Arthroscopic-assisted lower trapezius tendon transfer for irreparable rotator cuff tears

Posted on: September 2nd, 2025 by Our Team

Arthroscopic-assisted lower trapezius tendon transfer (A-LTTT) is an advanced reconstructive option for younger, active patients with irreparable posterosuperior rotator cuff tears that do not respond to non-operative care. The procedure restores a more normal line of pull for external rotation and elevation by mobilizing the lower trapezius tendon and bridging it to the greater tuberosity—most commonly with an Achilles tendon allograft—using arthroscopic guidance to minimize soft-tissue disruption.

Candidate selection focuses on patients with persistent pain and dysfunction, objective deficits in external rotation strength, and imaging that confirms an irreparable tear with retraction or fatty degeneration. Intact or reparable subscapularis, preserved joint cartilage, and goals that include overhead or athletic activity favor tendon transfer over salvage procedures. In these scenarios, A-LTTT can restore force coupling of the shoulder more effectively than partial repair alone.

Early and mid-term outcome studies report meaningful pain reduction, improvements in range of motion—particularly external rotation—and high rates of early healing on postoperative MRI within the first six months, supporting graded rehabilitation and return to work or sport over subsequent months. Recent systematic and cohort reports from 2024–2025 corroborate durable functional gains with arthroscopic-assisted techniques.

Key risks include tendon or graft failure, stiffness, hardware irritation, and neurovascular injury during the scapular harvest. Careful attention to the surgical anatomy—especially the course of the spinal accessory nerve near the medial scapular border—helps mitigate these risks.

Dr. Daniel Kaplan evaluates candidacy for A-LTTT as part of a comprehensive approach to shoulder preservation in Brooklyn and NYC. Consultation includes detailed imaging review, discussion of alternatives (such as superior capsular reconstruction or latissimus dorsi transfer), and a rehabilitation plan tailored to the patient’s activity goals.