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Endosteal Button Fixation for Latissimus Dorsi Tendon Rupture in a Bodybuilding Athlete
Jasraj S Raghuwanshi1, Jelle P van der List2, Nichole M Perry2
1Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia, USA.
Background:
Bodybuilders are uniquely at risk of shoulder injuries given training intensity, frequency, and heavy overhead loads through a full arc of motion. Latissimus tears are rare injuries that have increased incidence in overhead and weightlifting athletes, following forceful hyperabduction/adduction during sport-specific activities. Humeral avulsions of the latissimus tendon are treated with endosteal button fixation.
Indications:
Endosteal button repair is indicated for acute or chronic latissimus tears up to 2 years after injury, in patients who are unable to return to their desired level of competition or activities of daily living. Retracted tears or repairs under significant tension are often salvageable given the latissimus tendon's ability to stretch, and concurrent teres major injury may be addressed in a similar fashion.
Technique Description:
Latissimus repair entails posterior axillary dissection of the tendinous stump, identification and protection of the radial nerve intersecting the common brachial artery, tagging the tendon with polyethylene suture tape, and reduction to the footprint with endosteal buttons. Key steps of the technique involve protecting the neurovascular bundle and restoring the 90° turn of the tendon before inserting it on the humerus.
Results:
Latissimus repair has excellent patient-reported outcomes and return to elite competition in 2 prior case series of professional overhead athletes. Our patient was able to return to amateur bodybuilding without persistent pain or strength deficit.
Discussion/Conclusion:
Bodybuilders are at a unique risk of latissimus tendon ruptures given their high-demand training. Here, we present our best practices for endosteal button fixation in this unique population of athletes.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.