Transfer of Latissimus Dorsi for Irreparable Rotator-Cuff Tears

Abstract

We treated 12 shoulders in ten patients with irreparable rotator-cuff tears by transfer of the latissimus dorsi. There were nine men and one woman. Their average age was 64.0 years and the average follow-up was 35.6 months (26 to 42).The results were excellent in four shoulders, good in four, fair in one, and poor in three. Active forward flexion improved from a preoperative average of 99°t o a postoperative average of 135°. Osteoarthritic changes appeared in five shoulders and proximal migration of the humeral head progressed in six. EMG revealed that nine of the 12 transferred muscles showed activity which was synergistic with the supraspinatus on external rotation with abduction.We conclude that latissimus dorsi transfer can be effective in restoring shoulder function after massive irreparable tears of the rotator cuff.

Reverse Shoulder Arthroplasty Combined with a Modified Latissimus Dorsi and Teres Major Tendon Transfer for Shoulder Pseudoparalysis Associated with Dropping Arm

“…5). The gain in active elevation is high (+70°) while the gain in active external rotation (+36°) is similar or superior to that reported with the standard two-incision procedure [1,2,11,18,23,30,35,47]. As observed in our early experience with the RSA, without the tendon transfer patients would remain disabled, because in the absence of external rotator cuff muscles (infraspinatus and teres minor) there is no counterbalance to the strong functional internal rotators (pectoralis major, latissimus dorsi, teres major and subscapularis).…”

“…None of our patients could control the spatial positioning of their arm, as demonstrated by positive preoperative dropping, lag, and hornblower signs. Review of the literature suggests the reported gain in active external rotation after an isolated transfer of the LD is modest, but patient satisfaction remains high because the arm is stabilized by the transfer [1,2,18,23,30,35,47]. Gerber [19] has recently reported a similar series of patients treated with a LD transfer and reverse shoulder arthroplasty; his preliminary results suggested similar promise but demonstrated a lower gain in external rotation.…”

Modified L'Episcopo Tendon Transfers for Irreparable Rotator Cuff Tears: 5-year Followup

“…For treatment of posterosuperior rotator cuff tears, Gerber et al [8,11] and others [1,12,16,23] have described transfer of the latissimus dorsi tendon sutured to the insertion site of the supraspinatus tendon using a twoincision technique.…”

“…It now is standard practice to perform muscle transfer for treatment of irreparable posterosuperior cuff tears [1,3,12]. With these surgeries, satisfactory results can be achieved.…”

“…Two studies stressed the importance of an intact subscapularis muscle [1,10]. Furthermore, inferior results with respect to Constant and Murley score, active elevation, and active external rotation can be associated with fatty infiltration of the teres minor muscle [7].…”