Technical Guide and Tips to Anterior Arthroscopic Latissimus Dorsi Transfer for Irreparable Subscapularis Tears.

Abstract

In young patients, irreparable subscapularis tears can be managed by latissimus dorsi (LD) transfer on the lesser tuberosity. We provide a technical guide for isolated LD anterior transfer. The surgical procedure begins with glenohumeral exploration and release of the remaining subscapularis. Then, we dissect the LD tendon below the subscapularis. At the upper and inferior borders, we dissect the LD from the teres major, protecting the radial nerve anteriorly and inferiorly. Next, we detach the LD. Inferiorly, we cut the aponeurotic expansion for the triceps. A Foley catheter is used as a shuttle relay, anterior to the axillary nerve and medial and posterior to the radial nerve. We continue with an open dissection of the LD, posterior to the axillary fossa, to release the LD from the skin and tip of the scapula. The LD is transferred on the lesser tuberosity after retrieved by the Foley catheter, with care taken not to twist the tendon. It is fixed with 2 lateral anchors and 1 medial anchor. A shoulder brace is worn for 6 weeks. Physiotherapy begins thereafter.