Editorial Commentary : Arthroscopically Assisted Lower Trapezius Transfer: Promising Technique Still Searching for the Optimal Indications or Panacea for All Irreparable Rotator Cuff Tears?

Arthroscopic-assisted lower trapezius transfer (LTT) has gained in popularity as a technique to restore function and improve pain in large-to-massive irreparable posterosuperior rotator cuff tears. Surgeons who have adopted this technique have variable indications. While most agree that there is a limit of arthropathy, other factors appear to be contentious. Age, teres minor integrity, and degree of external rotation deficit remain debatable in terms of indications and contra-indications for LTT. The biomechanical narrative around LTT is sound and has been proven. Surgeons have recently raised questions as to whether an intact subscapularis is critical to avoid an imbalanced glenohumeral joint with LTT. There exists a variety of other surgical techniques for irreparable postero-superior cuff tears, including superior capsular reconstruction, muscle advancement (modified Debeyre-Patte procedure), and partial repair with long head of biceps tenotomy/tenodesis. Where does the LTT fit? Is it superior to the other techniques? What are the indications? Is a deficient subscapularis a contraindication. This editorial commentary will delve into these questions, but it is up to the reader to determine if there are any answers to be found.