Arthroscopy - 2026-04-16 - Journal Article
Combined Superior Capsular Reconstruction and Lower Trapezius Transfer Using an Achilles Tendon Allograft Show Better Clinical Outcomes and Lower Graft Tear Rates Versus Isolated Superior Capsular Reconstruction for Chronic Posterosuperior Irreparable Massive Rotator Cuff Tears With Severe Fatty Infiltration in the Infraspinatus.
Ben H, Lee JB, Lee HK, Jeon IH
Topics
Key Takeaway
Combined SCR + lower trapezius transfer reduced graft tear rates to 13.3% versus 47.6% for isolated SCR in irreparable massive rotator cuff tears with Goutallier grade 3-4 infraspinatus infiltration.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective study compared SCR combined with lower trapezius transfer versus isolated SCR for posterosuperior irreparable massive rotator cuff tears with Goutallier grade 3-4 infraspinatus fatty infiltration at minimum 24-month follow-up. SCR+LTT produced superior final ASES (87.7 vs 74.0), Constant (66.5 vs 55.6), VAS (0.7 vs 1.8), and active external rotation (47.3° vs 36.0°) scores. Graft tear rates were significantly lower in the combined group (13.3% vs 47.6%) with greater acromiohumeral distance (7.9 vs 6.3 mm).
Key Limitation
The small, non-randomized cohort with unequal group sizes and surgeon-determined procedure allocation makes it impossible to exclude selection bias as the primary driver of outcome differences.
Original Abstract
PURPOSE
To compare the surgical outcomes of superior capsular reconstruction (SCR) combined with lower trapezius transfer (LTT) using an Achilles tendon allograft versus isolated SCR for the treatment of posterosuperior irreparable massive rotator cuff tears with severe infraspinatus fatty infiltration (Goutallier grades 3-4).
METHODS
Between 2016 and 2023, patients who underwent SCR + LTT or SCR alone for posterosuperior irreparable massive rotator cuff tears with severe infraspinatus fatty infiltration and had ≥24-month follow-up were retrospectively reviewed. Clinical evaluation included American Shoulder and Elbow Surgeons (ASES), Constant, visual analog scale (VAS) scores, and active external rotation (ER) were evaluated. Radiographs assessed the acromiohumeral distance, while magnetic resonance imaging at 3 and 12 months evaluated graft integrity for all patients. The minimal clinically important difference (MCID) was calculated as half the standard deviation of score change from baseline to the latest follow-up for the SCR group. The frequency of MCID achievements was then calculated in both groups, based on the SCR-derived thresholds.
RESULTS
Thirty-six patients were analyzed (SCR + LTT group, n = 15; SCR, n = 21) with a mean follow-up time of 30.5 ± 6.9 and 36.5 ± 9.2 months, respectively (P = .067). The dataset was disaggregated by sex according to the Sex and Gender Equity in Research guidelines. Clinical and radiologic outcomes did not differ significantly between sexes, except for the preoperative Constant score, which was higher in the male group (male vs female: 60.4 ± 8.1 vs 54.4 ± 8.4, P = .017). At the final follow-up, SCR + LTT yielded superior ASES, Constant scores, lower VAS scores, and better ER than the SCR group (87.7 ± 5.0 vs 74.0 ± 18.3, P = .042; 66.5 ± 4.3 vs 55.6 ± 12.5, P = .004; 0.7 ± 0.6 vs 1.8 ± 1.6, P = .033; and 47.3 ± 13.7 vs 36.0 ± 12.1, P = .049, respectively). Graft tear rates were significantly lower in the SCR + LTT group compared with the SCR group (13.3% vs 47.6%, P = .040), with greater acromiohumeral distance (7.9 vs 6.3 mm, P = .033). At 6 months postoperatively, the SCR + LTT group showed higher ASES score, ER, and lower VAS scores than the SCR group (65.8 ± 13.7 vs 56.4 ± 13.6, P = .036; 37.3 ± 15.3 vs 24.8 ± 17.9, P = .036; and 1.0 ± 0.9 vs 3.5 ± 2.0, P < .001, respectively). The SCR + LTT group showed comparable MCID achievements for the ASES, Constant, VAS scores compared with the SCR groups (86.7% vs 66.7%, P = .252; 46.7% vs 33.3%, P = .449; 66.7% vs 71.4%, P = >.999, respectively).
CONCLUSIONS
Both SCR + LTT and SCR improved pain and function at ≥24 months postoperatively in patients with posterosuperior irreparable massive rotator cuff tears with severe infraspinatus fatty infiltration. However, SCR + LTT provided superior clinical outcomes, greater ER restoration, lower graft tear rates, and comparable MCID achievements compared with isolated SCR.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.