Reconstruction of Irreparable Pectoralis Major Tears

Abstract

Introduction: Pectoralis major (PM) tendon ruptures are common injuries in the active duty military population. Despite strong evidence supporting operative management, there is a dearth of literature regarding the management of medial PM tear patterns requiring intramuscular fixation. The present study was conducted to describe surgical techniques and outcomes of acellular dermal allograft reconstruction for irreparable junctional and intrasubstance PM tears.

Materials and methods: This study comprises a consecutive series of patients with full-thickness junctional or intrasubstance PM tears who underwent reconstruction with acellular dermal allograft. A single fellowship-trained shoulder and elbow surgeon performed the procedures, utilizing Decellularized Dermal Allograft (ArthroFLEX, Arthrex Inc., Naples, FL, United States). Each patient underwent both pre and postoperative chest magnetic resonance imaging (MRIs), the latter occurring at least 6 months after surgery to assess for graft incorporation. Clinical and functional outcome measures included the following: Single Assessment Numeric Evaluation (SANE) scores, range of motion, return to push-ups/bench press, workout modifications, and differences in self-reported preoperative and postoperative bench press 1-repetition maximums.

Results: Five male active duty service members (27-45 years) underwent PM reconstruction with acellular dermal allograft during the study period, with a mean follow-up of 31.9 (±9.5) months. There were 4 patients with intrasubstance tears and 1 patient with a tear at the musculotendinous junction which occurred while bench pressing. After reconstruction, there were no re-ruptures and postoperative MRIs universally demonstrated allograft incorporation. All patients regained full range of motion, and the mean SANE score was 83 (±14). Three patients modified chest workouts after injury, most commonly with dumbbell bench press. Two patients returned to a flat bench press, and of these 2, 1 regained 86% of his preoperative 1-repetition maximum.

Conclusion: Reconstruction of "irreparable" PM injuries with acellular dermal allograft is efficacious for the management of junctional or intrasubstance tears requiring intramuscular fixation. Postoperative outcome measures indicate this procedure is well-tolerated and reliably restores function after medial PM tendon ruptures. The novel surgical techniques described in the present study expand the armamentarium of shoulder surgeons to address PM injuries.