Arthroscopy-Assisted Lower Trapezius Transfer Using Long Head of Biceps Tendon Autograft as an Interposition Graft for Massive Irreparable Rotator Cuff Tears (LHBT)

Inclusion Criteria :

• symptomatic massive posterosuperior rotator cuff tear (involving ≥2 tendons and/or ≥5 cm in the anteroposterior dimension) confirmed by MRI
• Tear confirmed intraoperatively as irreparable despite maximal mobilization (medialized footprint repair not feasible)
• Intact or repairable subscapularis tendon
• Intact deltoid muscle function
• Failure of at least 3-6 months of conservative treatment (physiotherapy, analgesics, activity modification) or prior failed rotator cuff repair
• Preoperative active or passive forward elevation ≥ 0°-30° (i.e., not a pseudoparalytic shoulder with fixed loss of elevation, per surgeon's assessment) - to be defined per the surgical team's operative criteria
• Available and functioning lower trapezius muscle and long head of biceps tendon on preoperative examination/imaging
• Patient willing and able to comply with the postoperative rehabilitation protocol and scheduled follow-up visits

Exclusion criteria :

• Advanced glenohumeral osteoarthritis (Hamada grade ≥ 3)
• Irreparable subscapularis tear or anterosuperior tear pattern
• Deltoid dysfunction, paralysis, or previous deltoid detachment
• Lower trapezius dysfunction, atrophy, or prior denervation (e.g., spinal accessory nerve injury)
• Long head of biceps tendon absent, previously ruptured, or already tenotomized/tenodesed
• Axillary nerve palsy or brachial plexus injury
• Active glenohumeral or periprosthetic infection
• Uncontrolled systemic disease precluding surgery (e.g., uncontrolled diabetes mellitus, severe cardiopulmonary disease)
• Inflammatory arthropathy of the shoulder
• Previous ipsilateral shoulder arthroplasty
• Patients unable or unwilling to give informed consent or to comply with follow-up