Lower Trapezius Tendon Transfer With Achilles Allograft After Failed Repair of Full-Thickness Supraspinatus and Infraspinatus Tears: A Case Report

BACKGROUND: Massive and degenerative rotator cuff tears can lead to high failure rates with limited treatment options for younger, more active individuals. CASE PRESENTATION: A 49-year-old high-functioning male presented with irreparable full-thickness tears of the supraspinatus and infraspinatus following a failed prior repair. This case report presents a physical therapy protocol aimed at optimizing shoulder mechanics and restoring function following a lower trapezius tendon transfer, with Achilles tendon allograft augmentation. OUTCOME AND FOLLOW-UP: At eight months postoperative, the patient reported excellent functional recovery with no limitations in daily activities. The patient reported mild subjective overhead strength deficits; however, functionally adequate strength was demonstrated. The patient reported no pain, scapular instability, or dyskinesis. DISCUSSION: Individualized, criterion-based rehabilitation emphasizing scapular control, progressive loading, and neuromuscular retraining facilitated excellent recovery after lower trapezius tendon transfer with Achilles allograft, despite delayed physical therapy and complex prior surgical history.