Pectoralis major tendon ruptures are increasingly common given recent fitness trends and an older, more active population. Pectoralis major tendon ruptures most commonly occur in middle-aged patients as a result of intense athletic activity, particularly weight lifting or heavy contact sports. This video discusses the management of pectoralis major tendon ruptures and demonstrates reconstruction of a complex, chronic pectoralis major tendon tear with Achilles tendon allograft augmentation.

The video provides an overview of the pathogenesis, diagnosis, and management of pectoralis major tendon tears. The case presentation of a 39-year-old man who sustained a pectoralis major tendon rupture 3 weeks ago is discussed. Surgical management of the pectoralis major tendon was attempted at another institution; however, because of the complex nature of the tear at the musculotendinous junction and the chronicity of the injury, the patient did not undergo tendon repair and was referred to our center for definitive treatment. The patient underwent pectoralis major tendon reconstruction with Achilles tendon allograft augmentation via a Pulvertaft weave.

Postoperatively, early pendulum exercises were performed, and a sling was used for comfort. Physical therapy was initiated at 6 weeks postoperatively, with gradual stretching and active assisted range of motion. Gradual muscle strengthening was initiated at 3 months postoperatively. The patient did well and began returning to activity as tolerated at 1 year postoperatively.

Pectoralis major tendon ruptures are increasingly common. Although the literature on the reconstruction of chronic pectoralis major tendon tears is limited, studies suggest good to excellent results and patient-reported outcomes and favor surgical repair/reconstruction in young, active individuals. However, these outcomes are contingent on meticulous technique and proper patient selection.