[Surgical treatment of chronic pectoralis major rupture].

OBJECTIVE: Reconstruction of the chronic pectoralis major rupture with reconstruction of the anatomy and the original initial length of the muscle-tendon unit as well as the full strength.

INDICATIONS: Basically all chronic tears of the pectoralis major, causing discomfort.

CONTRAINDICATIONS: Infections and tumors in the operation area.

SURGICAL TECHNIQUE: Skin incision medial to the anterior axillary line about 6 cm long in the split lines of the skin. Locate and sharply mobilize the muscle stump. Preparation of the crest of the greater tubercle and positioning 2-4 JuggerKnots® (Zimmer Biomet, Warsaw, IN, USA). In adduction and internal rotation, reinsert the muscle. In case of chronic tears possibly interposition or augmentation of a tendon auto- or allograft.

POSTOPERATIVE MANAGEMENT: Immobilization in a sling for 6 weeks without mobilization. From week 7, no-load mobilization. Weight load building from week 13.

RESULTS: In a prospective study, 25 patients with chronic pectoralis major tears were reconstructed with 18 allografts and 7 autografts. According to Bak et al. the clinical outcome was good and very good in 92% of cases, but the complication rate was high at 24%. The secondary reconstruction of the chronic tear shows good and very good results even after years.