A survey of surgical technique preferences for lower trapezius tendon transfer for functionally irreparable rotator cuff tears

Background: Lower trapezius tendon transfer (LTT) has emerged as a promising surgical option for addressing deficits after functionally irreparable rotator cuff tears; however, there is limited consensus regarding the optimal technique used for this procedure. Methods: An anonymous 19-item survey was distributed to practicing shoulder and sports medicine surgeons. Questions covered demographics and preferences for LTT, such as indications, surgical technique, and postoperative rehabilitation protocols. Results: The survey had 39 total respondents, with 25 completing the entire survey and reporting experience with LTT in clinical practice. Most were self-taught (72%) and perform LTT with arthroscopic assistance (96%) in the beach chair position (80%), using an Achilles tendon allograft (95%) fixed initially to the tuberosity (100%) using a double-row anchor technique (80%). Significant variability was seen in respondents' contraindications, use of local tissue, and rehabilitation protocols. Conclusion: Substantial variability in technique preferences exists in modern clinical practice, which should be considered when interpreting results across different case series, as there are clearly different indications, surgical techniques, and rehabilitation approaches from surgeon to surgeon. Variability should be recognized as a positive sign of innovation in a nascent procedure, where further research is needed to identify best practices that can optimize patient outcomes.