Ten-year Survivorship after Anterior Latissimus Dorsi Transfer for Irreparable Subscapularis, Followed by Conversion to Reverse Total Shoulder Arthroplasty: A Case Report

Introduction: Anterior latissimus dorsi tendon transfer (LDT) is a joint-preserving procedure for irreparable subscapularis (SSC) tears, providing pain relief and functional improvement. However, progressive glenohumeral osteoarthritis may develop over time. When arthritic changes become advanced, conversion to reverse total shoulder arthroplasty (rTSA) may be required. This report describes the long-term survivorship of anterior LDT and subsequent conversion to rTSA with preservation of the transferred tendon. Case Report: A 61-year-old woman underwent anterior LDT for an irreparable SSC tear. Ten years later, she developed painful dysfunction and radiographic evidence of advanced glenohumeral osteoarthritis. rTSA was performed while preserving the LDT insertion on the lesser tuberosity. At the 2-year follow-up, pain decreased markedly (Visual Analog Scale 6→1), functional scores improved (Constant 56→87; American Shoulder and Elbow Surgeons 59→87), and range of motion was enhanced (forward elevation 165°, external rotation 50°, internal rotation T12). Radiographs confirmed stable fixation of prosthetic components, and ultrasonography demonstrated an intact, well-preserved LDT. Conclusion: Anterior LDT can provide durable functional benefit for up to a decade in irreparable SSC tears. When degenerative progression necessitates arthroplasty, conversion to rTSA with preservation of the tendon transfer can achieve excellent outcomes, particularly in maintaining internal rotation strength. Keywords: Irreparable subscapularis tear, latissimus dorsi tendon transfer, reverse shoulder arthroplasty.