Arthroscopic Middle Trapezius Transfer for Treatment of Irreparable Superior Rotator Cuff Tendon Tears

Abstract

Irreparable supraspinatus tendon tears are challenging to treat, especially in a young and high-demanding patient population. Whereas interposition tendon grafting and partial repair are limited by the quality of the remaining rotator cuff tendons and muscles, superior capsular reconstruction and subacromial spacers do not provide the active biomechanical principle of a contracting supraspinatus. The purpose of this technical note is to introduce an arthroscopic middle trapezius transfer below the acromion to replace the former supraspinatus unit. This technique might combine the benefits of both the static concepts seen with subacromial spacers or superior capsular reconstruction and dynamic concepts such as interposition grafting and partial repairs.

Fig 1

Operative setup. The patient is placed in the beach-chair position with the left arm resting in a pneumatic limb positioner.

Fig 2

View of a left shoulder from the top with the patient in the beach-chair position. After the clavicle, acromioclavicular joint, acromion, and scapular spine are identified, a 5-cm incision is performed parallel to the anterior border of the spino-acromial junction to harvest the middle trapezius tendon.

Fig 3

View of a left shoulder from the top with the patient in the beach-chair position. A 3-cm longitudinal split of the trapezius muscle is performed. Care has to be taken not to extend the split too far medially to avoid injuries to the accessory nerve. The released middle trapezius tendon is then armed with 2 No. 2 nonabsorbable sutures in Krackow stitch fashion.

Fig 4

View of a left shoulder from the top with the patient in the beach-chair position. The sutures of the middle trapezius transfer are shuttled underneath the acromion by the use of a Kocher clamp and then captured by an arthroscopic grasper intra-articularly via a posterolateral working portal. The inset shows an arthroscopic image of the left shoulder from the lateral viewing portal.

Fig 5

View of a left shoulder from the top with the patient in the beach-chair position. The anterior sutures of the middle trapezius transfer are shuttled through the anterolateral portal, and the posterior sutures are then shuttled via the lateral portal.

Fig 6

View of a left shoulder from the top with the patient in the beach-chair position. The final arthroscopic view (A), via the posterolateral portal, visualizing the greater tuberosity (GT) with partial repair of the infraspinatus tendon (ISP) and the final middle trapezius transfer (MTT) that is shuttled underneath the acromion as visible on the outside view of the left shoulder from the top (B).

Fig 7

Middle trapezius transfer with tendon harvest at the acromion–scapular spine site (A), shuttle process of the Krackow-stitched tendon stump (B) underneath the acromion, and final fixation to the greater tuberosity (C).

Fig 8

(A) Retracted and irreparable supraspinatus tendon stump preoperatively. (B) Middle trapezius transfer is performed underneath the acromion as a salvage option to treat irreparable superior rotator cuff tears.