Modified minimally invasive latissimus dorsi transfer in the treatment of massive rotator cuff tears: a two-year follow-up of 26 consecutive patients

Abstract

Since its inauguration by Gerber in 1988, the latissimus dorsi transfer has become an established surgical option for non-reconstructable, massive posterosuperior rotator cuff tears. We describe 26 consecutive patients, all of whom underwent a latissimus dorsi transfer using a modified single incision mini-invasive Herzberg transfer. The primary focus of this paper was to compare the applied clinical results of this new technique with the published results of the Gerber technique. Following transfer of the latissimus dorsi to restore external rotation, 26 patients were evaluated. The mean age was 60 +/- 18 years. The patients were examined after surgery at an average of 24 months (range: 12-41). The unweighted Constant score rose from 20 (range: 13-34) to 56 (range: 63-81). The acromiohumeral distance remained statistically unchanged from an initial value of 4.7 mm (1-9 mm) to a postoperative value of 4.8 (2-11 mm). In the Hamada classification the level of rotator cuff defect arthropathy increased from 1.7 (1-3) to 1.8 (1-3). On the basis of its low morbidity rate, the latissimus dorsi transfer in Herzberg's modified technique is a sensible alternative to the technique initially described by Gerber, especially when the initial situation exhibits pre-existing weakness of the deltoid muscle.

Fig. 1

a–c A 53-year-old patient with a massive posterosuperior rotator cuff tear, lateral decubitus position. The surgical approach was carried out reaching from the posterior deltoid approximately 5 cm below the posterolateral edge of the acromion along the triceps: a, b show the raised muscle belly of the latissimus dorsi and teres major during the operation. Please note the dorsal arthroscopy portal “loco typico”. c Intraoperative view after refixation of the tendon

Fig. 2

a–c The same patient 12 months postoperatively demonstrating near normal shoulder joint range of motion

Fig. 3

a, b Postoperative MRI with the placement of the suture anchor and the insertion of the latissimus dorsi tendon in a transverse and coronal plane. c Anteroposterior X-ray with the suture anchors at the insertion zone of the infraspinatus tendon