Lower Trapezius Transfer Using the Retrograde Keyhole Technique With an Achilles Tendon-Bone Allograft

For patients with irreparable rotator cuff tears and no arthritis progression, various treatment options can be considered, one of which is tendon transfer. In particular, latissimus dorsi transfer has conventionally been used for posterior-superior irreparable rotator cuff tears and is regarded as the standard procedure. Since lower trapezius transfer was first introduced in 2009, it has resulted in significant improvements in pain relief, range of motion, and functional scores. However, various complications have also been reported, with graft failure occurring in approximately 20% of cases, predominantly at the greater tuberosity. To address these issues, we describe a lower trapezius transfer using the retrograde keyhole technique with an Achilles tendon-bone allograft. This technique involves creating a keyhole along the biceps groove to insert the allograft bone plug and promote bone-to-bone healing for enhanced fixation strength, which is expected to reduce failure rates. To date, short-term follow-up results have shown resolution of the external rotation lag sign and improvements in range of motion, suggesting promising outcomes.