PMC5282417_01
Drawings (a) and (b) show how a LDT is typically transferred and sewn to the defect where the rotator cuff would normally insert. Drawing (c) shows how we extended the tendon with two allograft patches. The running stitches along the margins of the LDT shown in (a) were also done, but this is not shown in (c) (images (a) and (b) are reproduced from with permission of the Journal of Bone and Joint Surgery, Inc.).
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fig1
A number 2 nonabsorbable suture was passed with use of a Krakow suture technique along each side of the tendon from the musculotendinous junction to the end of the tendon (Figure 1(a)). In the conventional surgical technique, the latissimus dorsi muscle and tendon are routinely brought over the top of the humeral head and repaired anterior to the subscapularis, lateral to the greater tuberosity, and medial to the torn edges of the rotator cuff (Figure 1(b)). The folded margins of the patches were sewn together with number 2 nonabsorbable sutures (Figure 1(c)). The first patch was overlapped on the free end of the LDT by 12.5 mm and was then sutured with two rows of nonabsorbable number 2 sutures (Figure 1(c)). A Krakow suture technique with number 2 suture was then passed along the sides of the latissimus tendon to the free end of the graft extension as shown in Figure 1(a). As described below, the extended LDT was then attached directly to the "footprint" that was created for the supraspinatus, upper infraspinatus, and upper subscapularis (Figure 1(b)).
Photograph showing the patient's left shoulder motion at 18-month follow-up (active forward flexion is 165 ). Preoperative photographs were not available, but active forward flexion was only 65 .
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fig2
At follow-up 18 months later, the patient had regained significant strength and range of motion in his left shoulder (Table 1 and Figure 2).
A series of adjacent coronal MR images taken at 18 months after surgery showing the graft (thin white arrow) and suture anchor (thicker white arrow). Mild arthritic changes are also seen.
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fig3
The graft was found to be intact and without evidence of thinning (Figure 3).