Latissimus Dorsi Tendon Repair

Abstract

Latissimus dorsi tendon ruptures are less-common injuries that can occur in elite throwing athletes. Physical examination of the thrower with a latissimus injury may show ecchymosis of the upper arm and asymmetry of the posterior axillary fold along with possible weakness in shoulder adduction, extension, and internal rotation. Magnetic resonance imaging is used to confirm the diagnosis. Latissimus tendon ruptures are largely treated nonoperatively; surgical repair is only advocated for in professional throwing athletes with complete avulsion injuries or midsubstance latissimus tendon tears. Surgical repair options include the use of suture anchors, cortical suture buttons, or transosseous sutures via a single posterior axillary incision or a 2-incision technique. Given the limited literature on this topic, there have been no studies evaluating the different fixation options or surgical approaches for tendon repair. This article and accompanying video show the technique and discusses the technical pearls of a latissimus tendon repair using suture button fixation via a single-incision approach.

Teres Major and Latissimus Dorsi Repair With Biceps Tenodesis Utilizing Cortical Suspensory Fixation Buttons

“…There are no comparative biomechanical studies for fixation in LD and TM repair, but suture buttons have displayed superior strength in distal biceps. 7 Disadvantages to this technique include the technically demanding nature of this procedure, increased operative time due to two incisions, and the potential for foreign body reaction from the use of cortical suspensory fixation buttons. Although extremely rare, there is a report of a pitcher who sustained a spiral humeral shaft fracture originating from the inferior-most unicortical button drill hole 12 months postoperatively following a TM and LD repair.…”

Single incision latissimus dorsi surgical technique: a three button repair

“…6 The senior author prefers a small posterior axillary single incision approach comparable to previously described single incision techniques. 1,7,8 This incision combined with lateral decubitus positioning provides excellent exposure of the retracted tendon and the humeral insertion. Direct exposure of the humerus can be achieved with a relatively small incision and allows for appropriate intra-operative adjustments, easy identification of the entirety of the humeral insertion and appropriate tensioning assessment after repair.…”

Man with sharp pain in left upper back

“…4 Following surgery patients are expected to return to light activity at 3-4 months and return to competition around 6-8 months. 5…”