Lower Trapezius Tendon Transfer Using Achilles Tendon Allograft Effectively Restores Function After Failed Superior Capsular Reconstruction.

Purpose: To evaluate the clinical outcomes of lower trapezius tendon (LTT) transfer using an Achilles tendon allograft in patients with failed superior capsular reconstruction (SCR). Methods: A retrospective therapeutic review was conducted on patients who underwent LTT transfer using an Achilles tendon allograft after SCR failure between January 2018 and May 2020. The inclusion criteria encompassed both structural and functional failures of SCR in patients with minimal glenohumeral arthritis and a minimum follow-up of 2 years. Exclusion criteria were insufficient clinical data or loss to follow-up. Clinical outcomes were assessed preoperatively and at final follow-up using the visual analog scale (VAS), subjective shoulder value (SSV), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM). Results: Eighteen patients were included, with a mean follow-up of 42.5 months (range: 24-62 months). All outcome measures demonstrated statistically significant improvement: VAS scores improved from 5.9 ± 1.3 to 1.8 ± 1.4; SSV scores improved from 18.0 ± 9.1 to 61.4 ± 18.5; Constant score improved from 33.3 ± 5.3 to 65.5 ± 17.4; and ASES score improved from 38.5 ± 5.2 to 67.1 ± 17.7 (all P < .001). On the basis of the minimal clinically important difference (MCID) using a 0.5 SD distribution-based method, clinically meaningful improvements were observed in 88.9% of patients for VAS and ASES scores, and 94.4% for Constant and SSV scores. ROM gains included forward elevation (73° to 120°), abduction (57° to 93°), and external rotation (-22° to 40°). At final follow-up, 77.8% of patients had resumed occupational activities, and 61.1% returned to sports. Four patients (22.2%) required conversion to reverse shoulder arthroplasty. Conclusions: LTT transfer using an Achilles tendon allograft following failed SCR yields significant improvements in pain relief, functional outcomes, and ROM. LTT transfer using an Achilles tendon allograft following failed SCR may offer a potential treatment option, particularly in younger, active patients who seek to preserve native shoulder anatomy and function. Level of Evidence: Level IV retrospective case series.