Fully Arthroscopic Anterior Latissimus Dorsi Transfer for Irreparable Subscapularis Tears

Latissimus dorsi (LD) transfer can be used for the treatment of irreparable subscapularis tears. This article describes a fully arthroscopic LD transfer procedure to manage irreparable subscapularis tears. The LD tendon and muscle are dissected and released arthroscopically, and care must be taken to avoid injury to the axillary and radial nerves. With the use of a portal superior to the upper margin of the pectoralis major (PM) and a portal inferior to the lower margin of the PM, detachment of the proximal PM tendon is not necessary for access to the insertion of the LD tendon. The posterior axillary portal is used to release the connections between the LD muscle and skin. 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 stronger suture is weaved in open way compared with prepared arthroscopically. The LD tendon can be transferred anteriorly to the lesser tuberosity of the humeral head with fixation using 2 knotless anchors.