Techniques for lower trapezius tendon transfer for the management of irreparable posterosuperior rotator cuff tears

Irreparable posterosuperior rotator cuff tears are a challenging treatment problem. Several tendon transfers have been described for the treatment of irreparable tears. Recently the lower trapezius (LT) tendon transfer has grown in popularity. This procedure has shown promise in biomechanical studies, improving the external rotation moment arm at the side. This transfer may be done in several ways, including an open approach with an acromial osteotomy, mini-open, and arthroscopic-assisted. The purpose of this paper is to review the current evidence and rationale for the use of the LT transfer and to describe the available techniques. •The LT transfer improves external rotation in the adducted position.•TMay be performed via open approach (acromial osteotomy), mini-open, or arthroscopic-assisted.•Accessory nerve most at risk with dissection 2 cm medial to the medial scapular border.•Achilles tendon allograft commonly used