Reversal of Pseudoparalysis in Posterosuperior Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction vs Latissimus Dorsi Tendon Transfer vs Lower Trapezius Tendon Transfer

Background: Superior capsular reconstruction (SCR), latissimus dorsi tendon transfer (LDT), and lower trapezius tendon transfer (LTT) can be used to manage posterosuperior irreparable rotator cuff tears (PSIRTCs) with nonarthritic pseudoparalysis. However, no study has compared SCR, LDT, and LTT as joint-preserving treatment options for PSIRCTs with pseudoparalysis. Purpose/Hypothesis: This study aimed to compare the clinical and radiologic outcomes of SCR, LDT, and LTT in PSIRCTs with nonarthritic pseudoparalysis. It was hypothesized that LTT would be the most effective joint-preserving treatment option for PSIRCTs with pseudoparalysis. Study Design: Retrospective case-control study; Level of evidence, 3. Methods: A retrospective review was conducted of 59 patients with PSIRCTs who had nonarthritic pseudoparalysis and underwent surgical treatment between January 2014 and December 2020. The cohorts consisted of 19 patients who underwent SCR, 16 patients who underwent LDT, and 20 patients who underwent LTT. Pseudoparalysis was defined as forward elevation (FE) remaining <90° after pain was alleviated with a lidocaine injection. Because the best joint-preserving technique is defined by the reversal of pseudoparalysis, the primary outcome was the reversal rate of pseudoparalysis. Secondary clinical outcomes were assessed by visual analog scale score, patient-reported outcome measurements (PROMs), active range of motion (aROM), and muscle strength. Radiologic outcomes were evaluated by the progression of osteoarthritic change and graft integrity. All clinical and radiologic outcomes were compared between the preoperative evaluation and the 4-year postoperative evaluation. Results: In postoperative PROMs and aROM including abduction (ABD) and external rotation (ER), and muscle strength of FE, ABD, and ER, a statistically significant difference was found between the 3 groups, and the LTT group showed the most favorable outcomes among the 3 groups. Although postoperative mean FE did not show a significant difference among the 3 groups, the reversal rate of pseudoparalysis of the LTT group (90.0%) was significantly highest among the 3 groups (SCR group 52.6%; LDT group 68.7%; P = .014), indicating that LTT was the most effective method to reverse pseudoparalysis. The LDT group showed the highest rate of progression of osteoarthritic change, and the SCR group showed the highest rate of graft retear. Conclusion: Although SCR, LDT, and LTT all demonstrated significant improvements in clinical outcomes for patients with PSIRCTs and nonarthritic pseudoparalysis, LTT tended to show the most favorable results in terms of PROM, aROM, muscle strength, and reversal rate of pseudoparalysis. This may be attributed to the biomechanical advantages of LTT in restoring force coupling and counterbalancing the deltoid muscle. Therefore, LTT could be considered a preferred treatment option for PSIRCTs with nonarthritic pseudoparalysis.