Fully Arthroscopic Latissimus Dorsi Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears

Latissimus dorsi (LD) transfer can be used for the treatment of irreparable posterosuperior massive rotator cuff tears. This article describes a fully arthroscopic LDT procedure to manage irreparable supraspinatus or infraspinatus tears. Dissection and release of the whole LD tendon and muscle are performed arthroscopically. Great attention must be paid to avoid the neurovascular structures during the procedure. Using a portal superior to the upper margin of the pectoralis major (PM) and a portal inferior to the lower margin of the PM, partial detachment of the proximal PM tendon is not necessary to obtain access to the insertion of the LD tendon. By enlarging the posterior axillary portal to 2 to 3 cm in length, the LD tendon can be easily pulled out of the skin and is weaved in an open way. The muscular part of the LD can be further released to a sufficient length, and the posterior pathway of the LD transfer is created arthroscopically. The LD tendon can be transferred posteriorly to the greater tuberosity of the humeral head and fixed with 2 knotless anchors.