Pectoralis major tendon reconstruction using semitendinosus allograft following rupture at the musculotendinous junction

BACKGROUND: Pectoralis major (PM) rupture is an uncommon sports injury that has become more prevalent in the past 20 years as a result of an increase in recreational weight lifting and sports participation. Ruptures occur most commonly at the tendon insertion (65%) and musculotendinous junction (27%). This study describes an open technique and clinical outcomes after reconstruction of a PM rupture at the musculotendinous junction. METHODS: In this case series, 6 patients with PM ruptures at the musculotendinous junction were enrolled, with a 12-month follow-up period. The diagnosis was made with magnetic resonance imaging and correlated with clinical examination findings. All patients underwent PM reconstruction with a semitendinosus allograft, followed by a graduated rehabilitation protocol. Postoperative outcomes were assessed using the American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, cosmesis, return of strength, and overall satisfaction. RESULTS: The average age at the time of surgery was 39.5 years. At the 12-month follow-up visit, the average outcome scores were as follows: American Shoulder and Elbow Surgeons score, 98.3; Constant score, 98; and visual analog scale score, 0.67. All patients were pleased with their cosmetic outcomes, as well as return of strength, and showed overall satisfaction with their postoperative results. CONCLUSIONS: On review of the literature, this study is the first to describe the use of an isolated semitendinosus allograft to reconstruct a PM tendon following rupture at the musculotendinous junction. The excellent clinical outcomes suggest that the described technique can be a reliable tool in the orthopedic surgeon's armamentarium when approaching this uncommon PM tear.