Massive irreparable rotator cuff tears are a difficult problem to treat. Previously described treatments such as debridement alone or in conjunction with partial repair with the goal of pain relief have been inconsistent at best and often do not address or improve functional deficiencies. The younger active patient population is often unwilling to accept the lifelong limitations imposed by reverse total shoulder arthroplasty. Thus, tendon transfer is the preferred treatment in this subset of patients with higher functional demands. Initially, the latissimus dorsi transfer was ubiquitously used to cover the defect and restore motion; however, more recent data have suggested that alternate transfers may be better suited to addressing the complex role of the rotator cuff in the multiplanar motions of the glenohumeral joint.

Although many transfers have been described, our preference is the lower trapezius (LT) transfer for posterosuperior rotator cuff tears and the latissimus dorsi (LD) to address anterior deficiency. The ipsilateral LT is harvested from the medial scapular spine, augmented with Achilles allograft, and inserted at the superior aspect of the infraspinatus footprint to restore external rotation (ER) and the posterior force couple of the rotator cuff. The anterior force couple is addressed with LD harvested from its humeral insertion and transferred to the superior aspect of the subscapularis footprint.