Anterior cruciate ligament (ACL) tears in skeletally immature patients are on the rise; pediatric athletes are now in constant year-round sports participation. Nonoperative treatment may lead to poor functional outcomes and an increase in associated intra-articular lesions and sometimes can cause drop-out from sports activity. The treatment of these injuries is not at all clear, and appropriate guidelines do not exist. Physeal-sparing and partial physeal-sparing techniques have been described. Concerns about restoring normal knee kinematics with the previously described ACL reconstruction (ACLR) techniques are open to debate. We describe a partial epiphyseal ACLR to be done in skeletally immature patients involved in highly demanding sport activities. This technique is performed with an extraphyseal femoral tunnel drilled retrograde, a transphyseal tibial tunnel, and a retrograde tibial drilling without trespassing the tibial physis. We added a modified Lemaire procedure to improve rotational instability to the previously performed ACLR.
RESUMEN La reconstrucción del ligamento cruzado anterior es hoy una de las cirugías más frecuentes en el mundo. Sin embargo, ha supuesto un reto para los cirujanos desde principios del siglo XX y todavía quedan aspectos técnicos y biomecánicos controvertidos. La artroscopia ha facilitado mucho la recuperación de los pacientes y los resultados de larga evolución. Muchos autores han participado en su desarrollo, aunque algunos han quedado en el olvido. Conocer los pasos y las opciones de las diferentes escuelas nos puede ayudar a comprender mejor lo que se hace hoy, preparar nuevos retos para el futuro y saber que se sigue escribiendo la historia.
Introduction:Latissimus dorsi ruptures are rare injuries more commonly seen in elite overhead and hip throwers athletes. The most frequent mechanism of injury is indirect. The management of these injuries is unclear and controversial. Case Report:In this case report we present a professional female handball player with an acute intramuscular/costal tear of the latissimus dorsi, managed operatively. The patient injured extremity was the dominant throwing arm with a palpable muscle gap of 3 cm. Operative treatment was taken and objective follow-up using UCLA shoulder rating scale and DASH scores; demonstrating a progressive improvement between day zero (UCLA 13pts and DASH 36.7 pts) and the final 6 months (UCLA 33pts and DASH 0.8 pts) follow up; returning to sport at 12 weeks. Conclusion:Latissimus dorsi costal tears are uncommon injuries that can also be seen in hip throwing athletes. Surgical management should be considered if the dominant arm is affected and a 3cm muscle gap is present. Keywords:Latissimus dorsi, latissimus dorsi tear, latissimus dorsi costal tear, surgical management.
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