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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Pectoralis major (PM) rupture is an uncommon sports injury that has become more prevalent in the past 20 years, with more than half of all reported cases occurring in the past decade. This phenomenon can be attributed to the increase in recreational weight lifting and sports participation.^2,6, 7, 8, 9, 10 Total and near-total rupture injuries occur most commonly at the tendon insertion (65%) and the musculotendinous junction (27%).^6,9,10

The classic patient is a muscular man aged between 20 and 40 years. This injury typically occurs during eccentric contraction of the PM, most commonly while performing the bench-press exercise. Patients often describe an audible pop, tearing sensation, immediate pain, and localized swelling and ecchymosis at the time of injury. Physical examination will show a thin anterior axillary fold, bulging at the PM origin on the chest with active contraction, and weakness in adduction and internal rotation of the affected arm.8, 9, 10

Surgical repair is the treatment of choice for young active patients with acute or chronic ruptures. This has been correlated with improved patient satisfaction, strength, cosmesis, and a shorter time to return to competitive sports. It has also been associated with a lower incidence of strength deficiency, primarily loss of peak torque and strength impairment in shoulder adduction.^9,10

The purpose of this study was to report a reconstruction technique to address a PM rupture at the musculotendinous junction along with the clinical outcomes. By use of a semitendinosus allograft, a new PM tendon was created and the muscle was reattached to its anatomic insertion along the humerus. To our knowledge, this technique has not been reported in the literature.