Summary

We demonstrated that surgical repair of acute and subacute pectoralis major tendon ruptures can be performed safely with a low re-rupture rate and low risk of complications.

Abstract

Introduction

Pectoralis major tendon ruptures are relatively uncommon injuries. The literature is limited to several small case series, the largest containing 33 cases, and systematic reviews. However, still little is known about the demographics of this injury or the outcomes of operative repairs. We present a series of 134 traumatic pectoralis major tendon ruptures, which were treated surgically. This study aims to provide more information on injury demographics and surgical outcomes in order learn more about making the diagnosis, preferred method of repair, and complications surrounding surgical treatment of both acute and chronic tears.

Methods

A retrospective review was performed on 134 acute and chronic traumatic pectoralis major tendon ruptures that were repaired surgically from 2008 to 2014. Procedures were performed at a multi-surgeon (55 surgeons), multi-center (13 centers) community-based integrated health care system. Pre- and post-operative data were obtained by a retrospective chart and imaging review. The variables recorded were age, gender, race, hand dominance, occupation, smoking history, steroid use, medical comorbidities, mechanism of injury, examination findings, time from injury to surgery, type of repair, use of allograft, re-operation rate, infection rate, complications, and return to full duty.

Results

One hundred and thirty-four pectoralis major tendon ruptures were treated surgically within the time period of this study. The average age was 34 years (15 to 61 years). There were 133 males and 1 female. The dominant side was involved in 56% of cases. The median time from injury to surgery was 3 weeks (range 1 day to 1040 weeks). Seventy five percent were acute injuries, 8% were subacute, and 17% were chronic ruptures.

Surgical treatment with suture end-to-end repair had the highest complication rate (18%), followed by bone tunnels (16%), suture anchors (13%), suture button (4%) and tenodesis screw (0%). Surgical repair with a suture button had the lowest complication rate, which was significant (p = 0.04). Although tenodesis screw fixation demonstrated no complications, only 1 tenodesis screw fixation was used in our study.

Conclusions

This is the largest single series regarding the surgical treatment of pectoralis major tendon ruptures. Our study added to what we know about patient demographics and mechanisms of injury for a pectoralis tendon rupture. Surgical repair of pectoralis major tendon ruptures can be performed safely with a low re-rupture rate and low risk of complications. According to our study, chronic tendons can also be repaired with good results without an excessively increased complication rate. Using a suture button had the lowest complication rate and may offer improved outcomes. Further studies are needed to determine the best surgical repair technique with functional outcome data.