Morphological Analysis of the Latissimus Dorsi Tendon Insertion: Implications for Optimizing Tendon Transfer Surgeries in Rotator Cuff Repair

Latissimus dorsi (LD) tendon transfer is widely used to treat irreparable rotator cuff tears, particularly in cases with posterosuperior and anterosuperior tear patterns. We conducted a comprehensive anatomical analysis of the attachment of the LD tendon to the humerus, focusing on its morphological patterns and morphometric features, which are critical for optimizing the surgery. Dissection of 32 LD tendons in 16 Korean cadavers revealed three insertion patterns: fully combined (40.6%), partially combined (34.4%), and fully separated (25.0%). The mean width, length, and thickness of the tendons were 48.4, 56.2, and 6.2 mm, respectively. There were significant asymmetries in tendon dimensions. There were also tendinous slips connecting the LD tendon to the triceps tendon, adjacent brachial fascia, coracoid process, and anterior joint capsule of the shoulder in nine specimens, emphasizing the anatomical variability relevant to surgical planning. These findings provide insights for determining surgical approaches on the basis of patient anatomy, and whether to use LD transfer alone or combined LD and teres major transfers. Understanding the anatomical variations will help to make interventions more precise, which in turn should enhance the efficacy of tendon transfer procedures and improve functional outcomes for patients with complex shoulder pathologies.