Pectoralis major tendon rupture: A biomechanical analysis of repair techniques

Abstract

Rupture of the insertion of the pectoralis major muscle to the proximal humerus is becoming a common injury. Repair of these ruptures increases patient satisfaction, strength, and cosmesis, and shortens return to competitive sports. Several repair techniques have been described, but recently many surgeons are using suture anchors. The traditional repair technique uses transosseous sutures, but no study has biomechanically compared the strength of these two repair techniques in human cadavers. Twelve freshfrozen human shoulder specimens were dissected. The pectoralis major tendon insertion was cut from the bone and repaired using one of the two repair techniques: specimens were randomly assigned to transosseous trough with suture tied over bone versus four suture anchors. The fixation constructs were pulled to failure at 4 mm/s on a materials testing system. The mean ultimate failure load of the transosseous repairs was 611 N and the mean ultimate failure load of the suture anchor repair was 620 N. The mean stiffness of the transosseous repair was 32 and 28 N/mm for the suture anchor group. We found no statistically significant difference between these two repair techniques. ß

Biomechanical Analysis of the Pectoralis Major Tendon and Comparison of Techniques for Tendo-osseous Repair

“…6 Similarly, existing techniques of pectoralis repair demonstrate good results with low rates of hardware failure. A recent meta-analysis of all reported pectoralis ruptures showed 88% good or excellent results in surgically repaired patients compared to only 27% in those treated nonoperatively.…”

Suture Technique Influences the Biomechanical Integrity of Pectoralis Major Repairs

“…These studies have focused on methods of bony fixation and have shown few differences among fixation techniques. 5,6,10 Failure of specimens in biomechanical studies commonly occurs at the suture/ tendon interface. [5][6][7]10 Sherman et al 6 reported that all of their repairs failed from suture pulling through tendon.…”

“…5,6,10 Failure of specimens in biomechanical studies commonly occurs at the suture/ tendon interface. [5][6][7]10 Sherman et al 6 reported that all of their repairs failed from suture pulling through tendon. No studies have directly compared repair constructs, but biomechanical studies using Mason-Allen stitches have demonstrated overall lower ultimate failure loads (290-360 N) than those in which running, locking stitches were used (380-620 N).…”

Early Surgical Treatment of Pectoralis Major Tendon Rupture: A Case Report

“…, it is associated with tendon shortening (average of 9 mm) 4 . Using suture anchors allows for less extensive soft tissue stripping and reduced operative time.…”

“…Using suture anchors allows for less extensive soft tissue stripping and reduced operative time. In addition, any native tendon on the humeral side can be preserved and used to reinforce the repair 4 , yielding similar stiffness to transosseous repair. With its proven mechanical strength, we utilized this surgical technique in the present case.…”