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.
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.
Authors: Anthony Sanchez; Marcio B Ferrari; Salvatore J Frangiamore; George Sanchez; Bradley M Kruckeberg; Matthew T Provencher Journal: Arthrosc Tech Date: 2017-06-05
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