Isolated Latissimus Dorsi Transfer versus Combined Latissimus Dorsi and Teres Major Tendon Transfer for Irreparable Anterosuperior Rotator Cuff Tears

Figures

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  Fig. 1. Preoperative magnetic resonance imaging (MRI) evaluation. (A) Axial T2-weighted MRI of the left shoulder displayed a torn and medially retracted subscapularis (SSC) tendon, denoted by an asterisk. (B) Sagittal oblique T1-weighted MRI showed significant fatty infiltration in both the SSC and supraspinatus (SSP) tendons.

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  Fig. 2. (A) After dissecting the latissimus dorsi (LD) tendon separated from the teres major tendon, the LD was detached from its insertion at the humerus. Then, the tendon was sutured in a Krackow stitch pattern. Traction was applied to these sutures while the distal portion of the LD muscle was bluntly released to enhance the excursion. (B) Once an adequate length of the tendon was obtained, it was attached to the lesser tuberosity (LT).

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  Fig. 3. (A) The combined latissimus dorsi and teres major (LDTM) tendons were concurrently detached from the humerus, without individual tendon separation. Krackow stitching was applied to the LDTM tendons. (B) Following thorough dissection and release from the adjacent connective tissues, the LDTM tendons were affixed distally at the lateral margin of the greater tuberosity (GT) and just laterally to the biceps groove. LT: lesser tuberosity.

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  Fig. 4. The isolated latissimus dorsi (LD) tendon transfer affixed to the upper portion of the lesser tuberosity (LT) (A) and the combined latissimus dorsi and teres major (TM) tendon transfer secured to the greater tuberosity (GT) (B). Altering the attachment point to the GT modifies the trajectory of the transferred tendon (represented by a blue arrow) to a less vertical orientation, thereby enhancing tendon tautness. This modification not only mitigates the risk of axillary nerve entrapment between the remnant subscapularis muscle portion and upper portion of the teres major tendon, but also effectively increases the tension in the transferred combined latissimus dorsi and teres major (LDTM) tendon. BG: biceps groove. Adapted from Baek et al., with permission of Elsevier.14)

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  Fig. 5. Preoperative and 2-year follow-up examination. Axillary lateral radiographic findings illustrate the restoration of anterior subluxation of the humeral head (asterisk) following the combined latissimus dorsi and teres major transfer (A, preoperative; B, postoperative). In contrast, in the case of the latissimus dorsi transfer, the final follow-up radiographs show that the preoperative anterior subluxation has not been successfully restored (C, preoperative; D, postoperative). a) A line segment passing through the articular surface of the glenoid. b) A line segment perpendicular to line segment a), bisecting it at the midpoint of the glenoid. c) A circle that includes a portion of the articular surface of the humerus as its arc. *The center of the circle c).

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  Fig. 6. T2-weighted oblique axial-view magnetic resonance imaging demonstrating intact integrity of the transferred latissimus dorsi (LD) (A) and combined latissimus dorsi and teres major (LDTM) tendons (B), indicating difference in thickness of each transferred tendon. Arrow: isolated LD (A), combined LDTM (B).