This case series reports outcomes of lower trapezius transfer prolonged with Achilles tendon allograft for massive irreparable posterior-superior rotator cuff tears. All 33 patients had ≥2 irreparable tendon tears with Goutallier III-IV fatty atrophy. The study asks whether this transfer restores pain relief and shoulder function in younger active patients.
When you see a young active patient with an irreparable posterior-superior cuff tear (≥2 tendons, retraction to the glenoid, Goutallier III-IV) who has failed conservative care and does not want a reverse arthroplasty, the lower trapezius transfer is a functional reconstruction option.
The biomechanical argument is worth memorizing: the lower trapezius origin sits just medial to the infraspinatus fossa, so its line of pull mimics the infraspinatus better than the latissimus dorsi. It also has the largest external rotation moment arm of the transfer options.
Unlike the latissimus, it stabilizes rather than inferiorly subluxes the head, so partial subscapularis insufficiency is not a contraindication. Use preoperative flexion to counsel patients: those above 60° gain the most, while external rotation improves in nearly everyone. Remember this is Level IV evidence with no control group, so the comparison to latissimus transfer remains unsettled.
This case series reports outcomes of lower trapezius transfer prolonged with Achilles tendon allograft for massive irreparable posterior-superior rotator cuff tears. All 33 patients had ≥2 irreparable tendon tears with Goutallier III-IV fatty atrophy. The study asks whether this transfer restores pain relief and shoulder function in younger active patients.
When you see a young active patient with an irreparable posterior-superior cuff tear (≥2 tendons, retraction to the glenoid, Goutallier III-IV) who has failed conservative care and does not want a reverse arthroplasty, the lower trapezius transfer is a functional reconstruction option.
The biomechanical argument is worth memorizing: the lower trapezius origin sits just medial to the infraspinatus fossa, so its line of pull mimics the infraspinatus better than the latissimus dorsi. It also has the largest external rotation moment arm of the transfer options.
Unlike the latissimus, it stabilizes rather than inferiorly subluxes the head, so partial subscapularis insufficiency is not a contraindication. Use preoperative flexion to counsel patients: those above 60° gain the most, while external rotation improves in nearly everyone. Remember this is Level IV evidence with no control group, so the comparison to latissimus transfer remains unsettled.