A Case Series of Pectoralis Major Injuries on One Collegiate Football Team

Optimizing pectoralis major tendon repair: a modified knotless suture anchor technique using high-strength suture and tape

Background

Rupture of the pectoralis major (PM) tendon is infrequent but has shown an increased incidence in athletes, particularly weightlifters during bench presses. Various techniques for repair exist, yet no established gold standard has been defined.

Methods

We present a modified surgical technique utilizing knotless suture anchors for PM tendon repair. The technique involves bringing the tendon end superiorly and inferiorly to the decorticated bone surface, ensuring broader tendon-to-bone contact. Knotless anchors with a unique suture locking mechanism facilitate tension adjustment. Additionally, the repair's strength is reinforced by employing both surgical tape and high-strength suture.

Results

The utilization of both surgical tape and high-strength suture in conjunction with knotless suture anchors provides a secure and stable construct. This approach minimizes the risk of failure, reduces the potential for neurovascular injury associated with bicortical drilling, preserves imaging quality due to the absence of metal artifacts, and helps avoid the risk of fracture associated with traditional methods. However, surgeons should be aware of a potential disadvantage of increased surgical costs compared to traditional techniques.

Conclusion

Our modified technique offers multiple advantages, including increased tendon-to-bone contact, enhanced stability, reduced neurovascular risks, and avoidance of potential fractures. This makes it a valuable option for successful PM tendon repairs. Surgeons should consider its benefits and weigh them against the associated costs for optimal patient care.

Pectoralis Major Tendon Tear: A Critical Analysis Review

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Pectoralis major (PM) tendon tears are predominantly seen in young men, and the majority of tears occur as tendon avulsions involving the sternal head. Weightlifting, specifically bench-pressing, and sporting activities with eccentric overloading of the PM tendon are the 2 most common activities that result in PM injury.

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Early surgical repair or reconstruction should be offered to younger, active patients with a complete PM tear; the majority of the patients undergoing surgical repair achieve good-to-excellent outcomes.

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Nonsurgical treatment of a complete PM tear is an option but will result in cosmetic deformity and a deficit in adduction strength of the arm. Outcomes after nonsurgical treatment of complete PM tears are less satisfactory than those obtained after surgical treatment.

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Currently, there is no consensus on the chronological definition of PM tears (acute versus chronic), the critical time limit for performing surgical repair, the ideal fixation device (cortical button, bone tunnel, or suture anchors), the indications for allograft use, and the ideal rehabilitation protocol after treatment of PM tears.

Anatomic Pectoralis Major Repair With Intramedullary Anchor Fixation

Although previously described as a rare injury, pectoralis major tendon rupture has shown increased reports in recent years. This injury can be managed conservatively; however, given the propensity for young, physically active male individuals, surgical repair is often preferred. Definitive surgical repair can be performed through various techniques such as bone trough, transosseous fixation, suture anchor, and cortical button techniques. This technique guide describes surgical repair through intramedullary anchor fixation with a unique pull-through method using taped suture to secure the tendon repair to its anatomic footprint. We believe this method is biomechanically advantageous, reduces bone loss that may lead to postoperative fractures, and re-creates the anatomic footprint of the torn tendon.