The Journal of Bone and Joint Surgery (American). 2006;88:113-120.
doi:10.2106/JBJS.E.00282
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Latissimus Dorsi Transfer for the Treatment of Irreparable Rotator Cuff Tears

Christian Gerber, MD1, Gerardo Maquieira, MD1 and Norman Espinosa, MD1

1 Department of Orthopaedics, University of Zurich, Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. E-mail address for C. Gerber: christian.gerber{at}balgrist.ch

Investigation performed at the Department of Orthopaedics, University of Zurich, Zurich, Switzerland

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Resortho Foundation, Zurich. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Treatment of irreparable rotator cuff tears remains controversial. Latissimus dorsi transfer to the greater tuberosity has been proposed for the treatment of irreparable tears associated with severe functional impairment and chronic, disabling pain.

Methods: Sixty-seven patients with sixty-nine irreparable, full-thickness tears of at least two complete tendons were managed with latissimus dorsi transfer and were reviewed clinically and radiographically after an average of fifty-three months. The study group included fifty-two men and fifteen women, with an average age of sixty-one years. Thirteen patients also had deficient subscapularis function preoperatively. Outcome measures included the Constant and Murley score and the Subjective Shoulder Value. Osteoarthritis and acromiohumeral distance were measured on standardized radiographs.

Results: The mean Subjective Shoulder Value increased from 28% preoperatively to 66% at the time of follow-up (p < 0.0001). The mean age and gender-matched Constant and Murley score improved from 55% to 73% (p < 0.0001). The pain score improved from 6 to 12 points (of a possible 15 points) (p < 0.0001). Flexion increased from 104° to 123°, abduction increased from 101° to 119°, and external rotation increased from 22° to 29° (p < 0.05). Abduction strength increased from 0.9 to 1.8 kg (p < 0.0001). There was a slight but significant increase in osteoarthritic changes (from stage 0.8 to stage 1.3; p = 0.0002). In shoulders with a negative preoperative lift-off test, significant improvements were observed in terms of both function and pain, and strength doubled from 1.0 to 2.0 kg (p = 0.0001), but osteoarthritic changes progressed from stage 0.7 to stage 1.1 (p = 0.0006). In shoulders with poor subscapularis function, no improvement in these parameters was observed.

Conclusions: Latissimus dorsi transfer durably and substantially improves chronically painful, dysfunctional shoulders with irreparable rotator cuff tears, especially if the subscapularis is intact. If subscapularis function is deficient, the procedure is of questionable benefit and probably should not be used.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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