Simultaneous repair of chronic bilateral myotendinous junctional pectoralis major tendon tears: A case report and review of the literature

Abstract

While traumatic rupture of the pectoralis major is increasingly recognized, simultaneous bilateral pectoralis major tears remain exceedingly rare, with only five previously reported cases. Of these cases, only two were treated in a simultaneous fashion, both relatively acutely after injury. We present, to our knowledge, the first case of chronic bilateral pectoralis major myotendinous junctional tears treated with simultaneous repair. Additionally, given the occupational functional demands of our patient, we provide additional insight into the expected recovery of similar cases, with unrestricted activity at six months post-operatively and fully recovered strength at ten months postoperatively maintained at a three-year follow-up.

Keywords

Shoulder / Pectoralis tendon / Pec repair / Suture button

CRediT authorship contribution statement

Patrick M. Ryan: Writing - review & editing, Writing - original draft, Formal analysis. Garret Schuchart: Writing - original draft, Supervision, Conceptualization. Luke Villamaria: Writing - review & editing, Writing - original draft. Brett Robin: Writing - review & editing, Vali-dation, Supervision, Conceptualization.

Ethical approval statement

The Institutional Review Board stipulates that a case report or series (1-3 patients), which describes an interesting treatment, presentation, or outcome is not subject to the jurisdiction of the FDA. A critical compo-nent is that nothing was done to the patient(s) with prior “research” intent. Institutional review and approval and obtaining informed consent are waivered.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledge Statement

All listed authors provided key contributions listed below and acknowledge the submission of this manuscript.

References

[1] Potter BK, Lehman RA, Doukas WC. Simultaneous bilateral rupture of the pectoralis major tendon. A case report. J Bone Joint Surg Am. 2004; 86:1519-1521. https://doi.org/10.2106/00004623-200407000-00023.

[2] Kholinne E, Lim C-S, Kho JI, Jeon I-H. Surgical intervention for pectoralis major muscle rupture: report of Acute and Chronic Cases. Case Rep Surg. 2018; 2018:2380241. https://doi.org/10.1155/2018/2380241.

[3] Zvijac JE, Gampel B, Kiebzak GM. Simultaneous bilateral rupture of the pectoralis major tendons while exercising on the rings. Current Orthopaedic Practice. 2011; 22: 376-378. https://doi.org/10.1097/BCO.0b013e31821e5c75.

[4] Kusler JE, Chong ACM, Piatt BE. Bilateral pectoralis major tendon rupture while performing intermediate level bench press. Kans J Med. 2019;12:94-96.

[5] Abbas MJ, Buckley P, Shah S, Okoroha KR. Simultaneous repair of bilateral pectoralis major tendons: a case report. World J Orthop. 2021; 12:802-810. https://doi.org/10.5312/wjo.v12.i10.802.

[6] Valeriote J, Purchase RJ, Kelly JD. Simultaneous bilateral pectoralis major muscle rupture. Am J Orthop (Belle Mead NJ). 2005;34:301-302.

[7] Haley CA, Zacchilli MA. Pectoralis major injuries: evaluation and treatment. Clin Sports Med. 2014; 33:739-756. https://doi.org/10.1016/j.csm.2014.06.005.

[8] Kretzler HH, Richardson AB. Rupture of the pectoralis major muscle. Am J Sports Med. 1989; 17:453-458. https://doi.org/10.1177/036354658901700401.

[9] Nute DW, Kusnezov N, Dunn JC, Waterman BR. Return to function, complication, and reoperation rates following primary pectoralis major tendon repair in military service members. J Bone Joint Surg Am. 2017; 99:25-32. https://doi.org/10.2106/JBJS.16.00124.

[10] Bodendorfer BM, McCormick BP, Wang DX, et al. Treatment of pectoralis major tendon tears. A systematic review and meta-analysis of operative and nonoperative treatment. Orthop J Sports Med. 2020;8:2325967119900813. https://doi.org/10.1177/2325967119900813.

[11] Balazs GC, Brelin AM, Donohue MA, et al. Incidence rate and results of the surgical treatment of pectoralis major tendon ruptures in active-duty military personnel. Am J Sports Med. 2016; 44:1837-1843. https://doi.org/10.1177/0363546516637177.

[12] Aärimaa V, Rantanen J, Heikkilä J, Helttula I, Orava S. Rupture of the pectoralis major muscle. Am J Sports Med. 2004; 32:1256-1262. https://doi.org/10.1177/0363546503261137.

[13] Thompson K, Kwon Y, Flatow E, Jazrawi L, Strauss E, Alaia M. Everything pectoralis major. From repair to transfer. Phys Sportsmed. 2020; 48:33-45. https://doi.org/10.1080/00913847.2019.1637301.

[14] Bak K, Cameron EA, Henderson IJ. Rupture of the pectoralis major. A meta-analysis of 112 cases. Knee Surg Sports Traumatol Arthrosc. 2000; 8:113-119. https://doi.org/10.1007/s001670050197.

[15] Zacchilli MA, Fowler JT, Owens BD. Allograft reconstruction of chronic pectoralis major tendon ruptures. J Surg Orthop Adv. 2013; 22:95-102. https://doi.org/10.3113/jsoa.2013.0095.

[16] Provencher MT, Handfield K, Boniquit NT, Reiff SN, Sekiya JK, Romeo AA. Injuries to the pectoralis major muscle diagnosis and management. Am J Sports Med. 2010; 38: 1693-1705. https://doi.org/10.1177/0363546509348051.

[17] Sherman SL, Lin EC, Verma NN, et al. Biomechanical analysis of the pectoralis major tendon and comparison of techniques for tendo-osseous repair. Am J Sports Med. 2012; 40:1887-1894. https://doi.org/10.1177/0363546512452849.

[18] Sequeira SB, Sequeira LM, Wieland MD, Imbergamo CM, Tepper K. No difference in load to failure or stiffness between transosseous tunnels, suture anchors, and cortical buttons for pectoralis major tendon repair. A systematic review & meta-analysis. J Exp Orthop. 2023;10:56. https://doi.org/10.1186/s40634-023-00617-9.

[19] Hanson JA, Horan MP, Foster MJ, et al. Clinical outcomes of pectoralis major tendon repair with and without platelet-rich plasma. Arthrosc Sports Med Rehabil. 2022;4: e1739-e1746. https://doi.org/10.1016/j.asmr.2022.06.021.

[20] Butt U, Mehta S, Funk L, Monga P. Pectoralis major ruptures. A review of current management. J Shoulder Elbow Surg. 2015; 24:655-662. https://doi.org/10.1016/j.jse.2014.10.024.

[21] de Castro Pochini A, Andreoli CV, Belangero PS, 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. https://doi.org/10.1177/0363546513506556.