Latissimus dorsi transfer for irreparable rotator cuff tears. Surgical technique and evaluation of a series of 20 patients

Twenty patients with twenty irreparable full thickness tears of at least two complete tendons were managed with latissimus dorsi transfer and were reviewed clinically by UCLA score, by Visual Analog Scale for pain and radiographically by Hamada classification. In three patients only tendinous transfer was performed, in four patients we associated acromioplasty and in 13 patients we associated both acromioplasty and distal resection of 1 cm of the clavicle according to Mumford's technique. The average age was 63.9 years. The average follow up was 58 months (24 to 104 months). Postoperatively, 13 patients had 27 points, six patients had 21 to 27 points and only one patient had 9 points in UCLA score. The external rotation improved to an average of 50 degrees, and the abduction improved an average of 66 degrees. One patient had are rupture with no improvement of his shoulder function and pain. The Visual Analogic Scale for pain improved from nine to one point. Nineteen patients were satisfied with the procedure. The radiological evaluations showed two patients in stage one, 11 patients in stage two, six patients in stage three and only one patient in stage four of Hamada classification; therefore, there were no significant osteoarthritic changes.