PMC9122720_01
Clinical photographs: preoperative clinical photograph (a), six weeks after injury, demonstrating some residual left hemithoracic and axillary swelling with ecchymosis and a less conspicuous posterior axillary fold. Postoperative clinical photograph (b), one year after surgery, demonstrating symmetric contour of the left axillary fold and restoration of muscle bulk of the latissimus dorsi and teres major.
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Physical examination was remarkable for extensive ecchymosis around the posterior aspect of the arm and left hemithorax, as well as swelling in the posterior axillary region (Figure 1(a)). He had normal contour of the left posterior axillary fold and full shoulder ROM (Figure 1(b)).
Edema and fluid are noted along the medial aspect of the proximal humerus, originating near the medial margin of the distal bicipital groove. There is a full-thickness, retracted tear of the latissimus dorsi humeral attachment, with retraction of tendon fibers approximately 2.5 cm medially and 2 cm distally. The teres major humeral attachment shows irregularity along its inferior margin (a). Intraoperative pictures demonstrating the torn latissimus dorsi (right arrow) and teres major (left arrow) tendons after adequate mobilization (b). The two tendon ends were secured together in a conjoint fashion using high-strength nonresorbable sutures in a Krackow fashion (c). The footprint was prepared, and sutures were passed through the cortical button and inserted into the medullary canal via unicortical drill holes. The tendon was reduced to the footprint using the sliding suture technique (d).
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Magnetic resonance imaging demonstrated a retracted full-thickness tear of the LD tendon and irregularity of the TM humeral footprint (Figure 2(a)). Both tendons were mobilized and able to reach their insertional footprint for a direct primary repair (Figure 2(b)). Two high-strength, nonresorbable sutures were placed in a Krackow fashion to run up and down two inches of the tendon lengths (Figure 2(c)). The tendon was secured to the insertional footprint using two cortical buttons (Figure 2(d)).