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

Jin Soo Park; Soo Joong Choi; Kyu Chul Noh; Seong Yeon Kim; Hong Kyun Kim; Ji Hyo Hwang; Ki Nam Bae

doi:10.12790/jkssh.2016.21.4.181

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Park, Choi, Noh, Kim, Kim, Hwang, and Bae: Latissimus Dorsi Tendon Transfer for the Treatment of Irreparable Rotator Cuff Tears

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(4):181-188.

Published online: 11 December 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.4.181

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

Jin Soo Park¹, Soo Joong Choi^2,, Kyu Chul Noh¹, Seong Yeon Kim¹, Hong Kyun Kim¹, Ji Hyo Hwang¹, Ki Nam Bae¹

¹Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

²Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea

Correspondence to: Soo Joong Choi, Department of Orthopedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea, TEL: +82-31-380-1871, FAX: +82-31-382-1814, E-mail: csjwillow@gmail.com

^* This research was supported by Hallym University Research Fund (HR 01-2004-04)

Received 20 June 201625 September 2016 Accepted 30 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 nonabsorbable 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.

Keywords: Rotator cuff tear, Latissimus dorsi, Tendon transfer

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Fig. 1.

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

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.

Table 1.

Patients data

Case no.	Age (yr)	Sex	Follow-up (mo)	Goutalier et al.²⁰	Hamada et al.¹	Intraop. findings (torn muslces)	Preop./Postop. measurements
Case no.	Age (yr)	Sex	Follow-up (mo)	Goutalier et al.²⁰	Hamada et al.¹	Intraop. findings (torn muslces)	VAS pain	ASES	Fowrad flexion (°)	Abduction (°)	External rotation (arm at side) (°)
1	66	Male	65	IV	2	SS, IS	6/2	48/81	60/120	45/90	10/30
2	68	Male	48	IV	2	SS, IS, Tmi	5/2	49/82	90/130	60/110	10/20
3	69	Male	47	IV	1	SS, IS	7/3	40/85	60/120	50/110	10/35
4	55	Female	45	IV	1	SS, IS, Tmi	6/3	45/86	70/120	60/110	15/60
5	67	Female	68	III	1	SS, IS, Tmi, SubS	7/6	40/70	60/90	55/85	25/45
6	51	Male	28	IV	2	SS, IS	6/2	47/79	50/100	30/100	20/35
7	70	Male	30	IV	2	SS, IS, Tmi, SubS	7/5	42/50	45/53	45/55	15/15
Mean	64	-	47.3	-	-	-	6.3/3.3	44.4/76.1	62.1/104.7	49.3/94.3	15/34.3

Intraop., intraoperative; Preop., preoperative; Postop., postoperative; VAS, visual analogue scale; ASES, American Shoulder and Elbow Surgeons; SS, supraspinatus; IS, infraspinatus; Tmi, teres minor; SubS, subscapularis

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