JBJS - 2026-05-21 - Journal Article
Lower Trapezius Transfer at the Time of Reverse Shoulder Arthroplasty with an Allograft-Prosthetic Composite Can Restore External Rotation.
Sanchez-Sotelo J, Hart CM, Weir TB, Graden N, Gulzar M, ElHassan B, Wagner E
Topics
Key Takeaway
Combining lower trapezius transfer with RSA using an allograft-prosthetic composite restored active external rotation past neutral in 80% of surviving shoulders at mean 2.7 years, up from 15% preoperatively.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study evaluated a combined RSA with allograft-prosthetic composite and lower trapezius transfer in 26 shoulders with proximal humeral bone loss and posterosuperior cuff deficiency, performed by 2 surgeons between 2019 and 2023. Active external rotation past neutral improved from 15% to 80% of surviving shoulders; mean active elevation improved from 43° (with 11 of 27 pseudoparalytic preoperatively) to 79° (with only 3 remaining pseudoparalytic). The humeral complication revision/reoperation rate was 15%, with additional surgical complications including dislocation, hematoma, and glenosphere disassociation.
Key Limitation
The absence of a control group (RSA with APC alone, without LTT) makes it impossible to attribute external rotation gains specifically to the transfer versus the arthroplasty reconstruction itself.
Original Abstract
BACKGROUND
The purpose of this study was to describe, and report the outcomes of, a surgical technique that combines reverse shoulder arthroplasty (RSA) using an allograft-prosthetic composite (APC) with a lower trapezius transfer (LTT) to the infraspinatus of the allograft extended with the inferior capsule.
METHODS
Between 2019 and 2023, 2 surgeons performed a total of 27 RSAs using an APC in conjunction with an LTT. Once the RSA APC reconstruction had been performed, cuff-capsule allograft tissue was passed posterior to the glenosphere and secured to the harvested lower trapezius. One shoulder was resected for periprosthetic joint infection; the remaining 26 shoulders were followed for a minimum of 2 years (mean, 2.7 years; range, 2 to 5 years).
RESULTS
The rate of revision or reoperation for humeral complications was 15% and included secondary bone grafting (2 shoulders), resection for infection (1 shoulder), and internal fixation of a periprosthetic fracture (1 shoulder). Other complications requiring surgery included hematoma treated with evacuation (2 shoulders), dislocation (1 shoulder), and glenosphere disassociation (1 shoulder). Preoperatively, 11 shoulders presented with pseudoparalysis, and the mean active elevation of the remaining 16 shoulders was 43°, with only 1 shoulder demonstrating >90° of active elevation. At the most recent follow-up, 3 shoulders were pseudoparalytic, 11 had <90° of active elevation, 8 had >90° of active elevation, and 3 had active elevation to 90°. The overall mean active elevation of the 25 shoulders that could be assessed was 79°. Preoperatively, only 4 (15%) of the 27 shoulders demonstrated active external rotation past neutral; at the most recent follow-up, 80% of surviving shoulders had active external rotation past neutral.
CONCLUSIONS
LTT at the time of RSA using an APC has the potential to restore active external rotation in shoulders with proximal humeral bone loss and posterosuperior cuff deficiency.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.