Acute or chronic pectoralis major tendon rupture repaired with direct suture: Clinical and functional outcomes with a mean follow-up of 5 years

Lucile Breyne; Gaspard Lebot; Florent Borel; Gabriel Franger; Juien Cléchet; Yannick Carrillon; Arnaud Godeneche

DOI: 10.70885/hmsj.2025.02.001

Abstract

Background: Acute pectoralis major tendon ruptures can be treated with direct tendon repair, while chronic ruptures may benefit from graft.Purpose: To assess the clinical and functional outcomes after direct tendon repair through suture anchors in both acute and chronic tendon rupture of pectoralis major.Methods: A retrospective chart review of consecutive patients of a single surgeon who underwent direct tendon repair of both acute and chronic (6 weeks post injury) pectoralis muscle rupture was performed. Outcomes collected were shoulder ranges of motion (flexion, abduction, external rotation, internal rotation), functional recovery during follow-up (subjective shoulder value; SSV), score of the American Shoulder and Elbow Surgeons (ASES), Bak criteria, auto-Constant score, patient satisfaction and complications.Results: A total of 15 patients (mean age, 34.3 years) were analyzed: 6 with acute and 9 with chronic pectoralis major rupture. Mean (SD) follow-up was 5.2 (3.4) years (minimum, 2.2 years). Shoulder movement parameters were satisfying both in the acute and chronic rupture groups. Mean (SD) SSV was 88.3 (9.3) for acute and 87.8 (10.9) for chronic tendon rupture. Mean (SD) ASES scores were 95.8 (5.3) and 95.9 (4.8), respectively. Bak criteria were good or excellent in 6 (100%) and 7 (78%) patients, respectively. Mean (SD) auto-Constant total score was 98.3 (2.0) for acute rupture and 98.0 (3.0) for chronic rupture. All acute rupture patients were satisfied, and 7 of 9 (78%) patients with chronic rupture. The two dissatisfied patients were those with the longest repair delay (83 and 99 weeks). No other surgery and no complications were reported during the follow-up.Conclusion: Direct tendon repair for both acute and chronic pectoralis major tendon rupture led to satisfactory clinical and functional results up to a mean of 5 years after surgery.What this study adds: The number of cases of pectoralis major muscle rupture reported in the literature remains limited, particularly for chronic ruptures that may benefit from graft. This study reports 15 cases of pectoralis major muscle rupture (6 acute and 9 chronic) all repaired with direct suture. Potential impacts on research, practice, or policy: Direct tendon repair is technically possible in chronic ruptures and satisfying outcomes can be obtained 6 weeks or more after the rupture.Type of Study: Retrospective study with no comparison groupLevel of Evidence: Level IVKeywords: Shoulder injury; Pectoralis major; Tendon rupture; Muscle tendon repair; Sports injuryhttps://doi.org/10.70885/hmsj.2025.02.001

References

  1. Long MK, Ward T, DiVella M, Enders T, Ruotolo C. Injuries of the Pectoralis Major: Diagnosis and Management. Orthop Rev (Pavia). 2022;14:36984. DOI: 10.52965/001c.36984
  2. Aarimaa V, Rantanen J, Heikkila J, Helttula I, Orava S. Rupture of the pectoralis major muscle. Am J Sports Med. 2004;32:1256-62. DOI: 10.1177/0363546503261137
  3. Kircher J, Ziskoven C, Patzer T, Zaps D, Bittersohl B, Krauspe R. Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal. Open Access J Sports Med. 2010;1:201-5. DOI: 10.2147/OAJSM.S9066
  4. Gupton M, Johnson JE. Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2019;7:2325967118824551. DOI: 10.1177/2325967118824551
  5. Ganokroj P, Midtgaard K, Elrick BP, Dey Hazra RO, Douglass BW, Nolte PC, et al. Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study. Orthop J Sports Med. 2022;10:23259671221121333. DOI: 10.1177/23259671221121333
  6. Bak K, Cameron EA, Henderson IJ. Rupture of the pectoralis major: a meta-analysis of 112 cases. Knee Surg Sports Traumatol Arthrosc. 2000;8:113-9. DOI: 10.1007/s001670050197
  7. Kowalczuk M, Rubinger L, Elmaraghy AW. Pectoralis Major Ruptures: Tear Patterns and Patient Demographic Characteristics. Orthop J Sports Med. 2020;8:2325967120969424. DOI: 10.1177/2325967120969424
  8. Kowalczuk M, Elmaraghy A. Pectoralis Major Rupture: Evaluation and Management. J Am Acad Orthop Surg. 2022;30:e617-e27. DOI: 10.5435/JAAOS-D-21-00541
  9. Gilbart MK, Gerber C. Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg. 2007;16:717-21. DOI: 10.1016/j.jse.2007.02.123
  10. Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J. Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res (Hoboken). 2011;63 Suppl 11:S174-88. DOI: 10.1002/acr.20630
  11. Barrett WP, Franklin JL, Jackins SE, Wyss CR, Matsen FA, 3rd. Total shoulder arthroplasty. J Bone Joint Surg Am. 1987;69:865-72.
  12. Chelli M, Levy Y, Lavoue V, Clowez G, Gonzalez JF, Boileau P. The "Auto-Constant": Can we estimate the Constant-Murley score with a self-administered questionnaire? A pilot study. Orthop Traumatol Surg Res. 2019;105:251-6. DOI: 10.1016/j.otsr.2018.11.023
  13. Kretzler HH, Jr., Richardson AB. Rupture of the pectoralis major muscle. Am J Sports Med. 1989;17:453-8. DOI: 10.1177/036354658901700401
  14. Schepsis AA, Grafe MW, Jones HP, Lemos MJ. Rupture of the pectoralis major muscle. Outcome after repair of acute and chronic injuries. Am J Sports Med. 2000;28:9-15. DOI: 10.1177/03635465000280012701
  15. Antosh IJ, Grassbaugh JA, Parada SA, Arrington ED. Pectoralis major tendon repairs in the active-duty population. Am J Orthop (Belle Mead NJ). 2009;38:26-30.
  16. 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. Eur J Orthop Surg Traumatol. 2015;25:91-8. DOI: 10.1007/s00590-014-1451-y
  17. Beloosesky Y, Grinblat J, Weiss A, Rosenberg PH, Weisbort M, Hendel D. Pectoralis major rupture in elderly patients: a clinical study of 13 patients. Clin Orthop Relat Res. 2003:164-9. DOI: 10.1097/01.blo.0000076803.53006.12
  18. de Castro Pochini A, Andreoli CV, Belangero PS, Figueiredo EA, Terra BB, Cohen C, et al. Clinical considerations for the surgical treatment of pectoralis major muscle ruptures based on 60 cases: a prospective study and literature review. Am J Sports Med. 2014;42:95-102. DOI: 10.1177/0363546513506556
  19. de Castro Pochini A, Ejnisman B, Andreoli CV, Monteiro GC, Silva AC, Cohen M, et al. Pectoralis major muscle rupture in athletes: a prospective study. Am J Sports Med. 2010;38:92-8. DOI: 10.1177/0363546509347995
  20. Wolfe SW, Wickiewicz TL, Cavanaugh JT. Ruptures of the pectoralis major muscle. An anatomic and clinical analysis. Am J Sports Med. 1992;20:587-93. DOI: 10.1177/036354659202000517
  21. Kakwani RG, Matthews JJ, Kumar KM, Pimpalnerkar A, Mohtadi N. Rupture of the pectoralis major muscle: surgical treatment in athletes. Int Orthop. 2007;31:159-63. DOI: 10.1007/s00264-006-0171-2
  22. Joseph TA, Defranco MJ, Weiker GG. Delayed repair of a pectoralis major tendon rupture with allograft: A case report. J Shoulder Elbow Surg. 2003;12:101-4. DOI: 10.1067/mse.2003.128200
  23. Schachter AK, White BJ, Namkoong S, Sherman O. Revision reconstruction of a pectoralis major tendon rupture using hamstring autograft: a case report. Am J Sports Med. 2006;34:295-8. DOI: 10.1177/0363546505278697
  24. Alho A. Ruptured pectoralis major tendon. A case report on delayed repair with muscle advancement. Acta Orthop Scand. 1994;65:652-3. DOI: 10.3109/17453679408994625

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