title: Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear.
abstract: BACKGROUND
  Management of massive irreparable posterior-superior rotator cuff tear can be very challenging. This study reports the outcome of the lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear.
  
  
  METHODS
  Included were 33 patients with an average age of 53 years (range, 31-66 years). All patients had symptomatic massive irreparable rotator cuff tear that failed conservative or prior surgical treatment and underwent reconstruction with lower trapezius transfer prolonged by Achilles tendon allograft. The tear was considered irreparable based on the magnetic resonance imaging finding of ≥2 full-thickness rotator cuff tears associated with shortening and retraction of the tendon to the level of the glenoid and a high grade of fatty infiltration of the muscles. This was confirmed at the time of the surgery.
  
  
  RESULTS
  At an average follow-up of 47 months, 32 patients had significant improvement in pain, subjective shoulder value, and Disabilities of the Arm, Shoulder and Hand score and shoulder range of motion, including flexion, 120°; abduction, 90°; and external rotation 50°. One patient, with a body mass index of 36 kg/m(2), required débridement for an infection and then later underwent shoulder fusion. Patients with >60° of preoperative flexion had more significant gains in their range of motion. Shoulder external rotation improved in all patients regardless of the extent of the preoperative loss of motion.
  
  
  CONCLUSIONS
  Transfer of the lower trapezius prolonged with Achilles tendon allograft to reconstruct massive irreparable posterior-superior rotator cuff tear may lead to good outcome in most patients, specifically for those who have preoperative flexion of >60°.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: elhassan.bassem@mayo.edu.
authors.forename: Bassem T
authors.initials: BT
authors.lastname: Elhassan
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Wagner
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jean-David
authors.initials: JD
authors.lastname: Werthel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D064171:Superficial Back Muscles / Q000637:transplantation*; D016896:Treatment Outcome
keywords: Achilles tendon; Goutallier grade III or IV; fatty atrophy; lower trapezius transfer; massive irreparable tear; posterior-superior irreparable rotator cuff tear