Latissimus dorsi transfer for primary treatment of irreparable rotator cuff tears

There are several surgical options in patients with an irreparable cuff tear. These include arthroscopic decompression, herniarthroplasty, use of flaps of deltoid and transfer of a distant muscolotendinous unit, such as the teres major or latissimus dorsi. We explain our experience with the use of the latter. 22 patients (12 males and 10 women, mean age: 57 yrs) with irreparable rotator cuff tear, who had had no previous surgery for cuff repair, were submitted to the transfer of latissimus dorsi. Pre-operatively, the mean active shoulder motion was 83° in flexion, 71° in abduction and 21° in external rotation. 2 patients had a positive lift-off test. The average pre-operative Constant score was 45%. Diagnosis of irreparability of the cuff lesion was made pre-operatively only in three cases. In the remaining patients, the pre-operative 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 two patient also had a subscapularis tear. In all cases the latissimus dorsi tendon was inserted to the greater tuberosity and, in four and three cases also to the subscapularis tendon and to the bicipital tendon, respectively. Post-operatively all patients had relief of shoulder pain. The mean improvement in active flexion, abduction and external rotation was, respectively: 57°, 43° and 13°. At the latest follow-up, the average Constant score was 70%. The results of surgery were rated as excellent in nine cases, good in eleven, fair in one and poor in one. All patients but three 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.