Open latissimus dorsi transfer

Transfer of the latissimus dorsi tendon has been proposed as a viable treatment option for massive posterosuperior rotator cuff tears without osteoarthritis, especially in younger patients with loss of active external rotation. The procedure is thought to restore external rotation and reestablish the anterior-posterior force couple on the humeral head, thus leading to significant improvement of shoulder function along with pain relief. Current literature has demonstrated promising mid-to long-term outcomes for the treatment of irreparable posterosuperior rotator cuff tears, however, insufficiency of the subscapularis muscle and fatty infiltration of the teres minor muscle has been shown to be associated with inferior results. Thus, in cases with concomitant irreparable tears of the subscapularis muscle this procedure should not be performed, as sufficient reconstruction of the force couples is impossible. In addition, postoperative outcomes are varying dependent on patients' psychomotor learning skills as well as compliance with the rehabilitation program.