Pectoralis major tendon reconstruction using semitendinosus allograft following rupture at the musculotendinous junction

Abstract

BackgroundPectoralis major (PM) rupture is an uncommon sports injury that has become more prevalent in the past 20 years as a result of an increase in recreational weight lifting and sports participation. Ruptures occur most commonly at the tendon insertion (65%) and musculotendinous junction (27%). This study describes an open technique and clinical outcomes after reconstruction of a PM rupture at the musculotendinous junction.MethodsIn this case series, 6 patients with PM ruptures at the musculotendinous junction were enrolled, with a 12-month follow-up period. The diagnosis was made with magnetic resonance imaging and correlated with clinical examination findings. All patients underwent PM reconstruction with a semitendinosus allograft, followed by a graduated rehabilitation protocol. Postoperative outcomes were assessed using the American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, cosmesis, return of strength, and overall satisfaction.ResultsThe average age at the time of surgery was 39.5 years. At the 12-month follow-up visit, the average outcome scores were as follows: American Shoulder and Elbow Surgeons score, 98.3; Constant score, 98; and visual analog scale score, 0.67. All patients were pleased with their cosmetic outcomes, as well as return of strength, and showed overall satisfaction with their postoperative results.ConclusionsOn review of the literature, this study is the first to describe the use of an isolated semitendinosus allograft to reconstruct a PM tendon following rupture at the musculotendinous junction. The excellent clinical outcomes suggest that the described technique can be a reliable tool in the orthopedic surgeon's armamentarium when approaching this uncommon PM tear.

Pectoralis Major Rupture: Evaluation and Management

“…Direct repairs are often under increased tension, necessitating slowed rehabilitation, and in instances where the musculotendinous unit cannot be sufficiently mobilized, tendon reconstruction with autograft or allograft is required. Numerous techniques are described using semitendinosus, Achilles tendon, tensor fascia lata, patellar tendon, and dermal allograft 14,[33][34][35] (Figure 6). Despite these challenges, repair is often possible as opposed to reconstruction.…”

Pectoralis Major Tendon Tear

“…Multiple reconstruction grafts, including autografts and allografts, have been described. Hamstring and Achilles allograft are the most common graft choices that have been reported, although bone-patellar tendon-bone autograft, fascia lata allograft, dermal allograft, patellar tendon allograft, and semitendinosus allograft all have been used for reconstruction 6,16,110-117 . Fixation of the graft to the proximal aspect of the humerus for reconstruction has been reported with interference screws, cortical buttons, suture anchors, and bone tunnels 6,16,110-117 .…”

Akute muskulotendinöse Ruptur des M. pectoralis major

“…Da aber die Ergebnisse nach konservativer Therapie allgemein deutlich unterlegen sind, sollte auch hier, wenn möglich, eine operative Refixation erfolgen [ 14 ]. Zur Augmentation der fehlenden stichfesten Sehnenstruktur wurde daher bei muskulotendinösen Rupturen auch die Einflechtung von einem Sehnen-Allografts durch den Muskel und die robuste dorsale Faszie, mit guten klinischen Ergebnissen, beschrieben [ 19 ].…”