Is the trapezius transfer a useful treatment option for irreparable tears of the subscapularis? - 19/10/11

Doi : 10.1016/j.otsr.2011.05.012

D. Goutallier ^a,^⁎ , L. De Abreu ^a, J.-M. Postel ^a, P. Le Guilloux ^b, C. Radier ^c, S. Zilber ^a
^a Department of Orthopaedic Surgery, Henri-Mondor Hospital, Paris Public Assistance Hospitals Group, Paris XII Faculty of medicine, 94010 Créteil cedex, France
^b Department of Orthopaedic Surgery, Saint-Anne Military Teaching Hospital, 83800 Toulon, France
^c Department of Medical Imaging, Maussins Private Hospital, 75019 Paris, France

Corresponding author. 7, Gustave-Léveillé, 94320 Thiais, France.

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Summary

Introduction

When suture of the torn subscapularis could not be performed, a superior trapezius transfer was used for repair of the tendinous defect. The aim of this article is to report the mid-term functional and radiographic outcome of this technique when complete watertight rotator cuff healings were achieved and to investigate the usefulness of the trapezius transfer. The hypothesis of this work was that the trapezius transfer could not be considered as a useful treatment option.

Materials

The study included 20 shoulders demonstrating watertight healing of the rotator cuff on arthro CT-scan control performed 13.5months after open surgery consisting of a trapezius transfer and suture of all other torn tendons. The mean age at surgery was 58.4 years. The trapezius transfer operative technique is described.

Methods

The functional status of the shoulders was assessed preoperatively and at a mean follow-up of 30months according to the non-weighted Constant score and by measurement of active external rotation, arm at the side. Radiographic and CT-scan assessments were performed preoperatively and at a mean follow-up of 28.5months. The functional results obtained at last follow-up were compared with those “theoretically estimated” after anatomically successful suture of the torn supra and infraspinatous without associated repair of the torn subscapularis.

Results

Between the pre- and postoperative periods, pain, daily activities and Constant score had all statistically improved. Arthritis was not aggravated but the preoperative anterior subluxation of the humeral head persisted in most cases. The reported Constant scores correlated those “theoretically estimated” in case of non-associated subscapularis repair.

Discussion

This series is comparable to those evaluating the pectoralis major transfer technique and reports an identical functional outcome.

Conclusion

Since the Constant scores obtained after trapezius transfer correlate those estimated when not combining a subscapularis repair and taking into account the very frequent lack of improvement regarding the preoperative anterior subluxation of the humeral head, the trapezius transfer does not appear as a recommendable treatment option.