Summary
We recommend surgical treatment for the ruptures of the pectoralis major tendon. In cases of chronic ruptures in which direct repair to bone can’t be achieved, a tendon augmentation technique must be performed
Abstract
Purpose
Surgical treatment of pectoralis major ruptures is recommended by all authors, especially for people involved in sport activities that require upper body strength. We report a case of complete humeral avulsion treated surgically 2 years after the injury
Material And Methods
A 25 years old male patient was seen 2 years after sustaining an injury in his left shoulder while making bench press. He had a visible and palpable defect in the axillary fold and weakness on resisted shoulder adduction and internal rotation. At surgery a complete rupture of the pectoralis major tendon was identified. Despite circumferential mobilization of the muscle, anatomic direct repair to the humerus with the arm at the side was not possible. The homolateral semitendinosus was obtained and sutured to the muscle stump creating 2 appendixes of folded tendon of 3 cm in length. Using the Biotenodesis System (Arthrex, Inc, Creekside Boulevard, Naples, FL), these tendinous appendixes were fixed into bone holes with bioabsorbable interference screws at the anatomic insertion of the muscle. The patient was immobilized with a sling for 6 weeks
Results
At 3 months, he returned to sport activities gradually. At 6 months, he reached his previous level and practiced sports requiring upper body strength without restrictions. He is very satisfied with the cosmetic appearance, because there is no difference in muscle contour and axillary fold with the right side
Conclusion
We recommend surgical treatment for the ruptures of the pectoralis major tendon. In cases of chronic ruptures in which direct repair to bone can’t be achieved, a tendon augmentation technique must be performed. We present this technique using semitendinosus tendon in order to create cylindrical extensions of the tendon stump that can be attached to bone holes with bioabsorbable interference screws. In the case presented, the result is excellent, recovering cosmesis, function and strength