JSES - 2026-04-01 - Journal Article; Comparative Study
Is the graft position critical for functional outcomes following arthroscopy-assisted lower trapezius tendon transfer for posterosuperior irreparable rotator cuff tears? A comparison of anterior vs. posterior position of graft.
Baek CH, Elhassan BT, Lim C, Kim JG, Kim BT, Kim SJ
Topics
Key Takeaway
Anterior graft placement (supraspinatus footprint) in arthroscopy-assisted lower trapezius transfer yielded significantly greater postoperative forward elevation (160.2° vs. 150.4°), forward elevation strength (27.4 vs. 24.4 N·m), and AHD MCID achievement (68.2% vs. 45.6%) compared to posterior placement.
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Summary
This study asked whether interpositional graft position on the humeral head footprint affects outcomes after arthroscopy-assisted lower trapezius transfer for posterosuperior irreparable rotator cuff tears. Patients were retrospectively divided into anterior (supraspinatus footprint, n=44) and posterior (infraspinatus footprint, n=68) groups and assessed with PROs, active ROM, strength, AHD, Hamada grade, and acromial wear at minimum 2-year follow-up. Both groups improved significantly, but the anterior group demonstrated superior forward elevation, forward elevation strength, and AHD improvement meeting MCID (68.2% vs. 45.6%, P=.021), with no significant difference in osteoarthritis progression or acromial wear.
Key Limitation
Graft position was determined retrospectively from postoperative MRI rather than prospectively assigned, meaning posterior placement may be a surrogate for worse baseline tissue quality or more extensive tears rather than an independent variable.
Original Abstract
BACKGROUND
Arthroscopy-assisted lower trapezius tendon transfer (aLTT) has emerged as a reasonable treatment option for posterosuperior irreparable rotator cuff tears (PSIRCTs) due to its biomechanical advantages and favorable clinical outcomes. Although there are various surgical techniques for aLTT, the optimal positioning of the graft on the humeral head footprint is unknown in aLTT. This study aimed to evaluate clinical and radiological outcomes based on the interpositional graft position of aLTT graft in PSIRCTs.
METHODS
Patients who underwent aLTT for PSIRCTs from 2017 to 2022 were retrospectively analyzed, with a minimum follow-up period of 2 years. Patients were classified into anterior group (n = 44) if the interpositional graft was in the anterior position (supraspinatus footprint) or posterior group (n = 68) if it was in the posterior position (infraspinatus footprint) on postoperative magnetic resonance image. Clinical outcomes were evaluated with the visual analog scale score, patient-reported outcome measurements, active range of motion (aROM), and aROM strength. Radiological outcomes were evaluated by the acromiohumeral distance (AHD), Hamada grade, progression of osteoarthritis, and acromial wear.
RESULTS
Although both groups showed significant postoperative improvements in clinical outcomes, the postoperative forward elevation (160.2˚ ± 28.3˚ vs. 150.4˚ ± 22.0˚; P = .037) of the anterior group were significantly higher than that of the posterior group. Moreover, the postoperative forward elevation strength (27.4 ± 4.5 vs. 24.4 ± 4.4; P = .037) of the anterior group were significantly higher than that of the posterior group. Postoperatively, AHD significantly increased in the anterior group, whereas no significant change was observed in the posterior group. The achievement of minimal clinical importance difference for AHD (68.2% vs. 45.6%; P = .021) were significantly better in the anterior group. Although the posterior group demonstrated a numerically higher rate of progression of osteoarthritis and acromial wear, the difference was not statistically significant.
CONCLUSION
ALTT showed significant postoperative clinical improvement regardless of the interpositional graft position in patients with PSIRCTs. However, attaching the interpositional graft to the supraspinatus footprint is thought to provide dynamic stability and static stability in subacromial space, leading to favorable outcomes. Therefore, unless the posterior remnant cuff is insufficient for posterior side-to-side suturing, it is recommended to place the graft as anteriorly as possible.