Skip to main content

Table 3 Summarizes technical differences of currently reported technique of middle trapezius tendon transfer from that of Moroder et al.; AC acromio-clavicular, GH gleno-humeral, ISP infraspinatus, RC rotator cuff, SSP supraspinatus

From: Rotator cuff irreparability or failure of repair (re-tear): technical note on middle trapezius tendon transfer for reproduction of supraspinatus function

Technical Difference Current technique Technique of Moroder et al
Decubitus Beach-chair prone
Anatomic landmarks Medial half of scapular spine Clavicle, AC joint, acromion, and scapular spine
Approach for trapezius harvesting 5 cm skin incision over and parallel to medial half of the scapular spine 5 cm skin incision parallel to anterior border of the spino-acromial junction.
Released insertion of middle trapezius Medial half of its scapular-spine insertion (via sub-periosteal dissection) Acromial (lateral) insertion
(via sub-periosteal dissection)
Extensile harvesting of middle trapezius Feasible (in lateral direction)
*Medially: limited by spinal accessory nerve
Feasible (in medial direction)
*Laterally: limited by AC joint
Split of fleshy middle trapezius Oblique split (along its fibers), (for 5 cm) Longitudinal split, (for 3 cm)
Release of fleshy middle trapezius from underlying SSP Blunt dissection (finger sweeping)
Preparation of released tendon Sutured (in Pulvertaft/side-to-side fashion) to hamstring sheet Sutured (in Krakow fashion)
Interposed tendon graft Fashioned hamstring sheet Not used (directly re-attaching transferred tendon to footprint of excised SSP)
Corridor of transferred tendon Sub-trapezius/sub-acromial Sub-acromial
Fixation method to RC footprint Hamstring sheet is sutured to RC (SSP+/−ISP) footprint via trans-osseous sutures; and also, to repaired RC via direct suturing Free limbs of Krakow sutures are passed within trans-osseous tunnels in RC (SSP) footprint
Reproduction of SSP anatomic attachment
To its footprint
Feasible (via double-row/suture-bridge re-attachment of flattened periosteal end of hamstring sheet to SSP footprint)
Scapular/GH position during reconstruction Retracted scapula & 45O-abduction/ 45O-external rotation of GH joint Retracted scapula
Room for gliding motion of the tendon reconstruct SSP fossa & SSP outlet SSP outlet
Mechanical block of the tendon reconstruct Reported in protracted-scapular position
AC joint injury Potential risk
Force vector of the transferred tendon Horizontally-oriented (medially-directed) Vertically-oriented