1
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Thiebaud J, Sabate-Ferris A, David G, Murison JC. Fascia lata autograft for chronic Pectoralis Major ruptures - A technical note. Orthop Traumatol Surg Res 2024:103937. [PMID: 39033081 DOI: 10.1016/j.otsr.2024.103937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 06/02/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
Rupture of the pectoralis major tendon is an uncommon injury but increasing in incidence. Surgical management is often needed, and ruptures treated acutely show more favorable results. However, a significant number of ruptures are missed and diagnosed later in a chronic state. Direct suture without tension is a major challenge in these cases, and interposition grafts are required. Several techniques have been described however none uses a fascia lata autograft. This technical note aims to describe fascia lata autograft as a valid option to treat retracted chronic pectoralis major ruptures. LEVEL OF EVIDENCE: IV; Study Design: Technical Note.
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Affiliation(s)
- Julien Thiebaud
- Versailles Saint-Quentin-en-Yvelines University Paris, Ile de France, France.
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2
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de Castro Pochini A, Ejnisman B, Andreoli CV, Yamada AF, Godoy IRB, Cohen M, Seixas MT, Belangero PS, Hipolide DC. Surgical treatment of patients with chronic rupture of the pectoralis major muscle tendon. Prospective comparative study with 2 years of follow-up. J Surg Case Rep 2024; 2024:rjae093. [PMID: 38495048 PMCID: PMC10943627 DOI: 10.1093/jscr/rjae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/04/2024] [Indexed: 03/19/2024] Open
Abstract
To compare outcomes between autologous fascia lata and autologous hamstring grafts for chronic pectoralis major muscle (PMM) rupture repair, and perform histological, and imaging analyses. Forty male patients with chronic PMM ruptures (time since injury ranging from >3 months to 5 years) and a mean age of 37.3 years (SD = 9.7 years) were evaluated. One group (20 patients) received an autologous semitendinosus graft, and another group (20 patients) received an autologous fascia lata graft for PMM reconstruction. These patients with fascia lata grafts by Bak 2criterium 60% of the patients presented excellent results, 20% presented good results, 15% presented fair results, and 5% presented poor results. In the hamstring group 65% of the patients presented excellent results, 30% presented good results, and 5% presented fair results. In this comparative study, no difference was observed regarding the functional result, image, and histology between groups.
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Affiliation(s)
| | - Benno Ejnisman
- Orthopaedic Department, Federal University of Sao Paulo, Brazil
| | | | - Andre F Yamada
- Orthopaedic Department, Federal University of Sao Paulo, Brazil
| | - Ivan R B Godoy
- Orthopaedic Department, Federal University of Sao Paulo, Brazil
| | - Moises Cohen
- Orthopaedic Department, Federal University of Sao Paulo, Brazil
| | - Maria T Seixas
- Pathology Department, Federal University of Sao Paulo, Brazil
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3
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de Castro Pochini A, Ejnisman B, Andreoli CV, Lara PHS, Ribeiro LM, Cohen M, Belangero PS, Hipolide DC. Rupture of the bilateral and simultaneous tendon of the pectoralis major muscle. Description of three cases. J Surg Case Rep 2023; 2023:rjad531. [PMID: 38223468 PMCID: PMC10641291 DOI: 10.1093/jscr/rjad531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/08/2023] [Indexed: 01/16/2024] Open
Abstract
Pectoralis major muscle tendon ruptures associated with physical activity or effort are no longer uncommon in the medical literature. Treatment has also evolved significantly in the last 20 years. However, simultaneous bilateral rupture has only been described in a few cases. This article reports three cases with simultaneous bilateral rupture and describes the examinations and treatment performed. Bilateral lesions, although infrequent, also require early diagnosis and treatment in the acute phase. The chronic phase requires tendon grafting for full correction and a slow rehabilitation process.
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Affiliation(s)
| | - Benno Ejnisman
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos V Andreoli
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo H S Lara
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Leandro M Ribeiro
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Moises Cohen
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo S Belangero
- Department of Orthopaedic, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Debora C Hipolide
- Department of Psychobiology, Federal University of Sao Paulo, Sao Paulo, Brazil
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4
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Giordano JR, Klein B, Hershfeld B, Gruber J, Trasolini R, Cohn RM. A review of chronic pectoralis major tears: what options are available? Clin Shoulder Elb 2023; 26:330-339. [PMID: 37607861 PMCID: PMC10497927 DOI: 10.5397/cise.2023.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 08/24/2023] Open
Abstract
Rupture of the pectoralis major muscle typically occurs in the young, active male. Acute management of these injuries is recommended; however, what if the patient presents with a chronic tear of the pectoralis major? Physical exams and magnetic resonance imaging can help identify the injury and guide the physician with a plan for management. Nonoperative management is feasible, but is recommended for elderly, low-demand patients whose functional goals are minimal. Repair of chronic tears should be reserved for younger, healthier patients with high functional demands. Although operative management provides better functional outcomes, operative treatment of chronic pectoralis tears can be challenging. Tendon retraction, poor tendinous substance and quality of tissue, muscle atrophy, scar formation, and altered anatomy make direct repairs complicated, often necessitating auto- or allograft use. We review the various graft options and fixation methods that can be used when treating patients with chronic pectoralis major tears.
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Affiliation(s)
- Joshua R. Giordano
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery, Northwell Health Huntington Hospital, Huntington, NY, USA
| | - Brandon Klein
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Benjamin Hershfeld
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Joshua Gruber
- Nova Southeastern University College of Osteopathic Medicine, Davie, FL, USA
| | - Robert Trasolini
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery, Northwell Health Huntington Hospital, Huntington, NY, USA
| | - Randy M. Cohn
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Valley Stream, Valley Stream, NY, USA
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5
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Mardani-Kivi M, Maddahi A, Leili EK, Asadi K, Darabipour Z, Haghparast Ghadim-Limudahi Z. Pectoralis major rupture repair with Achilles tendon allograft in 22 bodybuilding athletes. J Orthop Sci 2023; 28:1118-1123. [PMID: 36064490 DOI: 10.1016/j.jos.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Pectoralis major tendon rupture rate is increasing due to increased tendency to bodybuilding exercises, specially the bench press workout, and weight-lifting. The aim of this study was to determine the results of pectoralis major rupture repair with Achilles tendon allograft in bodybuilding athletes. METHODS In this case series study, 22 bodybuilding athlete patients (24 pectoralis major ruptures) were undergone open surgical repair during January 2016 till December 2020. 21 ruptures were chronic (2 ruptures were revision) and 3 ruptures were acute. Surgical method was based on Achilles tendon allograft used to augment the ruptured site for lengthening the shortened tendon.The results were analyzed using Bak's criteria and Constant score in pre operation visit and 6th and 12th months and in the last follow up. RESULTS All cases were male with the mean age of 32.1 ± 5.4. The mean duration time between injuries to surgery was 37 ± 46 month (1-182 months). Return to professional sport began at 10.9 ± 2.8 months after surgery in which 16 cases (66.7%) have returned to their pre surgery bench press workout records. No infection or hematoma occurred. At the final follow-up, Bak criteria demonstrated excellent, good and fair in 4, 18 and 2 shoulders respectively. The constant score increased from 87.9 ± 7.9 in pre operation visit to 92.7 ± 6.4 in the last follow up (P < 0.001). CONCLUSIONS It seems that our surgical method is an effective approach in cases with acute or chronic pectoralis major ruptures. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Mohsen Mardani-Kivi
- Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Amirhossein Maddahi
- Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnejad Leili
- Statistics Department, School of Health, Guilan University of Medical Sciences, Rasht, Iran
| | - Kamran Asadi
- Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Zohre Darabipour
- Orthopaedic Research Center, Department of Orthopaedic, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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6
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Rivera PM, Dhytadak D, Cunningham G. Reconstruction of Chronic, Retracted Pectoralis Major Tendon Tear With Achilles Tendon Allograft. Arthrosc Tech 2023; 12:e449-e452. [PMID: 37138694 PMCID: PMC10149781 DOI: 10.1016/j.eats.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/10/2022] [Indexed: 05/05/2023] Open
Abstract
Rupture of pectoralis major tendon (PMT) is an uncommon injury, but its incidence has been increasing in the past 2 decades. Although open repair of the torn tendon is the preferred choice of treatment in acute and chronic cases, this often is not possible for chronic retracted tendon injuries. While several techniques have been described for PMT reconstruction, these allografts and autografts are often smaller and less thick than the native PMT. In this study, we describe the use of the Achilles tendon allograft with unicortical suture buttons for the reconstruction of a chronic and retracted PMT. Furthermore, the advantages and disadvantages of this technique are discussed.
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Affiliation(s)
- Paolo Miguel Rivera
- Centre Epaule Coude la Colline, Geneva, Switzerland
- Address correspondence to Paolo Miguel O. Rivera, M.D., Centre Epaule Coude la Colline, Geneva, Switzerland.
| | | | - Gregory Cunningham
- Centre Epaule Coude la Colline, Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Geneva, Switzerland
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Long MK, Ward T, DiVella M, Enders T, Ruotolo C. Injuries of the Pectoralis Major: Diagnosis and Management. Orthop Rev (Pavia) 2022; 14:36984. [PMID: 36589511 PMCID: PMC9797018 DOI: 10.52965/001c.36984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/21/2022] [Indexed: 12/05/2022] Open
Abstract
Pectoralis major ruptures are uncommon injuries that have become more prevalent over the past 20 years due to increased participation in weight lifting. Patients often present with localized swelling and ecchymosis, muscular deformity, thinning of the anterior axillary fold, and weakness in adduction and internal rotation of the affected arm. History and physical is often augmented with radiology, magnetic resonance imaging of the chest being the gold standard. Nonoperative management is reserved for old patients with low functional demands. Operative intervention is the treatment of choice with improved functional outcomes, cosmesis, and patient satisfaction.
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Affiliation(s)
| | - Taylor Ward
- Department of Osteopathic MedicineNassau University Medical Center
| | | | - Tyler Enders
- Orthopaedic SurgeryNassau University Medical Center
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8
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Magone K, Ben-Ari E, Gyftopoulos S, Virk M. Pectoralis Major Tendon Tear: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202108000-00004. [PMID: 34415856 DOI: 10.2106/jbjs.rvw.20.00224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
» 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. » 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. » 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. » 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.
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Affiliation(s)
- Kevin Magone
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
- Shoulder and Elbow Surgery, CHI Saint Joseph Medical Group-Orthopedic Associates, CHI Saint Joseph Health, London, Kentucky
| | - Erel Ben-Ari
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
- Division of Orthopaedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Soterios Gyftopoulos
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Mandeep Virk
- Division of Shoulder and Elbow Surgery, Department of Orthopedic Surgery, NYU Grossman School of Medicine, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Chronic Pectoralis Major Rupture Reconstruction With Interpositional Acellular Dermal Allograft. Ochsner J 2021; 21:217-223. [PMID: 34239387 PMCID: PMC8238110 DOI: 10.31486/toj.20.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Pectoralis major tendon (PMT) rupture commonly occurs in males 20 to 39 years of age. PMT rupture is most often associated with gym-based exercise, with attempted bench press being the most common causative event, but it is also associated with contact or impact sports. Delayed presentation, misdiagnoses, and chronic PMT rupture can result in a therapeutic dilemma. Case Series: We present 2 cases of chronic PMT rupture that were operatively managed using acellular dermal allograft as an interposition graft. Patients’ final follow-ups were at 20 and 30 months, respectively. Strength in their pectoralis major muscle was well preserved on the contralateral side: 88% for patient 1 and 110% for patient 2. Conclusion: Our reported technique using an interpositional acellular dermal allograft is a good option to treat chronic PMT rupture.
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10
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Abstract
Background: Pectoralis major ruptures are increasing in incidence primarily due to an increase in awareness, activity level among young males between 20 and 40 years of age, and use of anabolic steroids. Although the majority of pectoralis major ruptures are acute injuries, many chronic ruptures are unrecognized and it is imperative to understand the proper evaluation of these injuries, as well as the appropriate treatment for acute and chronic ruptures.Purpose: Pectoralis major ruptures can lead to deformity and physical disability if left untreated. This review paper discusses both acute and chronic ruptures as well as indications for nonoperative treatment and operative treatment to give the reader the best understanding of this diagnosis and proper management.Methods: A systematic review of the literature was performed using a search of electronic databases. Search terms such as pectoralis major rupture, pectoralis major repair, pectoralis major tendon transfer, and pectoralis major nonoperative treatment were used. Case reports, systematic reviews, prospective and retrospective studies were included to provide a comprehensive review. The only exclusion criteria consisted of studies not published in English. This review article includes the anatomy and biomechanics of the pectoralis major muscle, proper evaluation of the patient, operative and nonoperative treatment of acute and chronic pectoralis major ruptures, and outcomes of the recommended treatment.Conclusion: Nonoperative treatment is indicated for patients with medical comorbidities, older age, incomplete tears, or irreparable damage. Patients treated non-operatively have been shown to lose strength, but regain full range of motion. Patients with surgery before 6 weeks reported better outcomes than patients with surgery between 6 and 8 weeks. The chronicity of the rupture (>8 weeks) increases the likelihood of reconstruction, involving the use of autografts or allografts. Patients treated with delayed repair had significantly better strength, satisfaction, and outcomes than patients with nonoperative treatment. The pectoralis tendon can also be transferred in patients with rotators cuff tears, atrophy, or significant functional limitation. Tendon transfers have been shown to have unpredictable outcomes, but overall satisfactory results.
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Affiliation(s)
- Kamali Thompson
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Young Kwon
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Evan Flatow
- Department of Orthopaedic Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Laith Jazrawi
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Eric Strauss
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
| | - Michael Alaia
- Division of Sports Medicine, Department of Orthopaedic Surgery, NYU Langone Health, New York, NY
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Long M, Enders T, Trasolini R, Schneider W, Cappellino A, Ruotolo C. Pectoralis major tendon reconstruction using semitendinosus allograft following rupture at the musculotendinous junction. JSES OPEN ACCESS 2019; 3:328-332. [PMID: 31891034 PMCID: PMC6928300 DOI: 10.1016/j.jses.2019.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Pectoralis major (PM) rupture is an uncommon sports injury that has become more prevalent in the past 20 years as a result of an increase in recreational weight lifting and sports participation. Ruptures occur most commonly at the tendon insertion (65%) and musculotendinous junction (27%). This study describes an open technique and clinical outcomes after reconstruction of a PM rupture at the musculotendinous junction. Methods In this case series, 6 patients with PM ruptures at the musculotendinous junction were enrolled, with a 12-month follow-up period. The diagnosis was made with magnetic resonance imaging and correlated with clinical examination findings. All patients underwent PM reconstruction with a semitendinosus allograft, followed by a graduated rehabilitation protocol. Postoperative outcomes were assessed using the American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, cosmesis, return of strength, and overall satisfaction. Results The average age at the time of surgery was 39.5 years. At the 12-month follow-up visit, the average outcome scores were as follows: American Shoulder and Elbow Surgeons score, 98.3; Constant score, 98; and visual analog scale score, 0.67. All patients were pleased with their cosmetic outcomes, as well as return of strength, and showed overall satisfaction with their postoperative results. Conclusions On review of the literature, this study is the first to describe the use of an isolated semitendinosus allograft to reconstruct a PM tendon following rupture at the musculotendinous junction. The excellent clinical outcomes suggest that the described technique can be a reliable tool in the orthopedic surgeon's armamentarium when approaching this uncommon PM tear.
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Affiliation(s)
- Mitchell Long
- Department of Orthopedics, Nassau University Medical Center, East Meadow, NY, USA
| | - Tyler Enders
- Department of Orthopedics, Nassau University Medical Center, East Meadow, NY, USA
| | - Robert Trasolini
- Department of Orthopedics, Nassau University Medical Center, East Meadow, NY, USA
| | - William Schneider
- Department of Orthopedics, Nassau University Medical Center, East Meadow, NY, USA
| | | | - Charles Ruotolo
- Department of Orthopedics, Nassau University Medical Center, East Meadow, NY, USA
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12
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Nute DW, Kusnezov N, Waterman BR. Functional Outcomes and Complications Following Pectoralis Major Tendon Allograft Reconstruction in a Military Population. Orthop J Sports Med 2019; 7:2325967119878709. [PMID: 31692733 PMCID: PMC6811763 DOI: 10.1177/2325967119878709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are limited data available regarding outcomes following pectoralis major tendon (PMT) reconstruction with allograft. PURPOSE To evaluate the functional outcomes and complication profile following PMT reconstruction with allograft in a military population. STUDY DESIGN Case series; Level of evidence, 4. METHODS All active duty military personnel who underwent PMT allograft reconstruction between 2008 and 2013 were identified. Demographics, injury characteristics, and surgical technique were recorded from the electronic medical record. Self-reported pain scores and manual strength were evaluated pre- and postoperatively, as recorded in physician electronic medical record notes, in addition to the ability and degree to which each patient was able to return to function. Standardized outcome measures included the Bak criteria; visual analog scale for pain; Disabilities of the Arm, Shoulder and Hand (DASH) score; American Shoulder and Elbow Surgeons (ASES) score; and 36-Item Short Form Health Survey (SF-36). Complications, including rerupture and reoperation, were additionally recorded. RESULTS Nine male patients (mean ± SD age, 35.7 ± 5.8 years) underwent allograft PMT reconstruction. Mean improvement in self-reported pain score at a mean 53.5 months (range, 31.1-110.9 months) was 2.1 ± 1.3 points (P = .08). Improvements in manual strength during forward flexion (0.5 ± 0.7; P = .03), adduction (0.6 ± 0.6; P = .01), and internal rotation (0.5 ± 0.7; P = .03) were significant. Seven patients (78%) returned to full preinjury level of occupational function, and 88% returned to performing the bench press, although maximum weight decreased by a self-reported mean of 141.3 lb. According to the Bak criteria, 5 (56%) patients had excellent outcomes, 2 (22%) had fair outcomes, and 2 (22%) had poor outcomes. Mean visual analog scale for pain (1.9 ± 2.8), DASH (10.8 ± 17.4), ASES (88.1 ± 20.3), and SF-36 scores (96.3% ± 6.9%) were obtained for the 8 patients available at final follow-up. Complications included 2 cases (22%) of persistent shoulder pain leading to military separation, 1 rerupture (11%), and 1 (11%) surgical scar revision. CONCLUSION While allograft reconstruction is a reliable option to decrease pain and improve function in patients with tears not amenable to primary repair, patients should be educated about the risk profile and fitness limitations after surgery.
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Affiliation(s)
- Drew W. Nute
- Department of Orthopaedic Surgery and Rehabilitation, William
Beaumont Army Medical Center, El Paso, Texas, USA
| | - Nicholas Kusnezov
- Department of Orthopaedic Surgery, Blanchfield Army Community
Hospital, Fort Campbell, Kentucky, USA
| | - Brian R. Waterman
- Department of Orthopaedic Surgery, School of Medicine, Wake Forest
University, Winston-Salem, North Carolina, USA
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13
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Javed S, Monga P, Hallam L, Torrance E, Funk L. Surgical reconstruction of unrepairable pectoralis major rupture using tendo-achilles allograft. Shoulder Elbow 2019; 11:94-97. [PMID: 30936947 PMCID: PMC6434955 DOI: 10.1177/1758573217741319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/06/2017] [Accepted: 10/14/2017] [Indexed: 11/15/2022]
Abstract
Rupture of the pectoralis major remains an infrequent injury, although, recently, it has been reported more commonly as a result of the expansion and increasing popularity of competitive sports, as well as developments in sports medicine. A number of surgical repair techniques have been described for direct repair in the acute setting. However, on occasion, the pectoralis major muscle is so retracted that a tension-free direct repair is not possible. 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.
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Affiliation(s)
| | | | | | | | - Lennard Funk
- Lennard Funk, Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK.
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14
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Leśniewicz A, Furtak M, Żyrnicki W, Dawidowicz J, Maksymowicz K, Szotek S. Investigations of Human Fascia Lata Elemental Composition-the Effect of Different Preservation and Mineralisation Methods. Biol Trace Elem Res 2019; 187:357-366. [PMID: 29948909 DOI: 10.1007/s12011-018-1389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Abstract
Influence of fixation medium and storage conditions as well as impact of sample mineralisation procedure on determination of minerals in human fascia lata was examined and discussed. Freezing and storage in 10% neutral buffered formalin solution and in 2.5% glutaraldehyde were used as the preservation methods of the samples. The concentrations of, both essential and toxic, elements were measured by ICP-OES method in fascia lata samples mineralised with concentrated nitric acid in a closed microwave system and in open vessels heated on a hot plate. Freezing was found as the best preserving method of fascia lata samples because of the number of elements determined and determination precision. The trace element (Cd, Cr, Cu, Fe, Ni, Sr, Zn) concentrations obtained in samples decomposed using the conventional hot plate were different from analogous measurements in solutions obtained after application of closed vessels and microwave energy assistance. Differences between the mineral compositions of fascia samples variously preserved and mineralised were statistically evaluated and discussed. Interelement correlations were analysed taking into account an impact of various methods of sample conservation. Strong, positive association between element content was discovered for Cr-Ba, Mn-Ba, P-Ba, Sr-Ba, Sr-Ca, Zn-Ca, Mn-Cr, Pb-Cr, Sr-Cr, Mg-Fe, P-Fe, Pb-Ni, Ti-Ni and Sr-P pairs of elements.
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Affiliation(s)
- Anna Leśniewicz
- Analytical Chemistry and Chemical Metallurgy Division, Faculty of Chemistry, Wrocław University of Science and Technology, Wybrzeże St. Wyspiańskiego 27, 50-370, Wrocław, Poland.
| | - Milena Furtak
- Analytical Chemistry and Chemical Metallurgy Division, Faculty of Chemistry, Wrocław University of Science and Technology, Wybrzeże St. Wyspiańskiego 27, 50-370, Wrocław, Poland
| | - Wiesław Żyrnicki
- Analytical Chemistry and Chemical Metallurgy Division, Faculty of Chemistry, Wrocław University of Science and Technology, Wybrzeże St. Wyspiańskiego 27, 50-370, Wrocław, Poland
| | | | - Krzysztof Maksymowicz
- Faculty of Medicine, Department of Forensic Medicine, Wrocław Medical University, J. Mikulicza-Radeckiego 4, 50-368, Wrocław, Poland
| | - Sylwia Szotek
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Faculty of Mechanical Engineering, Wrocław University of Science and Technology, Łukasiewicza 7/9, 50-371, Wrocław, Poland
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15
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Surgical Intervention for Pectoralis Major Muscle Rupture: Report of Acute and Chronic Cases. Case Rep Surg 2018; 2018:2380241. [PMID: 30533241 PMCID: PMC6247640 DOI: 10.1155/2018/2380241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/28/2018] [Accepted: 10/11/2018] [Indexed: 11/17/2022] Open
Abstract
Pectoralis major muscle rupture is becoming more frequent due to the current trends toward high-contact sports. We reported 2 cases with acute and chronic injury settings along with the strategy to treat each of it.
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Neumann JA, Klein CM, van Eck CF, Rahmi H, Itamura JM. Outcomes After Dermal Allograft Reconstruction of Chronic or Subacute Pectoralis Major Tendon Ruptures. Orthop J Sports Med 2018; 6:2325967117745834. [PMID: 29318178 PMCID: PMC5753988 DOI: 10.1177/2325967117745834] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction. Purpose: The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome. Study Design: Case series; Level of evidence, 4. Methods: Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively. Results: Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores (r = 0.628, P = .016) and less forward flexion (r = –0.502, P = .048) and external rotation (r = –0.654, P = .006). Patients with workers’ compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction. Conclusion: This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.
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Affiliation(s)
- Julie A Neumann
- Kerlan-Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christopher M Klein
- Kerlan-Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Carola F van Eck
- Kerlan-Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hithem Rahmi
- Kerlan-Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John M Itamura
- Kerlan-Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw. Case Rep Orthop 2017; 2017:2095407. [PMID: 28251005 PMCID: PMC5303850 DOI: 10.1155/2017/2095407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/05/2016] [Accepted: 01/09/2017] [Indexed: 01/11/2023] Open
Abstract
Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. We report an open reconstruction technique and its outcomes in a case of chronic and retracted PM tear. At the last follow-up (12 months), the patient was pain-free, with a visual analogic scale at 0 all the time. He was very satisfied concerning the cosmetic and clinical results. The constant score was 93%, the SST value 95%, and the Quick DASH score 4.5. MRI performed one year postoperatively confirmed the continuity between PM tendon and graft, even if the aspect of the distal tendon seemed to be thinner than normal PM tendon. The excellent clinical outcomes at one-year follow-up suggest that PM tear with major tendon retraction can be reliably reconstructed with hamstring autograft, using a bioabsorbable screw to optimize the fixation device. This technique has proven its simplicity and efficiency to fill the gap.
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Lee YK, Skalski MR, White EA, Tomasian A, Phan DD, Patel DB, Matcuk GR, Schein AJ. US and MR Imaging of Pectoralis Major Injuries. Radiographics 2017; 37:176-189. [DOI: 10.1148/rg.2017160070] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Acevedo DC, Shore B, Mirzayan R. Orthopedic applications of acellular human dermal allograft for shoulder and elbow surgery. Orthop Clin North Am 2015; 46:377-88, x. [PMID: 26043051 DOI: 10.1016/j.ocl.2015.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Shoulder and elbow tendon injuries are some of the most challenging problems to treat surgically. Tendon repairs in the upper extremity can be complicated by poor tendon quality and, often times, poor healing. Extracellular matrices, such as human dermal allografts, have been used to augment tendon repairs in shoulder and elbow surgery. The indications and surgical techniques regarding the use of human dermal allograft continue to evolve. This article reviews the basic science, rationale for use, and surgical applications of human dermal allograft in shoulder and elbow tendon injuries.
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Affiliation(s)
- Daniel C Acevedo
- Department of Orthopedic Surgery, Kaiser Permanente, Baldwin Park, 13652 Cantara St, Panorama City, CA 91402, USA.
| | - Brett Shore
- Department of Orthopedic Surgery, Kaiser Permanente, Baldwin Park, 13652 Cantara St, Panorama City, CA 91402, USA
| | - Raffy Mirzayan
- Department of Orthopedic Surgery, Kaiser Permanente, Baldwin Park, 13652 Cantara St, Panorama City, CA 91402, USA
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Pectoralis major ruptures: a review of current management. J Shoulder Elbow Surg 2015; 24:655-62. [PMID: 25556808 DOI: 10.1016/j.jse.2014.10.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/19/2014] [Accepted: 10/30/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rupture of the pectoralis major tendon is increasing in incidence, with a spike in the number of reported cases in the last decade. This is commonly attributed to an increased interest in health, fitness, and weight training combined occasionally with concomitant use of anabolic steroids. It is essential for the diagnosis to be recognized and for the patient to be referred to a surgeon with expertise in dealing with these injuries so that appropriate and informed care can be implemented. METHODS Based on a comprehensive review of the literature and expert opinion, we present a review of pectoralis major ruptures, including information pertaining to the anatomy and biomechanics of the musculotendinous unit and how this relates to the injury pattern and management; the clinical diagnosis and indications for additional imaging; and the indications for nonoperative and operative management along with the authors' preferred technique. A summary of outcomes is presented. CONCLUSION The combination of patient demographics and clinical features frequently yields an accurate diagnosis, but further imaging is helpful. Magnetic resonance imaging with dedicated sequencing is the investigation of choice and can aid in diagnosis, surgical planning, and providing important information about prognosis and outcome. Early surgery is preferable, but good outcomes in the chronic setting are achievable. With a detailed understanding of the anatomy, direct repair to bone is possible with either transosseous or anchor repair techniques in acute and the majority of chronic cases. In chronic cases in which direct repair is not achievable, autograft and allograft reconstruction should be considered.
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22
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Merolla G, Paladini P, Artiaco S, Tos P, Lollino N, Porcellini G. Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:91-8. [DOI: 10.1007/s00590-014-1451-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/22/2014] [Indexed: 11/29/2022]
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23
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Dehler T, Pennings AL, ElMaraghy AW. Dermal allograft reconstruction of a chronic pectoralis major tear. J Shoulder Elbow Surg 2013; 22:e18-22. [PMID: 24054313 DOI: 10.1016/j.jse.2013.06.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/11/2013] [Accepted: 06/16/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Thomas Dehler
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Garrigues GE, Kraeutler MJ, Gillespie RJ, O'Brien DF, Lazarus MD. Repair of pectoralis major ruptures: single-surgeon case series. Orthopedics 2012; 35:e1184-90. [PMID: 22868603 DOI: 10.3928/01477447-20120725-17] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rupture of the pectoralis major is an uncommon injury that can lead to pain, loss of strength, and cosmetic deformity. The purpose of this study was to analyze the outcome of pectoralis major repairs by a single surgeon. Twenty-four patients who underwent pectoralis major repair by the senior author (M.D.L.) between May 2005 and March 2011 were retrospectively identified. Patients were assessed at least 6 months postoperatively with the use of various questionnaires, including the Penn Shoulder Score, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, and Single Assessment Numeric Evaluation (SANE). All patients were men with an injury to the sternal head of the pectoralis. Most (16/24; 67%) patients sustained the injury while bench or incline bench pressing. Nineteen (79%) patients were successfully contacted for follow-up. Of these, an average preinjury bench press of 318 lb (range, 145-525 lb) was restored to an average of 264 lb (range, 100-500 lb) at follow-up. Average preoperative Penn Shoulder Score was 60 points (range, 33-77 points), improving to 94 points (range, 64-100 points) at last follow-up (P=.011). Average postoperative ASES and SANE scores were 96 points (range, 60-100 points) and 93 points (range, 50-100 points), respectively. All but 1 patient were rated excellent (14/19; 74%) or good (4/19; 21%) by the Bak criteria. Operative treatment of pectoralis major rupture yields high patient satisfaction and allows predictable return of comfort, range of motion, cosmesis, and overall limb strength, with a slightly less predictable return of maximum bench press strength.
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Tomčovčík Ľ, Morochovič R, Resutík R. Pectoralis major muscle rupture: more than 440 cases already reported. A review of the recent literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0820-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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