¹McDermott M, ²Bell J, ³Bennett S, ²Kawashima G, ¹Byrne N, ¹Romeo A
¹Duly Health and Care, Naperville, IL, USA; ²Franciscan Health, Olympia Fields, USA; ³Kettering Health Dayton, Dayton, USA

Background
Latissimus dorsi tendon tears are a rare but significant injury to professional athletes. Professional baseball pitchers are specifically affected by this injury as the latissimus dorsi is heavily involved in the late cocking and acceleration phase of the throwing cycle. The treatment of these injuries is somewhat controversial as the few published studies that currently exist have demonstrated positive outcomes to both operative and non-operative treatment. The purpose of this article is to help further delineate the outcomes of operative treatment of latissimus dorsi tendon tears in professional baseball pitchers and examine the timeline to returning to pitching in professional baseball games.

Methods
A single surgeon retrospective cohort of professional baseball pitchers that underwent surgical repair of a latissimus dorsi tendon rupture or tear from March 2021 to August 2022 was established. Patients were followed for a minimum of 1 year to assess their ability to return to pitching in professional baseball. Return to sport for this study is defined in three parts: 1. the ability to return to pitching in games, 2. competing at the same level of sport as they were prior to injury and 3. The return to pitching must be documented in two baseball statistics reporting databases (Baseball-reference.com and baseballsavant.com). Time to return was tracked in each patient as well as throwing velocities before injury and after returning to pitching for those playing in the major league.

Results
A cohort consisting of 8 professional baseball pitchers (1 Major League, 7 Minor league) who underwent surgical repair of the latissimus dorsi tendon were included in the study; 50% (4/8) of these patients underwent simultaneous teres major repair in the same procedure. 87.5% (7/8) of these pitchers were able to full return to sport with an overall average time to return of 14.5 ± 6.0 months after operation. 50% (4/8) of patients returned to professional pitching in less than 1 year post operatively. After returning from injury, the single major league pitcher had an average throwing exit velocity at 96% of his preoperative average (91.7 mph prior, 88.4 mph after return). He also observed a restoration of his maximal throwing exit velocity, 107.2 mph in the season prior to injury and 111.9 mph in his return season. One patient was unable to return to sport at the time of writing this article (20 months postoperatively) due to a secondary injury. This player had an MRI after the second injury showing an infraspinatus tear, but the repaired latissimus dorsi tendon was found to be intact.

Conclusion
Surgical repair of a torn or ruptured latissimus dorsi tendon can allow a professional baseball pitcher to return to playing at the professional level.