This video features orthopedic surgeon Dr. Anthony A. Romeo performing a Latissimus Dorsi Tendon Repair on a 24-year-old right-handed baseball pitcher.

The player suffered a complete disruption/avulsion of his latissimus dorsi tendon from the humerus bone after feeling a "pop" while throwing a fastball. Because a complete avulsion makes it incredibly difficult for an elite pitcher to return to peak velocity and performance naturally, the surgical repair was elected to structurally reattach the tendon.

The surgical sequence and rehabilitation process are described below:

Surgical Workflow

1. Incision & Exposure

An incision is made along the outside of the posterior fold of the armpit (axilla). The surgeon dissects through the superficial tissue layers and thin fascia, continuously working toward the anterior aspect to locate the borders of the latissimus dorsi muscle and the intact teres major muscle.

2. Debriding Scar Tissue

Even though the injury occurred only three weeks prior, a significant amount of wavy, disorganized fibrous scar tissue has filled the space. The surgeon uses clamps to secure the retracted tendon, frees up tissue adhesions, and trims away the non-functional scar tissue to expose the healthy edge of the native tendon.

3. Visualizing the Footprint

To protect nearby neurovascular structures, a point Hohmann retractor is carefully placed through the edge of the adjacent, intact teres major tendon. This allows the surgeon a safe, clear view of the latissimus dorsi's original anatomical attachment footprint on the humerus.

4. Preparing the Bone Bed

A surgical burr and elevator are used to scrape down the cortical bone of the humerus. This creates a clean, bleeding bone channel that maximizes the biological potential for the tendon to knit and heal directly to the bone.

5. Cortical Anchor Placement

Working from inferior to superior to manage bleeding, the surgeon drills three holes into the humerus footprint. He inserts specialized cortical bone anchors loaded with both a heavy-duty suture and a high-strength fiber tape. The anchors are eccentrically pulled to ensure they flip and lock securely beneath the bone cortex.

6. Stitching the Tendon

The surgeon passes the suture lines through the edge of the latissimus dorsi tendon. He uses a secure locking stitch pattern for the standard sutures and a running whip-stitch pattern for the flat fiber tapes to combine the sliding strength of sutures with the broad holding power of the tape.

7. Tendon Reduction & Tie-Down

With the arm positioned to minimize tension, the surgeon systematically pulls the slack out of the lines to draw the retracted tendon flush against the prepared bone bed. The native sutures are tied down tightly first, followed by the fiber tapes over the top to maximize structural compression against the humerus.

Post-Operative Rehabilitation

After completing the repair, Dr. Romeo takes the shoulder through a passive range of motion to ensure the reattached tendon sits under appropriate tension, wraps correctly around the anatomy, and does not restrict movement.

• Fascial Closure: The relatively thick fascia separating the latissimus dorsi and the teres major is carefully stitched back together to optimize cosmetic healing and muscle alignment.
• Recovery Outlook: While undergoing a latissimus dorsi repair sidelined the pitcher for the current season, it offered the most reliable path toward restoring full structural integrity and velocity for the subsequent season.