# Fully Arthroscopic Latissimus Dorsi Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears

## TL;DR

This paper describes a fully arthroscopic technique for transferring the latissimus dorsi muscle to treat large rotator cuff tears.

## Contribution

The novel contribution is a fully arthroscopic method for latissimus dorsi transfer without requiring proximal pectoralis major tendon detachment.

## Key findings

- A fully arthroscopic LD transfer is feasible using specific portals and techniques.
- The LD tendon can be transferred posteriorly to the humeral head with knotless anchors.
- The procedure avoids neurovascular injury by careful dissection and portal placement.

## Abstract

Latissimus dorsi (LD) transfer can be used for the treatment of irreparable posterosuperior massive rotator cuff tears. This article describes a fully arthroscopic LDT procedure to manage irreparable supraspinatus or infraspinatus tears. Dissection and release of the whole LD tendon and muscle are performed arthroscopically. Great attention must be paid to avoid the neurovascular structures during the procedure. Using a portal superior to the upper margin of the pectoralis major (PM) and a portal inferior to the lower margin of the PM, partial detachment of the proximal PM tendon is not necessary to obtain access to the insertion of the LD tendon. By enlarging the posterior axillary portal to 2 to 3 cm in length, the LD tendon can be easily pulled out of the skin and is weaved in an open way. The muscular part of the LD can be further released to a sufficient length, and the posterior pathway of the LD transfer is created arthroscopically. The LD tendon can be transferred posteriorly to the greater tuberosity of the humeral head and fixed with 2 knotless anchors.