Editorial Commentary: Is It Time to Abandon the Latissimus Dorsi Tendon Transfer as a Salvage Procedure for Patients With Large Irreparable Rotator Cuff Tears That Failed Primary Repair?

Abstract

The management of large irreparable rotator cuff tears in the young and active patient population without arthritis presents a challenge for shoulder surgeons due to the limited number of treatment options available that provide predictable outcomes. Latissimus dorsi tendon transfer (LDTT) for the treatment of large, irreparable posterosuperior rotator cuff tears or as a salvage procedure for failed surgical (arthroscopic or open) repair was originally introduced in 1988. Multiple studies have reported both the short- and long-term outcomes after LDTT; however, the majority of these studies included patients without history of previous surgery or a mixed patient population. However, LDTT as a salvage procedure is not as predictable as a primary procedure in terms of pain relief and functional improvement. This is especially true in patients with severe fatty infiltration of the posterior cuff musculature and preoperative acromiohumeral distance <7 mm on static anteroposterior radiography. Conversely, we should not abandon the LDTT in young and active patients with large irreparable rotator cuff tear and intact or repairable subscapularis without arthritis as a primary procedure for treatment. There is plenty of clinical evidence that demonstrates good-to-excellent outcomes in this subset of patients. However, in the setting of one or multiple failed arthroscopic or open cuff repairs, limited range of motion, acromiohumeral distance <7 mm on static anteroposterior radiograph, and severe fatty infiltration of the posterior cuff musculature, I would caution against the use of LDTT as a salvage procedure due to the high failure rate and unreliable clinical results. Currently, there is no role in my own practice for LDTT as a salvage procedure in this patient population.