A unique case of Latissimus Dorsi Tendon Avulsion injury in an athlete cycling anabolic steroids and successful delayed repair utilizing an intracortical button technique

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Waters G

Fiona Stanley Fremantle Hospitals Group, Australia

: J Surg Clin Pract

Abstract

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Latissimus Dorsi is a large pectoral girdle muscle and powerful arm adductor (1, 2). Avulsion injuries of its tendinous insertion into the humerus are incredibly rare. Surgical repair has rarely been reported, literature showing fewer than 15 cases, most with tendon augmentation (1, 3-8). This unique and complex case of a delayed Latissimus Dorsi avulsion injury in a power-lifting athlete cycling anabolic steroids. Using an intracortical button technique, we proposed that this robust repair would enable restoration of full function, strength and cosmetic defects. 28-year-old competitive powerlifter cycling anabolic androgenic steroids and testosterone presented 15 weeks post injury. Clinical examination revealed obvious asymmetry, tenderness and posterior axillary fold defect. Profound weakness of resisted arm adduction. MRI revealed absent Latissimus Dorsi insertion, tendon stump in axilla. Surgical repair was undertaken via dual axillary approach. Retracted tendon mobilised and two titanium buttons with integrated Fibrewire Sutures (Arthrex Inc) created a modified Krakow suture, a novel technique. A dual fixation point at its anatomical insertion was created using an intracortical button. We described a successful delayed repair of this chronic injury without the need for tendon augmentation. Dual approach assists with tendon mobilization and preparation, along with restoration of anatomy and strong fixation at bicipital groove. Clinical and radiological evidence of recovery without pain, correction of cosmetic defects and full return to competitive powerlifting. This robust intracortical button technique produces a successful Latissimus Dorsi tendon avulsion repair with incredible results leading to restoration of full function, even in the most challenging competitive athletes.

Biography

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Georgina Waters is an Orthopaedic Registrar at Fiona Stanley Hospital in Perth, Australia. She completed her post-graduate Bachelor of Medicine and Surgery at the University of Western Australia in 2014.

E-mail: georginacwaters@gmail.com