Repair of a Chronic Pectoralis Major Rupture with Achilles Tendon-Calcaneal Allograft: A Case Report

In chronic pectoralis major (PM) tendon tears, muscle retraction and involution of the residual tendon usually preclude the use of direct repair, and augmentation methods are commonly required. Investigators have tried to find ways to maximize biomechanical fixation strength, with studies focusing mainly on methods of bony fixation and showing few differences among fixation techniques. Achilles allograft reconstruction of chronic pectoralis tendon ruptures is a viable treatment option.

A 38-year-old male weightlifter presented with a 2-year-old left-sided PM tendon rupture, sustained during bench press; he had been using anabolic steroids in the 6 months preceding the injury. Complete rupture was confirmed on physical examination and magnetic resonance imaging (MRI). The PM tendon was reconstructed with an Achilles tendon-calcaneal allograft. Unlike previously described techniques, the calcaneal bone block was embedded in a humeral bone trough (3 × 1.5 cm) at the footprint on the lateral lip of the bicipital groove and secured with an absorbable magnesium alloy interference screw; three suture anchors preloaded with #2 FiberWire were placed 1 cm medial to the trough using the Krackow locking-loop and a sliding-suture technique. Pendulum exercises were begun at the 2nd post-operative week. The patient returned to routine labor at 8 weeks and resumed weightlifting at 10 weeks. At 26-month follow-up, he had full painless range of motion, restored anterior axillary fold, a quick disabilities of the arm, shoulder, and hand score of 4.55/100, and an American Shoulder and Elbow Surgeons score of 95/100, indicating minimal residual disability and excellent shoulder-specific function.

The goals of chronic PM repair are maintaining structural integrity of the reconstruction and restoring full functional range of motion. In this case, the described technique met these requirements: it provided clinically sufficient fixation that allowed pendulum exercises from the 2nd post-operative week and produced excellent functional and cosmetic outcomes at 26 months. In selected active patients with long-standing chronic ruptures and a non-viable native tendon, in whom direct repair is not feasible, this technique may be a useful reconstructive option.