[Surgical treatment of chronic pectoralis major rupture].

OBJECTIVE

Reconstruction of the chronic pectoralis major rupture with reconstruction of the anatomy and the original initial length of the muscle-tendon unit as well as the full strength.

INDICATIONS

Basically all chronic tears of the pectoralis major, causing discomfort.

CONTRAINDICATIONS

Infections and tumors in the operation area.

SURGICAL TECHNIQUE

Skin incision medial to the anterior axillary line about 6 cm long in the split lines of the skin. Locate and sharply mobilize the muscle stump. Preparation of the crest of the greater tubercle and positioning 2-4 JuggerKnots® (Zimmer Biomet, Warsaw, IN, USA). In adduction and internal rotation, reinsert the muscle. In case of chronic tears possibly interposition or augmentation of a tendon auto- or allograft.

POSTOPERATIVE MANAGEMENT

Immobilization in a sling for 6 weeks without mobilization. From week 7, no-load mobilization. Weight load building from week 13.

RESULTS

In a prospective study, 25 patients with chronic pectoralis major tears were reconstructed with 18 allografts and 7 autografts. According to Bak et al. the clinical outcome was good and very good in 92% of cases, but the complication rate was high at 24%. The secondary reconstruction of the chronic tear shows good and very good results even after years.