J Korean Soc Surg Hand.  2016 Dec;21(4):181-188. 10.12790/jkssh.2016.21.4.181.

Latissimus Dorsi Tendon Transfer for the Treatment of Irreparable Rotator Cuff Tears

• Park JS
• Choi SJ
• Noh KC
• Kim SY
• Kim HK
• Hwang JH
• Bae KN

• KMID: 2364208
• DOI: http://doi.org/10.12790/jkssh.2016.21.4.181

Abstract

PURPOSE
Massive and irreparable rotator cuff tears present a difficult treatment problem, and if further progressed, then cuff tear arthropaty may develop. We treated seven cases of massive rotator cuff tears with latissimus dorsi tendon transfer and report their clinical results.
METHODS
Seven patients of mean age of 64 years (range, 51-70 years) with irreparable massive rotator cuff tears were treated using latissimus dorsi tendon transfer. The latissimus dorsi flap was harvested through an axillary approach and reattached on the greater tuberosity, using transosseous suture with non-absorbable sutures. Outcomes were assessed clinically and radiographically after an average of 48 months (range, 28-68 months).
RESULTS
The VAS pain scores improved from 6.3 to 3.3 points (p=0.019). Forward flexion increased from 62° to 105°, abduction increased from 49° to 94°, and external rotation increased from 15° to 34°. Postoperative antero-posterior radiography revealed a mean 0.1 mm depression of the humeral head, without statistical the mean American Shoulder and Elbow Surgeons score improved from 44 to 76. The acromiohumeral distance showed slight increase in amount of 0.1 mm without statistical significance. There was no complication.
CONCLUSION
Latissimus dorsi transfer is a useful surgical option for treating irreparable massive rotator cuff tears.

Keyword

Rotator cuff tear; Latissimus dorsi; Tendon transfer

MeSH Terms

Depression
Elbow
Humans
Humeral Head
Radiography
Rotator Cuff*
Shoulder
Superficial Back Muscles*
Surgeons
Sutures
Tears*
Tendon Transfer*
Tendons*

Figure

• 

  Fig. 1. A 68 year-old-male patient with a massive cuff tear shows limitation in forward flexion and abduction.

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  Fig. 2. Magnetic resonance imaging of the shoulder shows tendon tear with severe retraction, fatty degeneration of the supraspinatus muscle and superior migration of humeral head.

• 

  Fig. 3 (A) Intraoperative photograph showing massive cuff tear (dotted line). (B) Operative photograph showing a latissimus dorsi muscle-tendon unit freed from its insertion site and ready for transfer. (C) Operative photograph showing a complete repair of a rotator cuff defect with a transferred lattisimus dorsi tendon.

• 

  Fig. 4. Photograph showing nearly full elevation and abduction of the right shoulder four years after operation.

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