Latissimus Dorsi Tendon Reconstruction at the Myotendinous Junction With Acellular Dermal Allograft

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.

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Subscapularis Myotendinous Junction Tears Presenting with Posterior Shoulder Pain in Overhead Throwing Athletes

Acta Medica Academica ◽

10.5644/ama2006-124.259 ◽

2019 ◽

Vol 48 (2) ◽

pp. 205

Author(s):

Eric M. Tarkowski ◽

Imran M. Omar ◽

Kevin J. Blount ◽

Stephen M. Gryzlo

Keyword(s):

Shoulder Pain ◽

Case Reports ◽

Acute Onset ◽

Return To Play ◽

Myotendinous Junction ◽

Musculoskeletal Radiology ◽

Presenting Symptoms ◽

Posterior Shoulder ◽

Overhead Throwing ◽

Baseball Pitchers

Objective. Acute inferior subscapularis myotendinous junction injuries are occasionally seen in overhead throwing athletes, and can present with posterior shoulder pain.Case Reports. Four professional baseball pitchers presented with acute onset of posterior shoulder pain while pitching. After thorough, routine physical examination of the shoulder by the referring orthopaedic surgeon magnetic resonance imaging (MRI) was performed within 7-10 days of the onset of presenting symptoms and interpreted in consensus by 2 fellowshiptrained musculoskeletal radiologists with 9 and 5 years of experience and a musculoskeletal radiology fellow. The patients were then treated conservatively for subscapularis musculotendinous injuries and clinically assessed for symptom resolution before they were allowed to return to play.Conclusion. Inferior subscapularis myotendinous junction injuries should be included in the differential diagnosis of baseball pitchers with posterior shoulder pain.

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Immediate breast reconstruction following segmentectomy using a latissimus dorsi 'myoadipose' flap through a single axillary incision: a case series

Cases Journal ◽

10.4076/1757-1626-2-8116 ◽

2009 ◽

Vol 2 (1) ◽

pp. 8116 ◽

Cited By ~ 1

Author(s):

Vijay Naraynsingh ◽

Seetharaman Hariharan ◽

Dilip Dan

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Case Series ◽

Immediate Breast Reconstruction ◽

Axillary Incision

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Sports Injuries to the Latissimus Dorsi and Teres Major

The American Journal of Sports Medicine ◽

10.1177/0363546516676062 ◽

2016 ◽

Vol 45 (10) ◽

pp. 2428-2435 ◽

Cited By ~ 8

Author(s):

Benjamin F. Donohue ◽

Marc G. Lubitz ◽

Timothy E. Kremchek

Keyword(s):

Latissimus Dorsi ◽

Sports Injuries ◽

Case Reports ◽

Case Series ◽

Standard Of Care ◽

Operative Management ◽

Nonoperative Treatment ◽

Return To Play ◽

Surgical Patient ◽

Teres Major

Injuries to the latissimus dorsi and teres major muscles, while rare, are debilitating. They are seen in a variety of sports, although disproportionately in the throwing shoulder of baseball pitchers. There have been 25 case reports and 2 case series published on the nonoperative and operative management of these injuries. Latissimus dorsi and teres major muscle anatomy, function, and common injury patterns are well described in these case reports. Also well detailed are the typical patient presentation, physical examination, and imaging findings. Latissimus dorsi tendon injuries are sometimes treated operatively, whereas latissimus dorsi muscle belly or isolated teres major injuries are treated nonoperatively. Nonoperative treatment includes oral anti-inflammatories and shoulder physical therapy. A number of surgical patient positions, approaches, and fixation constructs have been described, although 2 techniques of positioning and surgical approach are used most commonly. Fixation is most often performed with suture anchors. Return-to-play timing, shoulder strength, and healing on magnetic resonance imaging are variable. No standard of care currently exists for the treatment of latissimus dorsi or teres major injuries. If treating a patient with an injury to either muscle, the clinician should be familiar with accumulated experience as reported in the published literature.

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Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-097659 ◽

2017 ◽

Vol 52 (2) ◽

pp. 83-88 ◽

Cited By ~ 24

Author(s):

Anne D van der Made ◽

Emad Almusa ◽

Rod Whiteley ◽

Bruce Hamilton ◽

Cristiano Eirale ◽

...

Keyword(s):

Case Series ◽

Return To Play ◽

Hamstring Injury ◽

Full Thickness ◽

Retrospective Case ◽

Cross Sectional ◽

Male Athletes ◽

Serious Injury ◽

The Individual ◽

Mean Time

BackgroundHamstring injury with intramuscular tendon involvement is regarded as a serious injury with a delay in return to play (RTP) of more than 50 days and reinjury rates up to 63%. However, this reputation is based on retrospective case series with high risk of bias.ObjectiveDetermine whether intramuscular tendon involvement is associated with delayed RTP and elevated rates of reinjury.MethodsMRI of male athletes with an acute hamstring injury was obtained within 5 days of injury. Evaluation included standardised MRI scoring and scoring of intramuscular tendon involvement. Time to RTP and reinjury rate were prospectively recorded.ResultsOut of 70 included participants, intramuscular tendon disruption was present in 29 (41.4%) injuries. Injuries without intramuscular tendon disruption had a mean time to RTP of 22.2±7.4 days. Injuries with <50%, 50%–99% and 100% disruption of tendon cross-sectional area had a mean time to RTP of 24.0±9.7, 25.3±8.6 and 31.6±10.9 days, respectively. Injuries with full-thickness disruption took longer to RTP compared with injuries without disruption (p=0.025). Longitudinal intramuscular tendon disruption was not significantly associated with time to RTP. Waviness was present in 17 (24.3%) injuries. Mean time to RTP for injuries without and with waviness was 22.6±7.5 and 30.2±10.8 days (p=0.014). There were 11 (15.7%) reinjuries within 12 months, five (17.2%) in the group with intramuscular tendon disruption and six (14.6%) in the group without intramuscular tendon disruption.ConclusionTime to RTP for injuries with full-thickness disruption of the intramuscular tendon and waviness is significantly longer (by slightly more than 1 week) compared with injuries without intramuscular tendon involvement. However, due to the considerable overlap in time to RTP between groups with and without intramuscular tendon involvement, its clinical significance for the individual athlete is limited.

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Immediate breast reconstruction following segmentectomy using a latissimus dorsi `myoadipose? flap through a single axillary incision: a case series

Cases Journal ◽

10.4076/1757-1627-2-8116 ◽

2009 ◽

Author(s):

Vijay Naraynsingh

Keyword(s):

Breast Reconstruction ◽

Latissimus Dorsi ◽

Case Series ◽

Immediate Breast Reconstruction ◽

Axillary Incision

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Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120981649 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098164

Author(s):

Steven F. DeFroda ◽

Devan D. Patel ◽

John Milner ◽

Daniel S. Yang ◽

Brett D. Owens

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Odds Ratio ◽

Cruciate Ligament ◽

Case Series ◽

National Basketball Association ◽

High Rate ◽

Return To Play ◽

Lower Percentage ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR). Purpose/Hypothesis: To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2. Study Design: Case series; Level of evidence, 4. Methods: An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints. Results: A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season ( P = .0056). Performance in the second postoperative season was not significantly different versus preinjury. Conclusion: NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.

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Histological case series of human acellular dermal matrix in superior capsule reconstruction

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.01.019 ◽

2021 ◽

Author(s):

Evan S. Lederman ◽

Julie B. McLean ◽

Kurt T. Bormann ◽

Dan Guttmann ◽

Kenneth D. Ortega ◽

...

Keyword(s):

Case Series ◽

Acellular Dermal Matrix ◽

Dermal Matrix ◽

Superior Capsule Reconstruction ◽

Acellular Dermal ◽

Human Acellular Dermal Matrix

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Citation Analysis in Breast Reconstruction Publications Between 2000 and 2010

Plastic Surgery ◽

10.1177/22925503211049947 ◽

2021 ◽

pp. 229255032110499

Author(s):

Rebecca Miller ◽

Sheina Macadam ◽

Daniel Demsey

Keyword(s):

Breast Reconstruction ◽

Citation Analysis ◽

Case Series ◽

Acellular Dermal Matrix ◽

Fat Grafting ◽

Fat Graft ◽

Level Of Evidence ◽

Dermal Matrix ◽

Number Of Patients ◽

Acellular Dermal

Introduction and Purpose: Breast reconstruction is an active area of plastic surgery research. Citation analysis allows for quantitative analysis of publications, with more citations presumed to indicate greater influence. We performed citation analysis to evaluate the most cited papers on breast reconstruction between 2000 to 2010 to identify contemporary research trends. Methods: The SCI-EXPANDED database was used to identify the 50 most cited papers. Data points included authorship, publication year, publication journal, study design, level of evidence, number of surgeons/institutions, center of surgery, primary outcome assessed, implant/flap/acellular dermal matrix/fat graft, acellular dermal matrix brand and use with implants/flaps, fat graft use with implants/flaps, unilateral/bilateral, one-/two-stage, immediate/delayed, number of patients/procedures, complications. Descriptive analysis of trends was performed based on results. Results: 20% of papers were published in 2006, 16% in 2007 and 12% in both 2004/2009. 66% were published in Plastic and Reconstructive Surgery. The majority were retrospective or case series, and of Level III or IV evidence. The one Level I study was a prospective multicenter trial. 21 and 7 papers discussed procedures by single/multiple surgeons, respectively. Results from single/multiple centers were discussed in 18 and 6 papers, respectively. 30 papers discussed implant-based reconstruction, 22 papers flap-based (19 microsurgical), 15 papers acellular dermal matrix, and five papers fat grafting. The primary focus in the majority was complications or outcomes. Conclusion: Our analysis demonstrates continually evolving techniques in breast reconstruction. However, there is notable lack of high quality evidence to guide surgical decision-making in the face of increasing surgical options.

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