Pectoralis major tendon repair outcomes: comparison of transosseous tunnel and cortical button fixation techniques

The traditional gold standard for repairing pectoralis major tendon ruptures involves the utilization of a cortical trough and transosseous bone tunnels. However, it has been shown to create stress risers that could increase the risk of developing humeral fractures. Modern repair techniques have evolved using either anchors or cortical button fixation. There is currently no clinical outcome data comparing the outcomes between the 2 repair methods. This retrospective cohort study aims to compare the clinical and patient-reported outcomes between the cortical button and transosseous tunnel repair techniques in pectoralis major tendon ruptures.

A retrospective chart review for pectoralis major tendon repairs was conducted, identifying 10 patients who underwent cortical-button fixation and 9 patients who underwent transosseous tunnel fixation between January 2011 and December 2021. Patient demographics and case characteristics were collected for comparison in addition to follow-up data on post-operative patient-reported outcomes, strength, range of motion, and complications.

At a median follow-up of 48 months (quartiles: 41, 50), we found that transosseous tunnel repair patients reported significantly worse scores compared to cortical button repair patients on both the Disabilities of the Arm, Shoulder and Hand surveys (5.0 [quartiles: 3.3, 8.3] vs. 1.3 [quartiles: 0.0, 2.3], P = .049) and American Shoulder and Elbow Surgeons surveys (88.3 [quartiles: 88.3, 91.7] vs. 98.5 [quartiles: 95.0, 100.0], P = .028).

The cortical button repair method for pectoralis major tendon ruptures may be associated with better long-term pain and functional outcomes as reported on the American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand surveys compared to the transosseous tunnel repair method, but further investigation is needed.