Superior Capsular Reconstruction or Lower Trapezius Transfer?

Which delivers greater functional improvement when treating posterosuperior irreparable rotator cuff tears—superior capsular reconstruction or lower trapezius transfer? A new study found evidence that lower trapezius transfer will more likely deliver greater functional improvement, patient satisfaction and graft integrity.

The study, “Superior Capsular Reconstruction Versus Lower Trapezius Transfer for Posterosuperior Irreparable Rotator Cuff Tears With High-Grade Fatty Infiltration in the Infraspinatus,” was published online on May 10, 2022 in The American Journal of Sports Medicine.

“Superior capsular reconstruction and lower trapezius transfer have recently been utilized to treat irreparable rotator cuff tears. There is still no clear guideline on which treatment method is a better fit for posterosuperior irreparable rotator cuff tears,” the researchers wrote.

For their study, they compared the clinical and radiological outcomes between arthroscopic-assisted superior capsular reconstruction and arthroscopic-assisted lower trapezius transfer in patients with posterosuperior irreparable rotator cuff tears with high-grade fatty infiltration in the infraspinatus muscle.

Fifty-eight patients were enrolled in the study and were treated between 2017 and 2019. All enrolled study participants had a minimum follow-up of 2 years. Twenty-two of the patients were treated with superior capsular reconstruction while 36 received a lower trapezius transfer.

The researchers assessed clinical outcomes including the Visual Analog Scale score for pain, active shoulder range of motion, the American Shoulder and Elbow Surgeons score, and patient satisfaction.

They also measured the radiological outcome the acromiohumeral distance. The progression of arthritis and graft integrity were also assessed.

While both groups had significant improvements in clinical outcomes, those who were treated with trapezius transfer had a higher active shoulder range of motion (ROM: forward elevation: 165.7°± 22.3°vs 145.5° ± 32.3 °, respectively [p = .015] and external rotation: 51.7°± 10.9° vs 41.1° ± 7.0 °, respectively [p < .001] as well as the postoperative American Shoulder and Elbow Surgeons score (84.8 ±  7.5 vs 76.8 ± 20.3 °, respectively; p = .045) and patient satisfaction (8.9 ± 1.2 vs 6.4 ± 2.1, respectively; p = .041).

In addition, while there was no significant difference in the acromiohumeral distance at 2 years postoperative, the rate of progression of arthritis and graft retear rate were higher in the superior capsular reconstruction group.

“Although arthroscopic-assisted superior reconstruction and the arthroscopic-assisted lower trapezius transfer both provided improvements in overall clinical outcomes for posterosuperior irreparable rotator cuff tears with high-grade 4 fatty infiltration in the infraspinatus, an arthroscopic-assisted lower trapezius was superior in terms of functional improvement, patient satisfaction, progression of arthritis and graft integrity. Therefore, we prefer arthroscopic-assisted lower trapezius transfer for posterosuperior irreparable rotator cuff tears under the condition of high-grade 4 fatty infiltration in the infraspinatus,” the researchers wrote.

Study authors included Chang Hee Baek, M.D., Chaemoon Lim, M.D., and Jung Gon Kim, M.D., all of Yeosu Baek Hospital, Yeosu, Republic of Korea.