Summary

Reconstruction of the pectoralis major tendon with Achilles allograft does not fully restore the objective mechanical strength of the tendon in most patients, but is otherwise associated with satisfactory subjective outcomes with regard to pain, function in activities of daily living, and cosmesis.

Abstract

Purpose

Pectoralis major tendon tears are rare injuries typically only seen in physically active males. Chronic tears and failed repairs usually require reconstruction of the tendon with an allograft. Achilles tendon allograft has become an increasingly popular choice for this purpose, but outcomes data is extremely limited. The purpose of this study was to describe postoperative outcomes of patients who underwent pectoralis major tendon reconstruction with Achilles allograft, including both muscle strength and patient-reported outcomes (PROs).

Methods

We prospectively recruited patients who underwent pectoralis major tendon reconstruction with Achilles allograft at a single center from 2018-2021. Patients were included if they underwent the procedure for primary treatment of a chronic tear or as a revision procedure for a previous failed repair and had a minimum of 3 months of follow-up. Postoperative pectoralis major muscle strength was assessed via isokinetic testing of shoulder internal rotation (IR) and D1 flexion motions at 60 and 120 degrees/s on a Biodex Systems 3 dynamometer. Strength values were reported as a ratio of peak torque to body weight and any operative-to-nonoperative shoulder strength deficits of =10% were noted. PROs included the Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and satisfaction with cosmesis.

Results

Eight patients were included in the study, all of whom were males between the ages of 35-50 years. Follow-up times ranged from 3-22 months. The group was evenly split between manual and non-manual laborers and 5 patients engaged in “high-impact” activities including weightlifting and/or combat sports. Five patients had no prior surgery to repair the ruptured tendon. Postoperative isokinetic testing data was obtained for seven patients, of whom five exhibited an operative-to-nonoperative shoulder strength deficit of =10% for at least one motion (IR or D1 flexion) at one or both testing speeds. Postoperative PROs were obtained for all eight patients. All patients reported a postoperative VAS of 0 (no pain) and ASES Shoulder Scores of =90 indicating normal or near-normal shoulder function. However, only three patients reported QuickDASH scores of 0 (no disability) with the remaining five patients all reporting some degree of postoperative arm/shoulder-related disability. Postoperatively, no patients reported having shoulder pain at night or having to regularly take any opioid or non-opioid pain medications. All patients reported cosmesis satisfaction =90%.

Conclusion

Reconstruction of the pectoralis major tendon with Achilles allograft does not fully restore the objective mechanical strength of the tendon in most patients, but is otherwise associated with satisfactory subjective outcomes with regard to pain, function in activities of daily living, and cosmesis. The procedure is an effective option for the surgical treatment of chronic pectoralis major tendon tears in high-demand patients.