Check out Dr. Garcia’s technique for lower trapezius transfer, one of the first performed in Washington State.

This video features Dr. Grant Garcia demonstrating an arthroscopic-assisted lower trapezius transfer using an Achilles tendon allograft. This highly advanced procedure is indicated for active patients with massive, irreparable posterosuperior rotator cuff tears who suffer from severe weakness in external rotation. In this specific case, the patient had previously failed a superior capsular reconstruction (SCR), making this a complex revision surgery.

The lower trapezius muscle is transferred because its line of pull closely mirrors that of the native infraspinatus muscle, allowing it to effectively restore external rotation power and shoulder centration.

The procedure is executed through the following key steps:

• Lower Trapezius Isolation: With the patient in a beach chair position, a 5 cm incision is made along the medial scapular border. Dr. Garcia identifies the lower trapezius, detaches it from the scapular spine, tags the tendonous base, and carefully avoids damage to the underlying infraspinatus muscle belly.
• Graft Preparation: On the back table, an Achilles tendon allograft is prepped using a Krakow whip-stitch fashion on both ends. One end is heavily marked for orientation so that its spatial alignment is known before it is pulled into the joint space.
• Revision Space Preparation: Arthroscopically, Dr. Garcia navigates the joint, removes scarred material and bio-composite anchors from the failed SCR, and uses a radiofrequency (RF) wand to release dense scar tissue and fascial bands around the infraspinatus access point. He uses his finger to dilate the path from the open posterior incision into the arthroscopic space.
• Graft Passing & Humeral Fixation: A large tendon clamp is passed through an anterolateral portal to grasp the allograft sutures and pull the Achilles tendon into the joint. Dr. Garcia anchors the graft to the greater tuberosity of the humerus using three knotless SwiveLock anchors (punching right through the old anchor holes). The final posterior anchor utilizes a luggage-tag stitch cinched around the graft to widen the footprint of compression. This graft acts as a humeral head suppressor and a tuberoplasty to stabilize the joint.
• Tendon-to-Tendon Weave: Turning back to the open incision, the shoulder is placed in maximum abduction and external rotation. Dr. Garcia splits the Achilles allograft and intricately weaves it into the pre-whip-stitched native lower trapezius tendon using multiple figure-of-eight stitches under high tension.

The intraoperative check ensures excellent structural hold and good tendon excursion. Post-operatively, the patient is placed in a specialized "gunslinger" brace for six weeks to protect the newly transferred muscle-tendon construct.