Arthroscopic Latissimus Dorsi Transfer in the Lateral Decubitus Position for Irreparable Posterosuperior Massive Rotator Cuff Tears

Abstract The management of irreparable posterosuperior massive rotator cuff tears remains challenging. With advances in arthroscopic techniques, minimally invasive arthroscopic latissimus dorsi tendon (LDT) transfer has been increasingly used for irreparable posterosuperior massive rotator cuff tears. The present article describes arthroscopic LDT transfer in the lateral decubitus position for irreparable posterosuperior massive rotator cuff tears. The dissection and release of the LDT were performed through the interval between long head of the biceps tendon and humeral shaft. When releasing the LDT, meticulous attention is required to avoid injury to the radial nerve located anterior to the tendon, as well as the anterior circumflex humeral artery and the axillary nerve superiorly. Limited release (<5 mm) of the superior margin of the pectoralis major tendon may be necessary to facilitate release of the inferior border of the LDT. After exteriorization of the tendon through the posterior axillary incision, sutures of different colors are used for tendon weaving. During establishment of the posterior transfer pathway, the axillary nerve should be clearly identified arthroscopically and carefully protected. The transferred LDT is fixed with 2 knotless anchors, followed by additional knot tying to reduce the risk of loosening.