BACKGROUND: Combined latissimus dorsi and teres major
musculotendinous transfer has been described for the treatment of massive
rotator cuff deficits. The procedure is technically complex because of the
proximity of the radial nerve, the axillary nerve and its posterior branches,
and the neurovascular bundles to the muscles. The purpose of the present
cadaveric study was to examine surgically relevant relationships for
latissimus dorsi and teres major tendon transfers.
METHODS: Twelve cadaveric shoulder girdles were dissected, and the
latissimus dorsi, the teres major, and the posterior cord of the brachial
plexus and its branches were identified. The relationships between the tendons
and local neurologic structures were measured during various steps of the
latissimus dorsi/teres major transfer procedure. The effect of humeral
rotation on the exposure of the latissimus dorsi and teres major tendons
through the posterior approach was quantified, and relevant surgical landmarks
RESULTS: The radial nerve passed directly anterior to the tendons at
an average of 2.9 cm medial to the superior aspect and 2.3 cm medial to the
inferior aspect of the humeral insertions. From the posterior axillary
approach, maximal internal rotation facilitated exposure for tenotomy by
delivering the tendon insertions on the humerus into the surgical field.
During axial mobilization of the musculotendinous units, the neurovascular
pedicles to the latissimus dorsi and teres major were identified at an average
of 13.1 and 7.4 cm axial to the humeral insertions, respectively. The
posterior branch of the axillary nerve was noted to cross superficially over
the transferred tendons as they were tunneled under the posterior deltoid.
CONCLUSIONS: Multiple steps of the combined latissimus dorsi and
teres major musculotendinous transfer place local neurologic structures at
risk. These steps include tendon release, musculotendinous axial mobilization,
and tendon tunneling in the plane between the infraspinatus-teres minor and
the posterior deltoid. We have quantified and described the relationship of
the axillary and radial nerves to the tendons during tenotomy, the distance
from the tendons' insertions to their neurovascular bundle that must be
identified during axial mobilization, and the course of the posterior branch
of the axillary nerve in relation to the tunneled path of the tendons.
CLINICAL RELEVANCE: The present study provides important anatomic
findings for the safe mobilization and transfer of the latissimus dorsi and
teres major tendons during the surgical treatment of irreparable rotator cuff
ORIGINAL ABSTRACT CITATION: "Surgical Technique and Anatomic Study of
Latissimus Dorsi and Teres Major Transfers"