Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Apr;17(4):93-100.
doi: 10.1007/s12178-024-09885-z. Epub 2024 Jan 31.

Lower Trapezius Transfer for Irreparable Posterosuperior Rotator Cuff Tears

Joaquin Sanchez-Sotelo  1
Affiliations
Review

Lower Trapezius Transfer for Irreparable Posterosuperior Rotator Cuff Tears

Joaquin Sanchez-Sotelo. Curr Rev Musculoskelet Med. 2024 Apr.

Erratum in

Abstract

Purpose of review: Functionally irreparable posterosuperior rotator cuff tears (FIRCT) represent a substantial source of morbidity for many patients. Several surgical options can be considered for the salvage of FICRTs. Transfer of the tendon of the lower trapezius to the greater tuberosity, originally described for surgical management of the paralytic shoulder, has emerged as an attractive option, particularly for patients with external rotation lag and those looking for strength restoration. The purpose of this publication is to review the indications, surgical technique, and reported outcomes of this procedure.

Recent findings: Lower trapezius transfer (LTT) to the greater tuberosity in patients with irreparable posterosuperior rotator cuff tears has been reported to be associated with satisfactory outcomes and low reoperation rates. It seems to be particularly effective in improving external rotation motion and strength, even when the teres minor is involved. In patients with a reparable infraspinatus, minimal fatty infiltration, and an intact teres minor, the outcome of LTT may be similar to that of superior capsule reconstruction (SCR), but LTT is more beneficial otherwise. The hospital cost of LTT has been reported to be less than the cost of SCR and equivalent to the cost of reverse arthroplasty. When reverse arthroplasty has been performed after a failed LTT, the outcome and complication rates do not seem to increase. LTT provides satisfactory outcomes for many patients with a posterosuperior FIRCT, particularly when they present preoperatively with an external rotation lag sign, involvement of the teres minor, or a desire to improve strength.

Keywords: Lower trapezius transfer; Rotator cuff tear; Tendon transfer.

PubMed Disclaimer

Conflict of interest statement

Dr. Sanchez-Sotelo receives royalties and consulting fees from Stryker, consulting fees from Acumed, and consulting fees from Exactech. Dr. Sanchez-Sotelo also receives publishing royalties from Elsevier and Oxford University Press. Other potential conflicts of interest include stock options in Orthobullets, PSI, and Precision OS, as well as honorarium from Journal of Shoulder and Elbow Surgery.

Figures

Fig. 1
Fig. 1
The ideal candidates for LTT are patients with a posterosuperior FIRCT, lack of active external rotation (A), and advanced fatty infiltration with involvement of the teres minor (B)
Fig. 2
Fig. 2
The patient is placed in the beach-chair position with the arm in a dedicated sterile arm holder and the surgical field prepared and draped medial to the medial border of the scapula. The black dashed lines represent the location of the spine and medial border of the scapula. The blue line represents the location of the skin incision
Fig. 3
Fig. 3
A The tendon of the lower trapezius is detached from the spine of the scapula and divided from the middle trapezius. B Subcutaneous dissection superficial to the lower trapezius may provide additional excursion
Fig. 4
Fig. 4
Preparation of the Achilles tendon allograft in the back table placing two nonabsorbable sutures in a running locking fashion
Fig. 5
Fig. 5
A Schematic demonstrates the fixation strategy for the Achilles tendon to the greater tuberosity. B Arthroscopic photograph from a lateral viewing portal demonstrates fixation of the Achilles allograft
Fig. 6
Fig. 6
A The allograft pierces the lower trapezius in a Pulvertaft fashion. B Completed tendon to allograft repair
See this image and copyright information in PMC

References

    1. Yanik EL, Chamberlain AM, Keener JD. Trends in rotator cuff repair rates and comorbidity burden among commercially insured patients younger than the age of 65 years, United States 2007–2016. JSES Rev Rep Tech. 2021;1(4):309–16. - PMC - PubMed
    1. Jensen AR, Taylor AJ, Sanchez-Sotelo J. Factors influencing the reparability and healing rates of rotator cuff tears. Curr Rev Musculoskelet Med. 2020;13(5):572–83. doi: 10.1007/s12178-020-09660-w. - DOI - PMC - PubMed
    1. Burnier M, Elhassan BT, Sanchez-Sotelo J. Surgical management of irreparable rotator cuff tears: what works, what does not, and what is coming. J Bone Joint Surg Am. 2019;101(17):1603–12. doi: 10.2106/JBJS.18.01392. - DOI - PubMed
    1. Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK. Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am. 2013;95(21):1920–6. doi: 10.2106/JBJS.M.00122. - DOI - PubMed
    1. Elhassan BT, Wagner ER, Werthel JD. Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. J Shoulder Elbow Surg. 2016;25(8):1346–53. doi: 10.1016/j.jse.2015.12.006. - DOI - PubMed