The biomechanical role of the subscapularis in latissimus dorsi transfer for the treatment of irreparable rotator cuff tears

Inferior functional results of latissimus tendon transfer for the treatment of irreparable rotator cuff tears have been reported in the presence of a subscapularis tendon tear. A biomechanical or experimental explanation for the necessity of an intact subscapularis is unavailable. It was, therefore, the purpose of this investigation to study the biomechanical role of the subscapularis in the treatment of a posterosuperior rotator cuff tear with latissimus dorsi transfer. A biomechanical cadaveric model was developed to reproduce glenohumeral motion patterns created by loading of the transferred latissimus dorsi tendon with and without simultaneous action of the subscapularis muscle. Significant differences could be demonstrated not only for translation but also for rotation of the humeral head depending on subscapularis action. In the neutral and in the abducted/externally rotated position of the arm, anterior translation and dislocation of the joint were encountered without subscapularis action. Our results provide evidence that motion patterns of the humeral head are significantly altered in the absence of the stabilizing effect of the subscapularis muscle. The inferior functional results of latissimus dorsi transfer in the presence of subscapularis dysfunction are explained by the loss of centering of the humeral head upon abduction and elevation if subscapularis function is deficient.