Secondary Middle Trapezius Tendon Transfer After Failed Rotator Cuff Repair Achieves Outcomes Comparable to Primary Transfer

Purpose To evaluate and compare the clinical and functional outcomes of primary middle trapezius tendon (MTT) transfer in patients without prior shoulder surgery with those of secondary MTT transfer in patients with failed supraspinatus repair. Methods This retrospective study included patients who underwent MTT transfer between December 2019 and September 2023. Inclusion criteria comprised irreparable supraspinatus tears with high fatty infiltration and minimal or no glenohumeral arthritis. Patients with follow‐up loss and incomplete data were excluded. All clinical outcomes were assessed preoperatively and at the final follow‐up. Clinical outcomes included visual analog scale, Constant, American Shoulder and Elbow Surgeons, University of California Los Angeles, and University of California Los Angeles scores, along with assessments of active range of motion and strength. Radiologic outcomes included acromiohumeral distance and tendon integrity. Between‐group comparisons were performed using independent tests, while categorical variables were compared using χ 2 or Fisher's exact tests. Results After excluding 3 patients, 53 were analyzed (primary, n = 39; secondary, n = 14). The mean age was 62.7 ± 5.9 and 64.1 ± 6.0 years ( P = .427), with a mean follow‐up of 41.4 ± 13.9 and 34.7 ± 13.6 months, respectively ( P = .124). Both groups showed significant improvements in clinical outcome, range of motion, and strength ( P < .001). Direct comparison between groups revealed no significant differences in any outcome measure. Minimal clinically important difference achievement rates for functional outcomes were high in both groups, with Constant scores (94.9% vs 100%, P = .397), University of California Los Angeles scores (94.9% vs 100%, P = .397), and American Shoulder and Elbow Surgeons scores (94.9% vs 92.8%, P = .785) showing no significant differences between the primary and secondary MTT groups. Postoperative magnetic resonance imaging showed preserved tendon integrity in most patients, with intact tendons in 97.4% of the primary MTT group and 92.8% of the secondary MTT group ( P = .450), with 1 retear observed in the secondary group. Complications included 1 retear and 1 infection in the secondary group and 1 progression to cuff tear arthropathy in the primary group, with no significant between‐group differences. Conclusions MTT transfer resulted in significant improvements in pain, shoulder function, and range of motion in patients with irreparable supraspinatus tears, regardless of prior rotator cuff surgery. Both the primary and secondary MTT groups showed comparable postoperative improvements in American Shoulder and Elbow Surgeons, Constant, University of California Los Angeles, and University of California Los Angeles scores, as well as active forward elevation and abduction, with no significant differences in clinical outcomes between groups. Level of Evidence Level IV, retrospective case series.