Latissimus dorsi transfer for primary treatment of irreparable rotator cuff tears

Abstract

Transfer of the musculotendinous unit of the latissimus dorsi was performed in seven patients (5 men and 2 women, with a mean age of 57 years) with irreparable rotator cuff tear who had had no previous surgery for cuff repair. Preoperatively, the mean active shoulder motion was 86° in flexion, 74° in abduction and 22° in external rotation. One patient had a positive lift-off test. The average preoperative Constant and Murley score was 44%. Diagnosis of irreparability of the cuff leasion was made preoperatively only in one case. In the remaining patients, the preoperative data only led to suspect that the tear was irreparable. At surgery, all patients had an irreparable tear of the superoinferior portion of the cuff and one patient also had a tear of the subscapularis tendon. In all cases the latissimus dorsi tendon was inserted to the greater tuberosity and, in four cases, to the subscapularis tendon; in three patients it was sutured to the bicipital tendon. Postoperatively all patients had relief of shoulder pain. The mean improvement in active flexion, abduction and external rotation was, respectively, 39°, 29° and 10°: At the latest follow-up, the average Constant and Murley score was 64%. The results of surgery were rated as excellent in three cases, good in two, fair in one and poor in one. All patients but one returned to preoperative work. Transfer of the latissimus dorsi muscle is an effective procedure for patients in middle or early elderly age who have an irreparable tear of the supraspinatus and infraspinatus tendons.