Title : Arthroscopically Assisted Lower Trapezius Transfer: Surgical technique and implications for rehabilitation
Abstract:
The prevalence of rotator cuff pathology is high and increasing with our aging populations. Many surgical options have been described to manage the difficult clinical presentation of massive irreparable rotator cuff tears. Recently, Arthroscopic Assisted Lower Trapezius Transfer (aaLTT) has shown great promise and rapidly growing popularity among Orthopaedic Surgeons world-wide. This procedure helps restore the glenohumeral force couple balance, and therefore works best with an intact and/or repairable subscapularis tendon. In addition to addressing associated pathology during initial arthroscopy, this technique affords the benefits of a minimally invasive approach, with less soft tissue dissection and therefore less post operative pain and bleeding.
This presentation will summarize the appropriate clinical triage for patients with symptomatic irreparable rotator cuff tears which have failed non-operative management, and specifically which clinical features make a patient ideal for aaLTT versus the many other surgical alternatives. Using a cognitive task analysis approach, the individual steps of the surgical technique will be reviewed. This step-by-step surgical technique review will incorporate intra-operative images and video to help illustrate the anatomy and pathology, adding to the unique tissue and biomechanical understanding of appropriate rehabilitation protocols after this procedure.
A cooperative relationship between surgeon and physiotherapist is critical to the common goal of improved patient outcomes. The insight gained by observing this complex surgical procedure can inform the best evidence-based approach to rehabilitation protocols development. surgical technique A surgical technique astute understanding of the surgical procedure will empower the therapist collaboratively modify protocol when required in consultation with the surgeon.
Audience Take Away:
- Learn the definition of a massive irrepairable rotator cuff tear
- Understand the clinical indications for an aaLTT surgery
- Unique access “in the OR” to observe the detailed step-by-step surgical technique for the aaLTT procedure, which is becoming increasingly popular
- Appreciate the tissue and biomechanical implications of aaLTT for an appropriate rehabilitation protocol
- Understand how surgeon and physiotherapist can cooperate to provide the best evidence -based protocols for early post operative brace immobilization and subsequent phased surgical rehabilitation
