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Acellular dermal matrix augmentation significantly increases ultimate load to failure of pectoralis major tendon
Raffy Mirzayan1, Steven M Andelman2, Paul M Sethi3
1Kaiser Permanente Southern California, Baldwin Park, CA, USA.
Background:
Biomechanical studies have demonstrated that standard pectoralis major tendon (PMT) repairs have inferior strength compared with native tendon.
Hypothesis:
Augmentation of PMT repair with an acellular dermal matrix (ADM) will increase the ultimate load to failure.
Methods:
Eighteen cadaveric specimens were allocated to 3 repair groups: standard repair (SR); augmented repair (AR) with ADM; and intact, native tendon (NT). Specimens were tested for cyclic elongation, linear stiffness, load to 5 mm displacement, maximum load to failure, and method of failure.
Results:
Maximum load to failure in AR (1450 ± 295 N) was significantly higher than SR (921 ± 159 N; P = .0042) and equivalent to NT (1289 ± 240 N; P = .49). NT required the highest load to displace 5 mm (709 ± 202 N), which was higher than AR (346 ± 95 N; P < .001) and SR (375 ± 55; P = .0015). NT stiffness (125 ± 42 N/mm) was greater than the AR (69 ± 19 N/mm; P = .0073) or SR (75 ± 11 N/mm; P = .015). The mode of failure for SR was suture pullout from the PMT as opposed to button pullout from the humerus (fracture) for AR.
Conclusion:
ADM augmentation of PMT repair significantly increases ultimate load to failure.
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