoulder Function scores and Single Assessment Numeric Evaluation (SANE) at 2 years (p<0.03). Arthroscopic-assisted LTT compared with open LDT demonstrated significantly improved ASES Shoulder Index score (20.0 vs 12.6; 84.8 vs 55.6) and visual analogue scale (VAS) (0.66 vs 4.14; 1.17 vs 3.88) at postoperative 6 months and 2 years, respectively. Arthroscopic-assisted LDT transfer compared with open LDT had improved VAS at 6 months (0.66 vs 2.11, p<0.05). In total, 6 (17.6%) complications were noted. These included two infections with Cutibacterium acnes, two axillary nerve injuries, complex regional pain syndrome and a postsurgical adhesive capsulitis.ConclusionsArthroscopic-assisted LDT and aa-LTT transfers provided improvement in pain and function at 2-year follow-up. The aa-LTT transfer provided significantly improved outcomes at 2 years compared with the open-LDT (latissimus dorsi tendon transfer) transfer. This study demonstrates superiority of arthroscopic-assisted tendon transfer techniques over traditional open techniques while establishing the aa-LTT transfer as a safe and effective alternative in the management of massive irreparable rotator cuff tears.Level of evidenceIV.


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