Latissimus Dorsi Transfer: From Mini-Open to Full-Arthroscopic Procedure. Pifalls, Techniques and Results

Introduction: the transfer of Latissimus Dorsi (LD) by dual approach axillary and trans-deltoid was proposed by Christian Gerber in 1988 to treat chronic postero-superior lesions of the rotator cuff. It is an adaptation of Hoffer's combined LD and Teres Major (TM) transfer technique published in 1978 for the treatment of sequelae of obstetric palsy of C5 and C6 roots (Erb’s palsy).
Technic: the operation is performed in a beach chair position. A posterior step locates the triangular space medial to the Long Triceps (LT) tendon and below the spine of the scapula. The axillary nerve is visible at the exit of the quadrangular space. The anterior step marks the humeral insertion of the Latissimus Dorsi tendon behind the Pectoralis Major and medial from the long head bicipital groove. The axillary (vertical) nerve dives back into the quadrilateral space. The radial nerve crosses the superficial face of the LD. The intermuscular septum is released between LD and LT then a double “Krackow” type suture is made to “uncross” the transfer back to its humeral reinsertion zone.
Results: when this transfer heals, the improvement in shoulder function is significant. The reinsertion of the transfer should ideally be located in the area of insertion of the infraspinatus.
Conclusion: the "all-arthroscopic" transfer of the Latissimus Dorsi should improve the results of open surgery through better anatomical control and less soft tissues damage.