Pectoralis Major Tendon Reconstruction at the Myotendinous Junction With Semitendinosus Allograft: An Operative Technique

Abstract

Background: Pectoralis major (PM) tendon tears are a relatively uncommon injury that typically occurs in a young, active population during weightlifting or recreational sports. Musculotendinous junction and chronic PM tears often require tendon reconstruction due to inadequate remnant tendon stump or inability to reduce the remnant tendon stump to humeral footprint. Indications: We favor operative repair or reconstruction of PM tears in all young and active patients medically appropriate for surgery as supported by the literature. We present a technique for PM tendon reconstruction with semitendinosus allograft. This technique is applicable to musculotendinous junction and chronic tears. Technique: A modified deltopectoral approach is used. The PM tear is identified at the musculotendinous junction and the retracted muscle belly is mobilized. The PM tendon is reconstructed with a semitendinosus allograft using a Pulvertaft weave technique. The humeral footprint is prepped and the reconstructed tendon is properly tensioned and reduced. Fixation is performed with fibertapes loaded on 3 unicortical buttons. Postoperatively, the patient follows a graduated rehabilitation protocol. Results: There is a paucity of literature regarding outcomes of PM tendon reconstructions for musculotendinous junction tears. One study reported outcomes on 6 patients who had musculotendinous junction tears and underwent semitendinosus allograft reconstruction with a technique similar to ours. They report good clinical outcomes with high patient satisfaction regarding cosmetic outcome, return of strength, and overall satisfaction postoperatively. Discussion: It is our experience that the described technique for reconstruction of the PM tendon with semitendinosus allograft provides a viable option with good clinical outcomes for patients with PM ruptures at the musculotendinous junction.