Background: Arthroscopically assisted latissimus dorsi tendon transfer (LDT) offers a joint-preserving option for irreparable posterosuperior rotator cuff tears, but long-term efficacy remains uncertain. We report outcomes after a minimum of 10 years. Methods: We retrospectively analyzed 33 shoulders in 33 patients (mean age, 62.2 years; 58% male; all ethnic Korean) after arthroscopically assisted LDT. Clinical assessment included range of motion and Constant-Murley, American Shoulder and Elbow Surgeons (ASES), and VAS pain scores. Osteoarthritis progression was assessed radiographically using the Hamada classification. Complications and reoperations, including reverse total shoulder arthroplasty (rTSA), were recorded. Results: The Constant-Murley score increased from 48.2 to 62.7, the ASES score increased from 49.5 to 68.7, and VAS pain decreased from 5.0 to 2.3 (all p < 0.001). Forward elevation increased from 115° to 143° and external rotation at 90° of abduction increased from 22° to 51° (both p < 0.001). The mean Hamada grade increased from 1.2 to 2.4, but clinical scores and range of motion were similar in the 12 shoulders (36%) that progressed to grade 3 or higher. On magnetic resonance imaging at the final follow-up (mean, 134 months postoperatively), 19 transfers (58%) remained intact (Sugaya types I to III) and 14 (42%) had a full-thickness retear (Sugaya types IV and V). Outcomes were similar between patients with and without osteoarthritis progression, but patients with intact transfers had better forward elevation, external rotation at 90°, and ADLER (activities of daily living that require active external rotation) scores. Late subscapularis tears occurred in 10 shoulders (30%) and were associated with preoperative grade-2 fatty infiltration (p = 0.002). Three shoulders (9%) required conversion to rTSA. Conclusions: Arthroscopically assisted LDT improved pain and function for most patients with irreparable posterosuperior rotator cuff tears. Despite frequent radiographic osteoarthritis progression, clinical outcomes remained favorable, and most shoulders retained the native joint. LDT may serve as an option to delay rTSA in appropriately selected younger patients. Level of Evidence: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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