Surgical repair of acute pectoralis major muscle ruptures.

OBJECTIVE: Surgical repair of a partial or complete tear of the pectoralis major muscle to restore internal rotation, adduction, and anteversion.

INDICATIONS: Acute avulsion, acute tear of the tendinous insertion, acute tear of the musculotendinous region (<6 weeks after trauma). Relative indication: chronic retracted tear (>6 weeks).

CONTRAINDICATIONS: Muscular tears, local infection, other general contraindications.

SURGICAL TECHNIQUE: Open repair using suture anchors or flip buttons.

POSTOPERATIVE MANAGEMENT: Week 1-3: early passive-assisted functional physical therapy. Week 3-6: early active-assisted functional physical therapy. Week 7-9: active assisted free range of motion (ROM). From week 9: free ROM. From week 12: exercise with resistance, careful strengthening.

RESULTS: Between 2005 and 2017, 20 men with an acute or subacute tear of the pectoralis major muscle underwent surgery. Mean age 36 years (range 28-55 years). No previous antibiotic treatment or steroid abuse/treatment reported. Reasons for rupture were weight lifting (bench-press, n = 10), skiing and snowboard accidents (n = 3), fitness training (n = 3), soccer (n = 1), martial arts (n = 1), a canyoning accident (n = 1), and a simple fall (n = 1). Follow-up examinations were performed 6 weeks and 3 months postoperative. No infections or wound healing disorders; no revisions necessary. Normal muscle function via open refixation of the tendon stump. No re-rupture observed. Free ROM observed 3 months after surgery.