Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears

Abstract

Background:Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome.Methods:Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported.Results:Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear.Conclusion:Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component.

Arthroscopic Superior Capsular Reconstruction and Over-the-Top Rotator Cuff Repair Incorporation for Treatment of Massive Rotator Cuff Tears

“… 2 Additionally, outcomes may be influenced by multiple elements such as age, pain, disability, functional demands, patient expectations, and willingness to adhere to lengthy rehabilitation protocols. 8 …”

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

“…In the setting of an irreparable cuff tear and no osteoarthritis in younger patients, tendon transfers may improve shoulder function 6,50,94 . For posterosuperior tears, transfer of the latissimus dorsi 97 is the most common procedure.…”

“…For posterosuperior tears, transfer of the latissimus dorsi 97 is the most common procedure. Careful patient selection is required and patients with pseudoparalysis and insufficient subscapularis function probably have much less gain from this procedure 6,94,214 . The variability of results, and the fact that the transferred latissimus tendon provides a quite vertical pull, have led to the development of the lower trapezius transfer 72 , in which the transferred lower trapezius, and the allograft that is required, provide a line of pull that is nearly identical to that of infraspinatus 50 .…”

Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears

“…Several studies have investigated preoperative factors that affect the clinical outcomes of latissimus dorsi transfer for MIRCTs. 1,8,17,24,29,50 Anastasopoulos et al 1 suggested that patients with irreparable posterior-superior rotator cuff tears with associated atrophy or fatty degeneration of the subscapularis and deltoid, as well as a large critical shoulder angle, are more likely to have poor clinical outcomes. Successful outcomes were associated with a preoperative critical shoulder angle of ≤36°.…”

“…8,10,29,[33][34][35]42,50 Indications for this procedure include younger patients who are suffering from severe functional disabilities caused by an irreparable posterior-superior rotator cuff tear and patients with minimal to no glenohumeral arthritis. 1,34,43 Numerous studies have discussed functional and clinical outcomes after latissimus dorsi transfer for MIRCTs (see Table 1). § One study 24 evaluated the functional outcome scores of 46 cases in which open transfer was performed.…”