Arthroscopic Latissimus Dorsi Transfer for Massive Irreparable Rotator Cuff Tears

In massive irreparable rotator cuff tears, at least two tendons are torn, with medial retraction, fatty infiltration, and muscle wasting, resulting in the impossibility to achieve a direct repair of the native tendon to the humerus despite mobilizing the soft tissues. Latissimus dorsi tendon transfer is an effective option for young and active patients with massive irreparable posterosuperior rotator cuff tears and intact subscapularis tendon, showing excellent outcomes on both short- and long-term follow-up. Published reports demonstrated marked pain reduction, associated with an almost complete functional range of motion (ROM), an increase in functional scores, and an overall high rate of patient’s satisfaction. The efficacy of latissimus dorsi tendon transfer relies on two main effects: the tenodesis effect, resisting humeral head migration, and the persistence of muscular activity, allowing the transferred tendon to cope with its new function. The present chapter provides insights into the use of this transfer, covering basic evidence, clinical results, and a step-by-step easy and reproducible surgical technique.