Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: A Modified Technique to Improve Tendon Transfer Integrity

Abstract

Latissimus dorsi tendon transfer achieves satisfactory clinical results in most patients who have a massive irreparable posterosuperior tear of the rotator cuff. Harvesting the tendon along with a small piece of bone enables direct bone-to-bone transosseous fixation, resulting in better tendon integrity and clinical results.

Rotator cuff tears treated with a modified deltoid flap repair technique

“…An alternative option for the deltoid flap for the treatment of posterosuperior cuff defects is latissimus dorsi transfer, which has the advantage of sparing the deltoid muscle. 2,8,22,24,25,31,34,38,50 The major difference between our study and prior series consists of the acromion elevation osteotomy. This significantly increases the subacromial space and should therefore spare the deltoid flap from subacromial impingement with potential jeopardy to flap vascularity.…”

Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes

“…Several surgical techniques have been used for latissimus dorsi transfer, including single-incision, double-incision, and more recently arthroscopically assisted transfer. 88,92 Normal function of the latissimus dorsi muscle-tendon unit on the humerus includes adduction, internal rotation, and extension. When it is transferred, the muscle no longer serves as an internal rotator but rather is an external rotator and humeral head depressor.…”

“…121 Clinical outcomes Studies regarding the clinical outcomes of latissimus dorsi tendon transfers are summarized in Supplementary Table III. 3,15,20,23,26,29,41,[43][44][45]61,62,75,89,92,98,116,121,122 A systematic review conducted by Namdari et al analyzed 10 studies between 1992 and 2010 to determine the expected outcomes, predictive factors for success, and complications of latissimus dorsi transfers. 94 Frequency-weighted mean follow-up was 45.5 months.…”

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“…[65,66] LD tendon without reinforcement or reinforced with bone or artificial tissue Moursy et al as compared, in consecutive series of sufferers, LD tendon switch on my own with LD tendon augmented with bone chips coming from its humeral insertion. [22] They located higher outcomes for bone augmented LD tendon. In different series, a few authors used vicryl mesh reinforcement, [48] PDS reinforcement, [51] or fascia lata augmentation of the LD tendon in their technique however they did now not evaluate their reinforced tendon technique organization with a manage institution with native LD tendons.…”

“…[20,21] In pursuit of attaining maximum reliability of tendon transfer some authors advocate confiscation of certain part of humerus to facilitate attachment of tendon to bone. [22,23] Preoperative dynamic scope of movement and sex are critical indicators of result in LDTT (females have more regrettable results). [24,25] Arthroscopic debridement is helpful as far as agony alleviation yet results may break down with time in youthful and dynamic patients.…”