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Published February 10, 2018

Arthroscopic Assisted Latissimus Dorsi Transfer

Irreparable posterosuperior rotator cuff tears represent a serious limitation for young and active patients. Epidemiologic studies have reported that rotator cuff tears occur more frequently in patients older than 50 years. Surgical repair of massive rotator cuff tears results in poor outcomes compared with surgical repair of isolated supraspinatus tears. This is because of poor quality of the rotator cuff, tendon retraction, and muscle fatty infiltration.

Various surgical techniques, such as arthroscopic débridement, biceps tenotomy/tenodesis, functional repair, use of allografts and synthetic mesh, tendon transfer, and reverse shoulder arthroplasty, have been described for the management of irreparable lesions or recurrent rotator cuff tears. Latissimus dorsi transfer is a surgical procedure for the management of irreparable posterosuperior rotator cuff tears in patients with complete loss of active external shoulder rotation. The drop arm sign and hornblower sign are sensitive and specific for the diagnosis of these lesions. Absolute contraindications to latissimus dorsi transfer are deltoid dysfunction and associated subscapularis tears.

The outcomes of latissimus dorsi transfer are good, resulting in the recovery of active external rotation and strength. We report good clinical and functional outcomes in our patients. Our arthroscopic-assisted approach, similar to the open approach, preserves the deltoid but is associated with less pain and a shorter period of postoperative discomfort.