Original Article With Video Illustration Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer for Massive, Irreparable Rotator Cuff Tears: Technique and Short-Term Follow-Up of Patients With Pseudoparalysis Ulunay Kanatlı, M.D., Mustafa Özer, M.D., Muhammet Baybars Atao glu, M.D., Burak Ya gmur Öztürk, M.D., Orkun Gül, M.D., Mehmet Çetinkaya, M.D., and Tacettin Ayano glu, M.D. Purpose: To describe a modified technique for arthroscopic-assisted transfer of the latissimus dorsi tendon in a selected group of patients with irreparable rotator cuff tears and pseudoparalysis and to evaluate its short-term results. Methods: Fifteen patients with irreparable rotator cuff tears and pseudoparalysis treated by arthroscopic-assisted latis- simus dorsi tendon transfer were included. The mean patient age was 61.53  6.24 years (range, 52-71 years). Patients were assessed with physical examination, University of California Los Angeles (UCLA) Score and Constant-Murley score, as well as visual analog scale score at a mean follow-up of 26.4  2.58 months (range, 24-31 months). Results: At final follow-up, mean UCLA score increased to 27.47  6.31 compared with the preoperative UCLA score of 6.53  2.1 (P < .001). Constant-Murley score was 21  7.41 and 59.73  13.62 (P < .001), visual analog scale pain score was 7.47  1.06 and 2.47  0.91 (P < .001), active forward flexion was 58   21.11  and 130   30.05  (P < .001), active abduction was 51   21.64  and 129.67   25.45  (P < .001), and active external rotation was 13.33   21.68  and 32   18.03  (P < .001) preoperatively and postoperatively, respectively. Mean acromiohumeral distance was 3.13  1.40 mm preopera- tively, whereas it was 5.67  1.67 mm postoperatively (P < .001). No significant complications requiring a revision surgery was observed during the final follow-up. Conclusions: The modified technique of arthroscopic-assisted transfer of the latissimus dorsi tendon is a feasible, minimally invasive option for the surgical treatment of irreparable rotator cuff tears in a subset of patients with pseudoparalysis. Level of Evidence: Level IV, therapeutic case series. L atissimus dorsi tendon transfer (LDTT) for massive, irreparable rotator cuff tears was described initially in 1988by Gerber et al. 1 With the LDTT to the greater tuberosity, the muscle’s internal rotator force is con- verted to an external rotator force that provides a bal- ance between internal and external rotation. 2,3 Various clinical studies have reported good functional results with conventional, open LDTT. 4-7 The arthroscopic- assisted variant of the LDTT is a relatively new tech- nique that offers the benefits of minimal iatrogenic damage to the deltoid muscle, shorter hospitalization time, and better cosmesis. 8 Pseudoparalysis is defined as the limitation of active shoulder abduction and forward flexion to 90  . It oc- curs as a result of rotator cable disturbance, resulting in limitation of active shoulder motion. Controversy exists regarding whether to perform a rotator cuff repair or an LDTT in presence of pseudoparalysis because of the loss of the rotator cable function, which is important in maintaining force generation and aids in force coupling. 9 In this study, we aimed to describe a modified tech- nique for arthroscopic-assisted transfer of the latissimus From the Department of Orthopaedics & Traumatology, Gazi University School of Medicine, (U.K., M.B.A., T.A.), Ankara; Department of Orthopae- dics & Traumatology, Necmettin Erbakan University Meram School of Med- icine (M.Ö.), Konya; Department of Orthopaedics & Traumatology, Fatih Sultan Mehmet Training and Research Hospital (B.Y.Ö), _ Istanbul; Depart- ment of Orthopaedics & Traumatology, Karadeniz Technical University Fac- ulty of Medicine (O.G.), Trabzon; and Department of Orthopaedics & Traumatology, Erzincan University Mengucek Gazi Training and Research Hospital (M.Ç.), Erzincan, Turkey. The authors report that they have no conflicts of interest in the authorship and publication of this article. Received April 10, 2016; accepted September 26, 2016. Address correspondence to Mustafa Özer, M.D., Department of Orthopae- dics & Traumatology, Necmettin Erbakan University Meram School of Med- icine, Konya 42010, Turkey. E-mail: mozer208@yahoo.com Ó 2016 by the Arthroscopy Association of North America 0749-8063/16299/$36.00 http://dx.doi.org/10.1016/j.arthro.2016.09.023 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 33, No 5 (May), 2017: pp 929-937 929 Downloaded for Anonymous User (n/a) at ULAKBIM Academic Gazi Universitesi from ClinicalKey.com by Elsevier on February 28, 2018. For personal use only. No other uses without permission. Copyright ©2018. Elsevier Inc. All rights reserved.