Patch-Augmented Latissimus Dorsi Transfer | Rotator Cuff Tear Treatment

An active gentelmen had severe pain and weakness in his shoulder after 3 failed rotator cuff repairs.Too young for reverse total shoulder arthroplasty. The MRI showed a massive rotator cuff tear.

The patient is positioned in the seated beach chair. The standard arthroscopic portals are established. The rotator cuff is mobilized and a latissimus doris transfer with patch-augmentation is addressed. The native rotator cuff is set with sutures for manipulation.

The arm is raised and an incision is made below the armpit. The latissimus tendon is harvested at its attachment site on the humerus. The latissimus muscle bell is freed and nerovasuclar pedicle is identified. The latissimus tendon is augmented using a patch allowing it to reattach to the native rotator cuff tendon.

The graft and latissimus is passed through the soft-tissue window. the native rotator cuff tissue is repaired with anchor loaded swivel lock. The latissimus graft is then tensioned onto the lateral aspect of the greater tuberosity. The final repair is seen demonstrating complete closure of the rotator cuff and reattachment of the latissimus.

Post-operatively, the patient starts with passive range of motion with limitations of 30 degrees of external rotation and 90 degrees of abduction and 120 degrees of forward flexion. At 6 weeks active and active-assisted motion are begun.