Surgical Reconstruction Of Unrepairable Pectoralis Major Rupture Using Tendo-Achilles Allograft
We describe a technique for allograft reconstruction of the pectoralis major, with our preliminary outcomes, where it is found or anticipated that a direct repair is not possible.
Rupture of the pectoralis major remains an infrequent injury but recently has been reported more commonly. A number of surgical repair techniques have been described for direct repair. However, on occasion, the pectoralis major muscle is so retracted that a tension-free direct repair is not possible.
The main indication for surgery is pain and functional loss that adversely affects a manual worker to perform their job or competitive sporting activity. We describe a technique for allograft reconstruction of the pectoralis major where a direct repair is not possible.
We performed a total of 142 pectoralis major repairs over a ten year period, of which 19 re-quired allograft reconstruction. Of these 19 patients, 11 were available for response. All 11 patients were male with a mean age of 38.3 years (21 to 48 years). The mean time between injury and surgery was 12.2 months (4 to 30 months). Ten patients (91%) were unable to perform their previous level of work pre-operatively, with all patients returning to pre-injury occupation levels post-operatively. The main complaint prior to surgery was pain on pushing and moving the affected arm across the body, which improved in nine patients (82%), with no improvement reported in two patients. Strength improved significantly post-operatively, with only three patients reporting no im-provement (paired t-test p=0.01). Six patients reported an improvement in cosmesis (50%).
This technique involves the use of cadaveric tendo-achilles allograft to reconstruct the pectoralis major tendon attachment to the humerus when a direct repair is not possible.