Chronic Rupture of the Pectoralis Major: Current Concepts and Various Surgical Repair Techniques - A Mini Review.

Abstract

Introduction: Various surgical repair techniques, including autograft and allograft reconstructions, have been reported for the management of chronic pectoralis major ruptures, but outcome reporting remains highly heterogeneous. This narrative review aimed to provide a deeper understanding of these techniques, emphasizing the need for larger-scale prospective trials to support evidence-based recommendations for surgeons.

Materials and methods: We conducted a search of PubMed/Medline, Cochrane Library, Embase, and Google Scholar for English-language articles published between 1822 and 2023, using the following keywords: "chronic pectoralis major ruptures," "chronic pectoralis major tears," and "patient outcomes."

Results: Overall, more than 60 reported cases were retrieved, along with a few prospective studies and review articles. Based on the compiled literature, most pectoralis major tears tend to arise at the tendo-osseus junction. In the absence of contra-indications such as old age and multiple comorbidities, surgical intervention is considered the golden care standard. The most commonly performed repair techniques include suture anchor fixation, transosseous fixation (TOS), and cortical bone fixation. Among the three techniques, no significant differences in cyclic loading or load-to-failure properties of the constructs were recorded. In chronic cases, in which direct repair is not possible, various autograft and allograft reconstructions were described, with quite heterogeneous outcome reporting, rendering comparative analyses difficult.

Conclusion: Currently, no single technique has been established as the gold standard for the treatment of chronic pectoralis major ruptures. The most commonly performed repair techniques include suture anchor fixation, TOS, and cortical bone fixation. In chronic cases where direct repair is not feasible, various autograft and allograft reconstructions are employed. There is a need for larger-scale prospective trials with standardized outcome reporting to develop evidence-based recommendations, providing surgeons with safe and effective guidelines for treatment.