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
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 (superiorly-directed) |