Surgical anatomy, biomechanics and clinical outcomes of latissimus dorsi transfer for irreparable rotator cuff tears: a review

Abstract

BACKGROUND: Latissimus dorsi transfer is a well-established joint-preserving option for irreparable rotator cuff tears in young, active patients without glenohumeral arthritis. Originally described by Gerber in 1988 for posterosuperior tears, indications now also include anterosuperior reconstruction, either as isolated transfer to the lesser tuberosity or in combination with the teres major. No recent review has integrated surgical anatomy, biomechanics, fixation strategies, clinical outcomes and patient selection in a single resource. MAIN TEXT: We reviewed the anatomy, biomechanics, surgical technique, outcomes, and patient selection for latissimus dorsi transfer, drawing on the PubMed/MEDLINE literature through January 2026. For posterosuperior tears, the transfer reduces pain and improves external rotation, with sustained gains at follow-up beyond ten years. Patients with pseudoparesis show the largest functional gains. Subscapularis insufficiency, Goutallier 3-4 fatty infiltration of the teres minor, and prior failed repair predict poor outcome. For anterosuperior tears, anterior latissimus dorsi transfer or combined latissimus dorsi and teres major transfer restores internal rotation and reduces anterior subluxation, with outcomes comparable to pectoralis major transfer and a line of pull that better matches the subscapularis. Arthroscopic and open techniques produce comparable functional outcomes in published series. CONCLUSIONS: Latissimus dorsi transfer is the most biomechanically rational joint-preserving option for irreparable rotator cuff tears in younger, active patients without glenohumeral arthritis. Reverse shoulder arthroplasty remains the salvage option when arthritis is present or in older patients. Patient selection is the most important determinant of outcome.