Recker Andrew J, Torres LeeAnne, Dennis Eric, Scholten Donald J, Waterman Brian R
Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Video J Sports Med. 2021 Sep 28;1(5):26350254211032671. doi: 10.1177/26350254211032671. eCollection 2021 Sep-Oct.
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.
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.
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.
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.
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.
有限的现有数据表明，背阔肌腱重建术是治疗精英过头投掷运动员特定亚群肌腱撕裂的有效方法。
背阔肌腱重建的主要适应症是有症状的全层肱骨撕脱，伴或不伴有大圆肌腱撕裂。手术候选人通常是年轻、高需求、精英或职业过头投掷运动员。在本病例中，患者是一名29岁的男性，曾是小联盟投手，现为投球教练，患有背阔肌腱全层撕脱。
患者取左侧卧位，使用动态肢体定位器将手臂保持在90°外展和最大内旋位。该技术采用单一后腋部切口，切开并解剖至破裂的背阔肌腱。我们在肌-腱交界处环形应用脱细胞真皮同种异体移植物以增强重建效果。随后，采用Krackow缝合技术准备移植物以便转移。使用缝线纽扣通过张力滑动技术将重建的背阔肌腱固定于肱骨近端的解剖足迹处。
一个病例系列显示，所有接受背阔肌重建术的棒球投手均恢复到先前的比赛水平，视觉模拟评分法疼痛评分、美国肩肘外科医师学会评分以及克尔兰-乔贝骨科诊所评分均有显著改善。另一项更大规模的研究表明，职业棒球投手背阔肌撕裂接受非手术或手术治疗后的重返比赛率相当。然而，接受手术治疗的投手表现未下降，而非手术治疗组的一些数据出现了下降。
在肌-腱交界处使用脱细胞真皮同种异体移植物进行背阔肌腱重建术，对于患有全层肌腱撕脱的精英过头投掷运动员来说是一种可行的治疗选择。它能使运动员完全恢复比赛，特别是在患者非手术治疗失败的情况下。
