A prospective series of 16 irreparable, massive rotator cuff tears treated with latissimus dorsi tendon transfer. The study asks whether transferring a vascularized latissimus tendon can restore function when the posterosuperior cuff cannot be repaired. Outcomes were measured against age- and gender-adjusted normal Constant scores at an average of 33 months.
The decision rule from this paper is simple: offer latissimus dorsi transfer for an irreparable posterosuperior cuff tear only when the subscapularis is intact and functioning.
The difference is stark. An intact subscapularis yields ~82% of normal function; a non-functional one drops that to 48%. The subscapularis provides the anterior half of the transverse force couple that centers the head, and without it the transfer cannot overcome superior migration.
Deltoid function matters too. The transfer depresses the head through a tenodesis effect, so a working deltoid is required to generate that tension. Manage expectations on external rotation. Strength improves reliably, but amplitude gains are modest (around 13°), and the transfer will not re-center a migrated head.
This paper frames the operation as a reconstruction for the truly irreparable defect, not a substitute for a repair you can still achieve.
A prospective series of 16 irreparable, massive rotator cuff tears treated with latissimus dorsi tendon transfer. The study asks whether transferring a vascularized latissimus tendon can restore function when the posterosuperior cuff cannot be repaired. Outcomes were measured against age- and gender-adjusted normal Constant scores at an average of 33 months.
The decision rule from this paper is simple: offer latissimus dorsi transfer for an irreparable posterosuperior cuff tear only when the subscapularis is intact and functioning.
The difference is stark. An intact subscapularis yields ~82% of normal function; a non-functional one drops that to 48%. The subscapularis provides the anterior half of the transverse force couple that centers the head, and without it the transfer cannot overcome superior migration.
Deltoid function matters too. The transfer depresses the head through a tenodesis effect, so a working deltoid is required to generate that tension. Manage expectations on external rotation. Strength improves reliably, but amplitude gains are modest (around 13°), and the transfer will not re-center a migrated head.
This paper frames the operation as a reconstruction for the truly irreparable defect, not a substitute for a repair you can still achieve.