The Latissimus Dorsi Transfer for Treatment of Massive Rotator Cuff Tears

Abstract

Objective

Improvement of shoulder mobility and of strength of the upper limb.

Alleviation of pain.

Indications

Massive tears not amenable to repair by suture.

Contraindications

Tendinous defect of subscapularis.

Loss of function of deltoid.

Advanced osteoarthritis of glenohumeral joint.

Surgical Technique

Preparation of a distally pedicled muscle flap of the latissimus dorsi. Acromioplasty in presence of a caudally pointing spur. Resection of the acromioclavicular joint, if indicated. Mobilization of the remaining medial stump of the rotator cuff. Tenotomy and tenodesis of the long head of the biceps. The tendon of the muscle flap is passed between posterior part of deltoid and posterocranial part of the cuff into the defect area and sutured to healthy tissue of the remaining cuff.

Results

Between 1986 and 1989 we performed this technique in 16 patients (one woman, 15 men) and followed them up for an average of 33 months. The patients’ average age was 60 (39–75) years. Postoperatively, a marked reduction in pain was noted as well as an improvement of shoulder function; the age-adjusted Constant score amounted to 73 (35–97) points.

Aspiration of a sterile fluid collection became necessary in one patient. In another patient in whom a torn subscapularis had been repaired, a revision surgery had to be performed on account of persisting pain and insufficiency of the subscapularis muscle. A further patient needed a subsequent resection of the acromioclavicular joint due to persistent pain.