Outcomes After Dermal Allograft Reconstruction of Chronic or Subacute Pectoralis Major Tendon Ruptures

Abstract

Background:Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction.Purpose:The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome.Study Design:Case series; Level of evidence, 4.Methods:Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively.Results:Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores (r = 0.628, P = .016) and less forward flexion (r = –0.502, P = .048) and external rotation (r = –0.654, P = .006). Patients with workers’ compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction.Conclusion:This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.

Bilateral Pectoralis Major Tendon Rupture While Performing Intermediate Level Bench Press

“…Upon taking the history, patients often report a tearing sensation or hearing a “pop” followed by sudden pain at the medial aspect of the upper arm, deformity, weakness, and swelling. Physical examination typically consists of a palpable defect, tenderness over the humeral insertion, an asymmetric axillary fold, weakness in shoulder adduction and internal rotation, and occasionally ecchymosis 15–17. The swelling and discoloration down the arms can be mistaken for a proximal biceps injury instead of PM rupture.…”

“…Late surgical repair or reconstruction, however, may be considered if the patient fails to progress over the first three to four months. Operative treatment is favorable in all young active patients regardless of the chronicity of injury, as surgical repair provides the best outcomes in satisfaction, pain relief, restoration of pre-injury strength and function, superior cosmetic results, and ability to return to sport 10,15–17,21–23. Various fixation techniques, such as beach chair versus supine positions through a deltopectoral or anterior axillary approach, tendon-to-tendon, bone trough, suture anchors, cortical buttons, and staged versus simultaneous tendon repairs have been used to reattach the PM tendon to its normal humeral insertion site 3,22.…”

Eficaz solución quirúrgica a una rotura completa del pectoral mayor

“…Mención aparte merecen las roturas de evolución crónica, considerando como tal aquellas lesiones con una evolución mayor a las 6 semanas (11) , y que debido a la retracción del muñón proximal pueden plantear problemas en la reparación. Ante estas lesiones, siempre se intentará la reparación primaria, pero si esta no es posible, la utilización de autoinjertos o aloinjertos tendinosos o dérmicos, ha mostrado buenos resultados (12) . En estos casos, cuando la reparación primaria no es posible, el aloinjerto de tendón de Aquiles podría ser considerado de elección por su buena morfología y excelentes características de carga.…”

Operative Behandlung der chronischen Pectoralis-major-Ruptur

“…5) erlaubt kleine Bohrlöcher (2,9 mm [1,2,5,17,23,24,26,29]. Durch die Verwendung von Auto-und Allografts können die Ergebnisse bei den sekundären Rupturen verbessert werden [9,21]. In der akuten Versorgung werden die besten Ergebnisse mit 90-100 % bei primärer Operation innerhalb der ersten 2 Wochen nach Trauma erreicht.…”

“…Die Augmentation/Interposition mit einem Auto-oder Allograft führt in der Therapie der chronischen Risse zu deutlich besseren Ergebnissen. Als Grafts sind Semitendinosus-, Grazilis-und Achillessehne sowie Fascia lata oder humane azelluläre Dermis beschrieben [9,21]. Sekundäre Rekonstruktionen sind so auch nach Jahren noch erfolgreich möglich.…”