Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: A Modified Technique Using Arthroscopy

Abstract

Latissimus dorsi transfer is a well-established method for the treatment of posterosuperior massive irreparable rotator cuff tears. We propose using an arthroscopically assisted technique that avoids insult to the deltoid. With the patient in the lateral decubitus position, an L-shaped incision is made along the anterior belly of the latissimus muscle and then along the posterior axillary line. The latissimus and teres major are identified and separated. The tendon insertion of the latissimus is isolated, and a FiberWire traction suture (Arthrex, Naples, FL) is placed, facilitating dissection of the muscle to the thoracodorsal neurovascular pedicle and subsequent mobilization. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the lateral aspect of the infraspinatus and supraspinatus footprints by multiple suture anchors.

Latissimus dorsi tendon transfer for irreparable postero-superior cuff tears: current concepts, indications, and recent advances

“…Only Villacis et al [70] described a small series of eight patients but with short follow-up and few postoperative datas with no assessment scores. We have conducted a multi-center study with a new arthroscopic assisted technique for LD tendon transfer with tendon tubularization and fixation in a bone tunnel of the humeral head [68, 69•].…”

Anterolateral Mini-open Fixation with a Patch Augmentation for Latissimus Dorsi Tendon Transfer in Irreparable Rotator Cuff Tears: Technical Note

“…Recently, in an efforts to avoid deltoid damage, less invasive procedures using arthroscopic technique have been described. 3,5,6) However, arthroscopically assisted latissimus dorsi tendon transfer is a technically demanding procedure. Cho et al 8) In patients with a short and small body type such as Asian harvested latissimus dorsi tendon may be too thin and short for transfer to the greater tuberosity.…”

“…[1][2][3][4][5] Classic technique of latissimus dorsi tendon transfer requires violation of the deltoid for attachment of the transferred tendon. 1,5) Deltoid detachment is a disadvantageous step in the classic technique in that it can produce an inferior clinical outcome by deltoid morbidity. Recently, in an efforts to avoid deltoid damage, less invasive procedures using arthroscopic technique have been described.…”

“…5) Recently, in an effort to avoid deltoid damage, less invasive procedures including single-incision or arthroscopic technique have been described. 3,5,6) In patients with a short and small body type, harvested latissimus dorsi tendon may be too thin and short for transfer to the greater tuberosity. In these cases, several augmentation techniques using allograft or tensor fascia lata have been proposed.…”

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“…[71,72] Only 1 author described a small series of eight sufferers but with short observe-up and few postoperative records and not using an assessment rankings. [73] This technique regarded to bring about a higher mechanical resistance to traction than other already published techniques. [74] The sole negative issue for postoperative consistent score turned into preoperative surgical treatment with postoperative consistent rating being significantly one of a kind between sufferers operated on in a number one manner (imply postoperative constant rating: 70) and patients operated on in a revision system (suggest postoperative steady rating: 60).…”