Arthroscopic latissimus dorsi transfer

Definition and anatomy of latissimus dorsi tendon transfer to shoulder

In some forms of irreparable rotator cuff tears, it is possible to improve shoulder function by re-routing a muscle located at the lower part of the shoulder (latissimus dorsi) to position it at the insertion site of the infraspinatus’ tendon. 

 

Shifting this muscle from its anatomic insertion to a new site is referred to as muscle-tendon transfer surgery.

The muscle taken from the lower region of the shoulder is the latissimus dorsi; it is the body’s longest and most powerful muscle.
Access to the muscle is gained through a small, 5 to 8-cm incision under the axilla, then the tendon of the lat dorsi muscle is transferred under the deltoid muscle to be reattached to the infraspinatus tendon's natural insertion site

Video of arthroscopic latissimus dorsi transfer to shoulder

Shoulder surgery video showing arthroscopic lat dorsi transfer surgery / Toulouse specialist

Surgical technique: arthroscopic latissimus dorsi transfer:

When a tendon of the shoulder has undergone several repairs or when fatty degeneration of the muscle is excessive, the tendon can no longer be directly repaired. For a muscle of the rotator cuff, repair by muscle-tendon transfer (flap) is possible.
For an irreparable lesion of the infraspinatus muscle, the surgeon can perform a muscle-tendon transfer of the lat dorsi.
This shoulder surgery is performed to wait until reverse total arthroplasty of the shoulder is carried out.

Fatty degeneration of supra- and infraspinatus, lat dorsi arthroscopyArthroscopic shoulder surgery for subacromial impingement syndrome: preoperative CT arthrography: pre-acromial bone, Toulouse

 

 

This shoulder surgery is performed on an overnight basis, under regional and general anaesthesia.
Surgery is carried out with the patient in the lateral decubitus position, dissection begins with an incision less than 10 cm long under the axilla, the latissimus dorsi is located lateral to the shoulder blade, the vasculo-nervous pedicle is located and will be carefully preserved. The tendon is then identified and separated from the teres major muscle. Under internal rotation, the tendon is detached from its humeral insertion. Once the humeral insertion tendon is harvested, the latissimus dorsi muscle is released from the tip of the shoulder blade, and satisfactory musculo-tendinous excursion confirmed. Using the finger, the muscle tunnel coursing from under the posterior deltoid to the underside of the acromion can be prepared.

Irreparable massive cuff tear, indication of latissimus dorsi transferDissection is carried to the scapula’s spine, then the forceps are passed subacromially

 

 

The arthroscopic stage can then begin. Biceps tenotomy is performed if it hasn't been carried out in previous operations, then the subacromial space is debrided, the acromiocoracoid ligament is resected and the footprint exposed: insertion site for the rotator cuff, and for the future flap. The spine of the scapula is identified then forceps are advanced to the axilla to retrieve the tendon of the latissimus dorsi. The flap is then positioned in the subacromial space.

The next step in this shoulder surgery consists in dissecting the bicipital groove, and then, using a specific target guide, drilling a humeral insertion tunnel where the latissimus dorsi flap can be attached. 
The latissimus dorsi tendon is then introduced in the tunnel: it is permanently secured using an endobutton positioned at the humeral groove. .
At the end of the procedure, the surgical incisions are closed with absorbable sutures

 

Latissimus dorsi attached at the infraspinatus’ natural insertion siteEndobutton, arthroscopic fixation of latissimus dorsi flap

 

Recovery of shoulder after arthroscopic lat dorsi transfer:

After surgery, the shoulder must be immobilized for 5 weeks. Specialized shoulder rehabilitation must be started immediately after surgery, and follow a specific protocol. Active shoulder rehabilitation only starts the 6th week after surgery. Driving often resumes toward the end of the 2nd postoperative month. Normal recovery spreads over 4 to 6 months, with maximal recovery of active articular range of motion toward the end of the 6th post-operative month, and maximal shoulder strength recovery toward the end of the 9th month after surgery.