Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear

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 degrees; abduction, 90 degrees; and external rotation 50 degrees. One patient, with a body mass index of 36 kg/m(2), required debridement for an infection and then later underwent shoulder fusion. Patients with >60 degrees 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 degrees. Level of evidence: Level IV; Case Series; Treatment Study (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.