The rotator cuff is essential for dynamic concentric compression of the glenohumeral joint (GHJ). Irreparable rotator cuff tear (RCT) is a complex and frustrating condition that affects patients' quality of life and function and Leads to a painful shoulder. A lower trapezius tendon transfer is an evolving technique that has shown promising results; it improves patients' function and range of motion and reduces pain. This video will demonstrate our approach for arthroscopic-assisted lower trapezius transfer for massive irreparable rotator cuff tear.

52 -year-old patient, male, right hand dominant, non-smoker, works as a painter, complained of persistent right shoulder pain and limitation of movement. His exam revealed Active forward elevation 140, Passive external rotation 40 with 20 degrees external rotation lag. Passive internal rotation T10, weakness of forward elevation 4/5, and external rotation 3/5. Massive retracted RCT was confirmed in MRI with fatty infiltration and positive tangent sign. After the failure of non-surgical treatment, lower trapezius transfer was done.

This video demonstrates a simplified six steps to achieve arthroscopic-assisted lower trapezius transfer. The patient is positioned in a beach chair with an arm holder. Prep and drape about 2 cm medial to the scapular edge, Achilles tendon, and four suture anchors were used to achieve stable fixation. Saw bone was used to illustrate anchor insertion and locations.

Postoperatively the patient was held in an external rotation sling for 6-8 weeks. At eight weeks, we started passive and assisted active range of motion. Isometric strengthening of peri-scapular muscle, deltoid, and rotator cuff was begun at 12 weeks. At six months, no limitations.

In conclusion, This video shows a reliable technique of arthroscopic-assisted lower trapezius transfer using achilles tendon allograft.