Title: A unique case of La􀆟 ssimus Dorsi Tendon Avulsion injury in an athlete cycling anabolic steroids and successful delayed repair u􀆟 lizing an intracor􀆟 cal bu􀆩 on technique

Biography:

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.

Abstract

La􀆟 ssimus Dorsi is a large pectoral girdle muscle and powerful
arm adductor (1, 2). Avulsion injuries of its tendinous
inser􀆟 on into the humerus are incredibly rare. Surgical repair
has rarely been reported, literature showing fewer than 15
cases, most with tendon augmenta􀆟 on (1, 3-8). This unique
and complex case of a delayed La􀆟 ssimus Dorsi avulsion injury
in a power-li􀅌 ing athlete cycling anabolic steroids. Using an
intracor􀆟 cal bu􀆩 on technique, we proposed that this robust
repair would enable restora􀆟 on of full func􀆟 on, strength and
cosme􀆟 c defects. 28-year-old compe􀆟 􀆟 ve powerli􀅌 er cycling
anabolic androgenic steroids and testosterone presented
15 weeks post injury. Clinical examina􀆟 on revealed obvious
asymmetry, tenderness and posterior axillary fold defect.
Profound weakness of resisted arm adduc􀆟 on. MRI revealed
absent La􀆟 ssimus Dorsi inser􀆟 on, tendon stump in axilla.
Surgical repair was undertaken via dual axillary approach.
Retracted tendon mobilised and two 􀆟 tanium bu􀆩 ons with
integrated Fibrewire Sutures (Arthrex Inc) created a modifi ed
Krakow suture, a novel technique. A dual fi xa􀆟 on point at its
anatomical inser􀆟 on was created using an intracor􀆟 cal bu􀆩 on.
We described a successful delayed repair of this chronic injury
without the need for tendon augmenta􀆟 on. Dual approach
assists with tendon mobiliza􀆟 on and prepara􀆟 on, along with
restora􀆟 on of anatomy and strong fi xa􀆟 on at bicipital groove.
Clinical and radiological evidence of recovery without pain,
correc􀆟 on of cosme􀆟 c defects and full return to compe􀆟 􀆟 ve
powerli􀅌 ing. This robust intracor􀆟 cal bu􀆩 on technique
produces a successful La􀆟 ssimus Dorsi tendon avulsion repair
with incredible results leading to restora􀆟 on of full func􀆟 on,
even in the most challenging compe􀆟 􀆟 ve athletes.