Lower Trapezius Transfer Maintains Meaningful Outcomes at 5 Years Based on Procedure‐Specific Minimal Clinically Important Difference and Patient Acceptable Symptom State Achievement
Chang Hee Baek, Jung Gon Kim, Bo Taek Kim, Chaemoon Lim, Seung Jin KimPurpose
To quantify patient‐reported outcomes at 5 years after arthroscopic‐assisted lower trapezius tendon transfer irreparable posterosuperior rotator cuff tears and to establish procedure‐specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds.
Methods
From 2017 to 2019, we retrospectively reviewed consecutive lower trapezius tendon transfer cases for irreparable posterosuperior tears with a minimum 5‐year follow‐up. Patient‐reported outcome measures (PROMs) (American Shoulder and Elbow Surgeons [ASES] score, Constant‐Murley, Activities of Daily Living and External Rotation [ADLER] score, visual analog pain scale [VAS]) were collected pre‐ and postoperatively. MCIDs were calculated by a distribution‐based approach (.5 SD), and PASS thresholds were derived by receiver operating characteristic‐Youden for PROMs with acceptable discrimination (area under the curve (AUC) > .70). Associations of age, sex, body mass index, diabetes, hypertension, and teres‐minor trophicity with MCID/PASS attainment were evaluated.
Results
We analyzed 34 shoulders (23 men/11 women; mean age 63.5 ± 5.5 years) at a mean 76.5 ± 5.7 months (range, 65‐89). MCID thresholds were ASES 8.2 (79.4%), Constant 7.4 (70.6%), ADLER 3.0 (76.5%), and VAS 3.0 (70.6%). AUC values were as follows: ASES .97 (95% CI, .92‐1.00), Constant .72 (.48‐.91), ADLER .74 (.54‐.91), and VAS .70 (.54‐.92). PASS thresholds were ASES ≥ 83 (61.8%), Constant ≥ 73 (41.2%), and ADLER ≥ 28 (61.8%); VAS showed borderline discrimination and was not retained for PASS reporting. Higher teres minor trophicity correlated with ADLER MCID ( ρ = −.743, P < −.001) and PASS ( ρ = −.649, P < −.001). Younger age correlated with ASES PASS ( ρ = −.427, P = .012) and Constant PASS ( ρ = −.504, P = .002). Sex and comorbidities were not associated.
Conclusions
Arthroscopic‐assisted lower trapezius tendon transfer yielded durable, clinically meaningful improvement at least 5 years, and procedure‐specific MCID and PASS thresholds were established for ASES, Constant‐Murley, and ADLER. Preoperative trophicity of the teres minor was a significant predictor of PASS achievement.
Level of Evidence
Level IV, therapeutic retrospective cohort study.