Philipp Moroder1, Doruk Akgün2, Lucca Lacheta2, Kathi Thiele2, Marvin Minkus2, Nina Maziak2, Thilo Khakzad2, Christian Festbaum2, Katja Rüttershoff2, Sophia Ellermann2, Torsten Weiss3, Thomas Jöns3, Victor Danzinger2. 1. Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany. philipp.moroder@icloud.com. 2. Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany. 3. Department for Anatomy, Institute for Functional Anatomy, Center for Surgical-anatomical Training, Charité -Universitaetsmedizin Berlin, Berlin, Germany.
Abstract
PURPOSE: The purpose of this study was to investigate the anatomical feasibility of a middle trapezius transfer below the acromion for treatment of irreparable supraspinatus tendon tears. METHODS: This study involved 20 human cadaveric shoulders in 10 full-body specimens. One shoulder in each specimen was dissected and assessed for muscle and tendon extent, force vectors, and distance to the neurovascular structures. The opposite shoulder was used to evaluate the surgical feasibility of the middle trapezius transfer via limited skin incisions along with an assessment of range of motion and risk of neurovascular injury following transfer. RESULTS: The harvested acromial insertion of the middle trapezius tendon showed an average muscle length of 11.7 ± 3.0 cm, tendon length of 2.7 ± 0.9 cm, footprint length of 4.3 ± 0.7 cm and footprint width of 1.4 ± 0.5 cm. The average angle between the non-transferred middle trapezius transfer and the supraspinatus was 33 ± 10° in the transversal plane and 34 ± 14° in the coronal plane. The mean distance from the acromion to the neurovascular bundle was 6.3 ± 1.3 cm (minimum: 4.0 cm). During surgical simulation there was sufficient excursion of the MTT without limitation of range of motion in a retracted scapular position but not in a protracted position. No injuries to the neurovascular structures were noted. CONCLUSION: Transfer of the acromial portion of the middle trapezius for replacement of an irreparable supraspinatus seems to be feasible in terms of size, vector, excursion, mobility and safety. However, some concern regarding sufficiency of transfer excursion remains as scapula protraction can increase the pathway length of the transfer. LEVEL OF EVIDENCE: Basic Science Study/Anatomical Study.
PURPOSE: The purpose of this study was to investigate the anatomical feasibility of a middle trapezius transfer below the acromion for treatment of irreparable supraspinatus tendon tears. METHODS: This study involved 20 human cadaveric shoulders in 10 full-body specimens. One shoulder in each specimen was dissected and assessed for muscle and tendon extent, force vectors, and distance to the neurovascular structures. The opposite shoulder was used to evaluate the surgical feasibility of the middle trapezius transfer via limited skin incisions along with an assessment of range of motion and risk of neurovascular injury following transfer. RESULTS: The harvested acromial insertion of the middle trapezius tendon showed an average muscle length of 11.7 ± 3.0 cm, tendon length of 2.7 ± 0.9 cm, footprint length of 4.3 ± 0.7 cm and footprint width of 1.4 ± 0.5 cm. The average angle between the non-transferred middle trapezius transfer and the supraspinatus was 33 ± 10° in the transversal plane and 34 ± 14° in the coronal plane. The mean distance from the acromion to the neurovascular bundle was 6.3 ± 1.3 cm (minimum: 4.0 cm). During surgical simulation there was sufficient excursion of the MTT without limitation of range of motion in a retracted scapular position but not in a protracted position. No injuries to the neurovascular structures were noted. CONCLUSION: Transfer of the acromial portion of the middle trapezius for replacement of an irreparable supraspinatus seems to be feasible in terms of size, vector, excursion, mobility and safety. However, some concern regarding sufficiency of transfer excursion remains as scapula protraction can increase the pathway length of the transfer. LEVEL OF EVIDENCE: Basic Science Study/Anatomical Study.
Authors: Jacques Guery; Luc Favard; François Sirveaux; Didier Oudet; Daniel Mole; Gilles Walch Journal: J Bone Joint Surg Am Date: 2006-08 Impact factor: 5.284
Authors: Philipp Moroder; Aaron Chamberlain; Stefan M Gabriel; Marc C Jacofsky; Mehmet Z Sengun; David B Spenciner; John M Tokish; Lucca Lacheta Journal: Orthop J Sports Med Date: 2022-05-23