Latissimus Dorsi Transfer Combined With Dynamic Biceps Rerouting for Massive Irreparable Rotator Cuff Tear

Treating patients with irreparable massive rotator cuff tears, particularly those with loss of external rotation and active elevation function, has always been a challenging clinical problem. Latissimus dorsi transfer has shown long-term clinical reliability, especially as a preferred surgical option for relatively young patients. However, isolated tendon transfer appears insufficient to restore the range of motion in patients with bidirectional deficits. There are various surgical techniques using the long head of the biceps tendon to mimic superior capsular reconstruction, among which dynamic biceps rerouting is a superior capsular reconstruction with more tension that can reconstruct the balance of vertical pairs acting on the shoulder. Latissimus dorsi transfer combined with dynamic biceps rerouting can compensate for the bidirectional functional deficiencies of the rotator cuff and minimize the risk of latissimus dorsi tendon rupture and related complications.