Background: Limited available data have shown latissimus dorsi tendon reconstruction to be an effective treatment for tendon tears in specific subpopulations of elite overhead throwing athletes. Indications: Primary indication for latissimus dorsi tendon reconstruction is a symptomatic, full-thickness humeral avulsion with or without a concomitant teres major tendon tear. Surgical candidates are typically young, high-demand, elite or professional overhead throwing athletes. In this case, the patient is a 29-year-old male former minor league pitcher and current pitching coach with a full-thickness avulsion of the latissimus dorsi tendon. Technique Description: The patient was positioned left lateral decubitus with a dynamic limb positioner maintaining the arm in 90° abduction and maximal internal rotation. This technique used a single posterior axillary incision, which was performed and dissected down to the ruptured latissimus dorsi tendon. We circumferentially applied an acellular dermal allograft to augment the reconstruction at the myotendinous junction. Subsequently, the construct was prepared for transfer with a Krackow suture technique. Suture buttons were used to secure the reconstructed latissimus dorsi tendon to the anatomic footprint on the proximal humerus with a tension slide technique. Results: One case series showed return to the previous level of competition for all baseball pitchers who underwent a latissimus dorsi reconstruction with excellent improvement in visual analog scale pain, American Shoulder and Elbow Surgeons, and Kerlan-Jobe Orthopaedic Clinic scores. Another larger study demonstrated equal return to play rates for professional baseball pitchers with a latissimus dorsi tear treated either nonoperatively or operatively. However, those treated operatively had no decline in performance, whereas the nonoperative cohort saw decline in some statistics. Conclusion: Latissimus dorsi tendon reconstruction using an acellular dermal allograft at the myotendinous junction is a viable treatment option for elite overhead throwing athletes with full-thickness tendon avulsions. It allows for full return to play, particularly if the patient has failed nonoperative management.

The use of biologics in sports medicine is increasing rapidly. Bone marrow concentrate has recently increased in popularity because it includes mesenchymal stem cells which, combined with AlloSync Pure, could lead to better incorporation and healing. The mixture of bone marrow concentrate and Allosync Pure can be used in anterior cruciate ligament reconstruction. We recently expanded on this approach with the addition of saving the host bone normally lost from tunnel reaming, using the GraftNet. After harvesting the autograft bone, we combine it with the AlloSync Pure and bone marrow concentrate. In this Technical Note, we show how this unique biologic composite is obtained and then added back into the tunnels on both the femur and tibia during a quadriceps tendon autograft all-inside anterior cruciate ligament reconstruction.

Introduction: Digastric is a suprahyoid muscle and usually consists of two bellies. Its action consists in drawing the mental region downwards and backwards when opening the mouth, resulting in the depression of the mandible. Methods and Results: During a routine dissection of the cervical region, a muscle bundle arising from the intermediary tendon going towards the middle line was found. The supranumerary belly arised from the intermediary tendon so that some bundles inserted on the middle rafe and others continued towards the mento and inserted on the belly of mylohyoid muscle at the same side. These anatomic variations on the anterior belly of the digastric muscle could be significant during surgical procedures involving the submental region. Conclusion: Besides this surgical importance, we suggest that these supranumerary bellies have no direct action on the mandible, but on the floor of the mouth, due to its insertions on the mylohyoid muscle.

No abstract