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Background: Lower trapezius tendon (LTT) transfer has demonstrated promising results for patients with posterosuperior irreparable rotator cuff tears (PSIRCTs). However, there has been no study evaluating return to work (RTW) and return to sports (RTS) after LTT transfer., Purpose/hypothesis: The purpose of this study was to assess the rates of RTW and RTS and identify associated factors among patients who have undergone LTT transfer for PSIRCTs. It was hypothesized that LTT transfer would result in favorable functional outcomes and high rates of RTW and RTS., Study Design: Case series; Level of evidence, 4., Methods: A retrospective review was conducted on patients who underwent LTT transfer for symptomatic PSIRCTs with minimal glenohumeral arthritis. The clinical assessment included patient-reported outcome measures, testing of active range of motion, and a radiological evaluation of arthritis. Patients were surveyed on occupation, sports activity, RTW or RTS status, time to return, and degree of resumption of previous work and sports levels. Exclusion criteria included a follow-up period of <1 year, revision surgery, postoperative infections, loss to follow-up, and unavailability of data., Results: A total of 110 patients (mean age, 63.0 ± 6.9 years; mean follow-up, 35.3 ± 15.7 months) were included. Clinical scores and active range of motion significantly improved at the final follow-up, with no significant differences between the different work levels. For RTW, 93.6% (n = 103) returned to work (63.1% completely, 36.9% partially), with a mean time to return of 5.2 ± 1.7 months; 6.4% (n = 7) did not return. Patients with lighter work levels had higher return rates and quicker times to return than those with heavier work levels. For RTS, 90.7% (n = 86) returned to sports (70.5% completely, 29.5% partially), with a mean time to return of 5.7 ± 1.3 months. For patients who participated in shoulder sports, 89.9% returned, and 10.1% failed to return. Multivariable logistic regression showed significant associations of higher RTW rates with lighter work levels (odds ratio [OR], 2.72; P = .005) and lower retear rates (OR, 5.41; P = .021). A lower retear rate was also significantly associated with a higher RTS rate (OR, 7.66; P = .010)., Conclusion: LTT transfer for PSIRCTs yielded favorable functional outcomes with high rates of RTW and RTS. Patient-related factors, notably work level and retears, influenced successful RTW and RTS., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.