Latissimus Dorsi Transfer | Massive Rotator Cuff Tear | Colorado Shoulder Specialist

In this video, a Latissimus Dorsi Transfer in the Modified Beach Chair Position is performed. Massive rotator cuff tears present as a complex and challenging problem. These tears typically have poor tendon quality, scarring and retraction and atrophy/fatty infiltration. These characteristics lead to a high re-tear risk. For these reasons, multiple treatment options have been presented.

Debridement with bicep tenotomy have been reported to provide satisfactory short-term pain relief, but is primarily indicated for lower demand for patients. Partial rotator cuff repair is also reported to provide good outcomes when residual rotator cuff tissue is robust and can improve pain and function even if the entire rotator cuff can be repaired. More recently, tissue repair with augmentation is primarily considered when rotator cuff tissues can re-approximated but reinforcement of the repair may minimize retear. Early results indicated improved function. Tendon transfer such as the latissimus dorsi transfer is an option for patients with massive posterior/superior tears, and when the patients primary symptoms are weakness, pain and impaired active motion. Frequently, patients with demanding occupations are also excellent candidates for tendon transfers and can typically expect to improve one muscular grade. Finally, patients with glenohumeral arthrosis, or older patients with significant active motion limitations may be excellent candidates for reverse shoulder arthroplasty. In this group of patients, functional improvements can be dramatic. However, long term results in younger patients have been yet to be fully defined.

The indications for latissimus dorsi transfer are massiver irreparable posterosuperior rotator cuff tears in younger patients with minimal glenohumeral arthritis. Patients with residual active motion above the shoulder level and pain due to active acromial impingement and mild weakness, tend to show an exceptional benefit after a latissimus dorsi tendon transfer.

Contraindications include subscapularis deficiency, deltoid deficiency and advanced glenohumeral arthrosis. This case study is a 54 year old male laborer that is experiencing pain with overhead activity.

The latissimus dorsi transfer is performed using an Achilles allograft augmentation of the latissimus dorsi tendon. Pre-operative MRI shows a full thickness retracted posterosuperior rotator cuff tear. A latissimus dorsi transfer is performed.

Rehabilitation following this procedure involves abduction brace for 6 weeks and passive range of motion begins at 2 weeks. Strengthening will begin at 10 -12 weeks. Biofeedback is important to appropriately utilize the transferred muscle and its new function.

Clinically, outcomes following this procedure are relatively good considering it is used largely as a salvage procedure for many patients. Warner et al reported a 73% overall patient satisfaction and a 27% rerupture rate.

In summary, an appropriate selected patients the latissimus dorsi transfer is capable of providing improved shoulder function and decrease shoulder discomfor