Arthroscopic Lower Trapezial Transfer for Irreparable Rotator Cuff Tears

Abstract

Irreparable rotator cuff tears are challenging in the young, active, high-demand patient with limited degenerative changes. The goal of treating irreparable rotator cuff tears is to re-establish the transverse and coronal force couples in an effort to balance the glenohumeral joint. Tendon transfer surgery is a viable option in patients desiring not only pain relief, but also for improvements in range of motion, strength, and function. Isolated posterosuperior tears can effectively be addressed with a lower trapezius tendon transfer. The procedure has the ability to reverse external rotation pseudoparalysis with restoration of strength. An arthroscopically assisted lower trapezius tendon transfer has recently been described and is the senior author's Bassem T. Elhassan (B.T.E.) preferred technique to address irreparable posterosuperior rotator cuff tears. The advantages of the arthroscopically assisted compared to the open technique are its less invasive nature, which decreases the risk of hematoma and seroma, speeds recovery, and avoids the need for an acromial osteotomy or detachment of the deltoid muscle. Nonetheless, a thorough understanding of the anatomy around the shoulder girdle, sufficient arthroscopic skill, and careful patient selection are imperative for optimizing outcomes.