Revision Surgery for Failed Rotator Cuff-related Surgery with Arthroscopic-assisted Lower Trapezius Tendon Transfer and Reverse Shoulder Arthroplasty in Patients with Preserved Glenohumeral Joint: A Two-year Retrospective Cohort Study

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Abstract
Background: Massive irreparable rotator cuff tears (MIRCTs) following failed rotator cuff-related surgery pose a significant challenge in shoulder surgery. Both lower trapezius tendon (LTT) transfer and reverse shoulder arthroplasty (RSA) offer potential solutions for patients without advanced glenohumeral arthritis. Objectives: The aim of this study was to compare surgical results, functional outcomes, and pain relief after RSA and LTT in patients with MIRCTs without advanced glenohumeral arthritis following failed rotator cuff-related surgery. Materials and Methods: This retrospective cohort study included 36 patients with MIRCTs and prior failed cuff-related surgeries treated between January 2018 and May 2022. Fourteen underwent arthroscopic-assisted LTT with an average follow-up of 24.9 ± 0.9 months, and 22 underwent RSA with an average follow-up of 25.0 ± 1.6 months. Pre- and postoperative range of motion (ROM), pain visual analog scale (VAS), Constant score (CS), American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV) were assessed. Results: The LTT group was significantly younger than the RSA group (59.6 ± 4.8 vs. 71.3 ± 3.7 years, P < 0.001). Preoperative forward flexion (FF) was higher in the LTT group than in the RSA group (108.6° ± 53.0° vs. 50.5° ± 39.0°). Both LTT and RSA significantly improved ROM, pain, and function. LTT demonstrated greater improvement in external rotation (ER) compared with RSA (39.3° ± 19.8° vs. 10.5° ± 17.6°, P < 0.001). RSA demonstrated greater improvement in FF compared with LTT (76.8° ± 41.4° vs. 32.1° ± 36.2°, P = 0.002). Pain VAS, CS, ASES, and SSV improvements from the preoperative baseline were similar between groups. Conclusions: Both LTT and RSA are effective treatment options for MIRCTs after failed rotator cuff-related surgery in patients with preserved glenohumeral joint surfaces. LTT may be preferable for younger patients with preserved preoperative FF seeking greater ER recovery, whereas RSA may be more suitable for patients with severe preoperative FF limitation or those ineligible for LTT.

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