Performing a Latissimus Dorsi Transfer: A Conversation with Dr. Uma Srikumaran
Editor’s note: During the upcoming Critical Concepts in Shoulder & Elbow Surgery course, Dr. Umasuthan Srikumaran will present on the topic, Latissimus Transfer for Irreparable Subscapularis Tears. We asked Dr. Srikumaran to preview the key points of this talk.
FORE, the Foundation for Orthopaedic Research and Education: One of your presentations will address management of irreparable subscapularis tears. Why is this an important topic to include in the agenda for Critical Concepts in Shoulder & Elbow Surgery?
Umasuthan Srikumaran, MD, MBA: The subscapularis is the biggest and perhaps most important rotator cuff tendon. A compromised subscapularis can lead to notable disability and shoulder dysfunction. It is particularly important for this tendon to heal after total shoulder arthroplasty.
When the subscapularis does not heal, the surgeon needs a reliable surgical technique to salvage the tendon. Latissimus dorsi transfer offers a non-reverse shoulder arthroplasty solution that can substantially improve pain and function in patients with an irreparable subscapularis tear.
FORE: Why is the latissimus dorsi muscle the best option when a tendon transfer is indicated to manage an irreparable subscapularis tear?
Dr. Srikumaran: This transfer respects the major principles for an effective tendon transfer, namely, a similar line of pull, adequate excursion and appropriate tension, and a 1:1 function.
FORE: How often do you perform a latissimus dorsi transfer for an irreparable subscapularis tear, and what outcomes have you observed? What is the success rate for this surgery – and how do you define “success” in these patients?
Dr. Srikumaran: Latissimus dorsi transfer is an uncommon procedure, as irreparable subscapularis tears are rare. In the small group we have done for both native cases and failed subscapularis repairs following total shoulder arthroplasty, we have noted substantial improvements in humeral head position, glenohumeral motion, and strength, which were all meaningful for our patients.
FORE: What are the key points you want attendees to take away from your presentation?
Dr. Srikumaran: I want them to understand:
- The indications for latissimus dorsi transfer
- The construct biomechanics
- The clinical evidence supporting its use
- The technical approach to perform the procedure safely
ABOUT THE EXPERT
Umasuthan Srikumaran, MD, MBA, is vice chair of quality, safety, and service for the Department of Orthopaedics at Johns Hopkins University School of Medicine; director of the Johns Hopkins Shoulder Fellowship; and an associate professor of orthopaedic surgery. He treats patients with shoulder pain, rotator cuff disease, traumatic injuries, instability, fractures, osteoarthritis, and sports-related injuries.
ABOUT THE COURSE
Dr. Srikumaran is among the 29 faculty members of the completely redesigned Critical Concepts in Shoulder & Elbow Surgery, taking place November 14-16, 2024, at FIVE Labs Las Vegas.
This is the only course where you’ll learn how to do shoulder and elbow procedures by actually doing them. We aren’t going to tell you how to address a rotator cuff tear, or tackle shoulder instability, or expose the glenoid and humerus for anatomic shoulder replacement. We’re going to show you, and then we’re going to coach you as you perform the techniques on anatomic specimens in our brand-new, state-of-the-art bioskills lab.
Click here for more information and to register for the course.