Hi, it's a real pleasure to be here on behalf of the Argentine Arthroscopy Association. I would like to thank Diana to become us as a guest as invited nation. Okay, let's talk about latissimus dorsi augmentation, not only a transfer. As we already know and as we already seen for the previous speaker, if you do a good job when you're isolated, massive calf repair, you will have good results and we all know that. But we know that this good result tend to end in time and you will have structural failure even if you got clinical results. So we know that this good, best, massive calf repairs goes well, but we are cornered that we got to improve our results. So when you got an issue, you got two ways of thinking. You do it completely different or you improve the good result that you already have. So how it's doing differently, you could do a latissimus dorsi, but you know the latissimus dorsi got some issues with external rotator and also deteriorates with time. You do the STAR, the superior capsular repair, that also is quite different doing as a massive calf repair, or you try to improve what you already got. For example, you do your massive calf repair plus a graft. So this is other way. And I would like to introduce other way of improving result is this one. Latissimus dorsi, as we know, we got some issue about external rotation, but what about if we do our lat dorsi just before doing, after doing your rotator calf repair? So why don't we do both? We do our regular repair in the lateral decubitus. So we got the only thing that we should do the repair, it's very stable, so we can move around the calf easily and then remove the arm from traction and, sorry. We remove the arm from traction. Let's go to the next slide, please. And while removing the arm from traction, we can take out our tendon. Be very careful with the neurovascular bundle. To do, you use fiber tape and then you put your arm in traction, put the tendon on the posterior part and regain all the suture from the anterior part and put it with a knotless suture and you see here the tendon on top of the previous rotator calf repair. So this is ongoing work for eight years for me. Next slide, please. So another tool is we have the patient. It's very important to aware the patient of the activation of the latissimus dorsi. So before doing the surgery, they should start doing this, adduction and external rotation. So they are aware of the activation of the latissimus dorsi in the new transfer position. So you can do it quite easily after the procedure. This is a case of, of course, the best one, as always. And this is a guy, 52 years old, with a paracetamol in the other side. Nearly no motor tendons, huge, massive tear. This was the previous case. And this is the guy four years later. And as we see, he got good external scales and also good internal rotation. He got good subscapular. I'm sorry for the last video. This is eight years and send it by WhatsApp. Next slide, please. Eight years and still doing the same. So next slide, please. Just to finish, we got, we are doing a lot of things right now. We don't, should not forget remembering how good is the isolated massive calf repair. And we should see at the long term of all the things that we're doing right now. So this is another way, and I expect that it goes well in time. Thank you so much.

Argentine Arthroscopy Association

latissimus dorsi muscle

shoulder surgeries

rotator cuff repair

graft