Lower trapezius transfer with Achilles tendon graft tear

Status post arthroscopically-assisted lower trapezius tendon transfer with Achilles tendon allograft, performed 10 months ago. PatientThe patient now presents with increased pain and difficulty with an active forward elevation of the arm above 90 degrees.

Lower trapezius transfer with Achilles tendon augmentation is used to treat patients with irreparable posterosuperior rotator cuff tears, or for those with shoulder paralysis which impedes external rotation¹. This surgery uses the Achilles tendon to attach the lower trapezius tendon to the greater tuberosity of the humerus.

Promising clinical and radiographic outcomes have been seen for this surgery in functionally irreparable rotator cuff tears². Candidacy for this technique requires intact or reparable subscapularis tendon, no advanced glenohumeral arthritis, and no humeral head femoralisation.

This is the first reported case of Achilles tendon graft retraction from a lower trapezius transfer, proven on imaging. In our patient, the cause for lower trapezius transfer graft failure is unknown; there was no history of trauma. The patient is scheduled for right reverse total shoulder arthroplasty.

Case co-contributor: Jason Lee (Loyola University).

CT of the right shoulder shows severe atrophy of the infraspinatus muscle. There is a thick linear hyperdense structure overlying the atrophied infraspinatus muscle which represents the Achilles tendon allograft. This is at the level of the inferior border of the scapular spine. Medially, this graft is contiguous with the native trapezius tendon. Laterally, this extends towards the posterior aspect of the humeral head. There are 3 suture anchors in the region of the greater tuberosity. A cortical endobutton in the proximal humeral diaphysis is related to biceps tenodesis. There is superior migration of the humeral head, best seen onin the coronal images. Postsurgical changes of subacromial decompression and acromioplasty are also noted.