This study compares two joint-level treatments for massive irreparable rotator cuff tears without arthritis: arthroscopic-assisted lower trapezius tendon transfer and reverse shoulder arthroplasty. Using dynamic digital radiography, it measures scapulohumeral rhythm to see which surgery restores more native shoulder motion. The question: does joint preservation with tendon transfer keep kinematics closer to normal than arthroplasty?
When you have a nonarthritic massive irreparable cuff tear in a younger, active patient, joint preservation matters, and this paper gives a biomechanical reason to consider lower trapezius transfer. ALTT restored scapulohumeral rhythm into the native 2.2-2.7 range, while RSA sat lower at 1.8, meaning the arthroplasty shifts work onto the scapula.
That matters because higher scapulothoracic contribution raises glenohumeral joint forces, which the authors link to accelerated component loosening and shorter implant longevity in RSA. Think of the decision this way: an ER lag or Hornblower's sign with preserved subscapularis and healthy deltoid favors aLTT, while poor elevation and function favor RSA.
The key caveat for the study group: this is a basic science kinematic study with unmatched groups (RSA patients were older and more often female), and it does not prove that better SHR yields better pain or function. Treat it as biomechanical rationale, not outcome evidence.
Lower Trapezius Tendon Transfer vs.. Reverse Shoulder Arthroplasty for Massive Irreparable Rotator Cuff Tears: an In-Vivo Scapulohumeral Rhythm Dynamic Radiography Study
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This study compares two joint-level treatments for massive irreparable rotator cuff tears without arthritis: arthroscopic-assisted lower trapezius tendon transfer and reverse shoulder arthroplasty. Using dynamic digital radiography, it measures scapulohumeral rhythm to see which surgery restores more native shoulder motion. The question: does joint preservation with tendon transfer keep kinematics closer to normal than arthroplasty?
When you have a nonarthritic massive irreparable cuff tear in a younger, active patient, joint preservation matters, and this paper gives a biomechanical reason to consider lower trapezius transfer. ALTT restored scapulohumeral rhythm into the native 2.2-2.7 range, while RSA sat lower at 1.8, meaning the arthroplasty shifts work onto the scapula.
That matters because higher scapulothoracic contribution raises glenohumeral joint forces, which the authors link to accelerated component loosening and shorter implant longevity in RSA. Think of the decision this way: an ER lag or Hornblower's sign with preserved subscapularis and healthy deltoid favors aLTT, while poor elevation and function favor RSA.
The key caveat for the study group: this is a basic science kinematic study with unmatched groups (RSA patients were older and more often female), and it does not prove that better SHR yields better pain or function. Treat it as biomechanical rationale, not outcome evidence.