Background

Pectoralis major tendon tears are rare, most commonly occurring during weightlifting or sports such as football and wrestling. These injuries are commonly misdiagnosed, and chronic tears may develop. Surgical repair is an acceptable treatment option for the management of these injuries; however, adequate repair strength must be achieved to avoid a re-tear or chronic tear development. Several graft options have been described for reconstructing pectoralis major tendons, including Achilles tendon allografts to restore strength, tendon contour, and proper humeral footprint insertion. These grafts also are an option for reconstruction of failed primary repair.

Purpose

This video and case presentation demonstrates the surgical technique for revision reconstruction of failed pectoralis tendon tear repair with the use of multiple Achilles tendon allografts.

Methods

The evaluation, diagnosis, and management of chronic pectoralis major tendon tears is discussed. The case presentation of a 48-year-old man in whom pectoralis major tendon tear reconstruction failed is discussed. The patient was subsequently treated via revision reconstruction with the use of multiple Achilles allografts.

Results

The patient progressed through a standardized rehabilitation protocol. At 2.5 months postoperatively, the patient had no pain or weakness, and physical examination revealed restoration of the pectoralis major tendon contour. Biodex testing revealed improved strength compared with preoperative scores.

Conclusion

Surgical reconstruction of the pectoralis major tendon with the use of Achilles tendon allografts is a dependable treatment option for patients with a chronic pectoralis major tendon tear to restore strength and normal tendon contour. Early results show good radiographic and clinical outcomes.