Arthroscopic Latissimus Tendon Transfers for Irreparable Rotator Cuff Tears

Abstract

Irreparable massive rotator cuff tears in the active population are a common cause of pain, loss of overhead hand positioning, and potentially pseudoparalysis in external rotation and forward elevation. After failure of conservative treatment, a wide variety of surgical techniques have been utilized for treatment including debridement and/or tenodesis, partial repair, superior capsular reconstruction, tendon transfers, as well as reverse total shoulder arthroplasty. The latissimus transfer was proposed to augment the diminished external rotation forces and to restore mechanical shoulder balance. This technique has now been utilized for nearly 3 decades with notable improvements in patient reported pain and outcome measures as well as increases in range of motion and strength. Arthroscopic assisted latissimus dorsi tendon transfer (A-LDTT) was subsequently described as a minimally invasive means to reduce iatrogenic deltoid injury and allow precise subscapularis repairs, when necessary. Multiple studies with ≥2 year follow-up have showed similar clinical outcomes to the open technique. A-LDTT is an effective, safe, and reliable treatment option for patients with irreparable posterosuperior rotator cuff repairs. This paper will describe our method and experience with the A-LDTT procedure.