scholarly journals Pectoralis major tendon reconstruction using semitendinosus allograft following rupture at the musculotendinous junction

2019 ◽  
Vol 3 (4) ◽  
pp. 328-332
Author(s):  
Mitchell Long ◽  
Tyler Enders ◽  
Robert Trasolini ◽  
William Schneider ◽  
Anthony Cappellino ◽  
...  
Keyword(s):  
Pectoralis Major ◽  
Musculotendinous Junction ◽  
Tendon Reconstruction

scholarly journals Pectoralis Major Tendon Reconstruction at the Myotendinous Junction With Semitendinosus Allograft: An Operative Technique

2021 ◽  
Vol 1 (2) ◽  
pp. 263502542199713
Author(s):  
John Wickman ◽  
Daniel Goltz ◽  
Brian Lau
Keyword(s):  
Clinical Outcomes ◽  
Pectoralis Major ◽  
Myotendinous Junction ◽  
Recreational Sports ◽  
Musculotendinous Junction ◽  
Muscle Belly ◽  
Tendon Reconstruction ◽  
Active Population ◽  
Active Patients ◽  
Deltopectoral Approach

Background: Pectoralis major (PM) tendon tears are a relatively uncommon injury that typically occurs in a young, active population during weightlifting or recreational sports. Musculotendinous junction and chronic PM tears often require tendon reconstruction due to inadequate remnant tendon stump or inability to reduce the remnant tendon stump to humeral footprint. Indications: We favor operative repair or reconstruction of PM tears in all young and active patients medically appropriate for surgery as supported by the literature. We present a technique for PM tendon reconstruction with semitendinosus allograft. This technique is applicable to musculotendinous junction and chronic tears. Technique: A modified deltopectoral approach is used. The PM tear is identified at the musculotendinous junction and the retracted muscle belly is mobilized. The PM tendon is reconstructed with a semitendinosus allograft using a Pulvertaft weave technique. The humeral footprint is prepped and the reconstructed tendon is properly tensioned and reduced. Fixation is performed with fibertapes loaded on 3 unicortical buttons. Postoperatively, the patient follows a graduated rehabilitation protocol. Results: There is a paucity of literature regarding outcomes of PM tendon reconstructions for musculotendinous junction tears. One study reported outcomes on 6 patients who had musculotendinous junction tears and underwent semitendinosus allograft reconstruction with a technique similar to ours. They report good clinical outcomes with high patient satisfaction regarding cosmetic outcome, return of strength, and overall satisfaction postoperatively. Discussion: It is our experience that the described technique for reconstruction of the PM tendon with semitendinosus allograft provides a viable option with good clinical outcomes for patients with PM ruptures at the musculotendinous junction.

scholarly journals Outcomes After Dermal Allograft Reconstruction of Chronic or Subacute Pectoralis Major Tendon Ruptures

2018 ◽  
Vol 6 (1) ◽  
pp. 232596711774583 ◽  
Author(s):  
Julie A. Neumann ◽  
Christopher M. Klein ◽  
Carola F. van Eck ◽  
Hithem Rahmi ◽  
John M. Itamura
Keyword(s):  
External Rotation ◽  
Constant Score ◽  
Case Series ◽  
Pectoralis Major ◽  
Tissue Quality ◽  
Level Of Evidence ◽  
Allograft Reconstruction ◽  
Tendon Reconstruction ◽  
Number Of Patients ◽  
Patient Reported

Background: Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction. Purpose: The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome. Study Design: Case series; Level of evidence, 4. Methods: Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively. Results: Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores ( r = 0.628, P = .016) and less forward flexion ( r = –0.502, P = .048) and external rotation ( r = –0.654, P = .006). Patients with workers’ compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction. Conclusion: This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.

scholarly journals Pectoralis Major Ruptures: Tear Patterns and Patient Demographic Characteristics

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096942
Author(s):  
Marcin Kowalczuk ◽  
Luc Rubinger ◽  
Amr W. Elmaraghy
Keyword(s):  
Primary Repair ◽  
Case Series ◽  
Patient Characteristics ◽  
Demographic Characteristics ◽  
Pectoralis Major ◽  
Level Of Evidence ◽  
Musculotendinous Junction ◽  
Patient Demographic ◽  
Tear Pattern

Background: The pectoralis major (PM) is made up of multilaminar muscle segments that form a complex insertion on the proximal humerus; it is composed of an anterior and a posterior tendon layer. The tear patterns and patient characteristics of operatively treated PM ruptures in the general population remain poorly understood. Purpose: To comprehensively report the demographic characteristics of patients who are clinically diagnosed with structurally significant PM ruptures and to describe PM tear patterns identified during surgery. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of surgically treated PM tears was performed for a single-surgeon case series between January 1, 2003, and November 1, 2017. Patient demographic characteristics, classification of tear pattern, and treatment (repair/reconstruction) were recorded. Results: A total of 104 surgical cases of PM tendon rupture were identified; 100 patients underwent primary repair and 4 underwent dermal allograft reconstruction. All patients were male, with a mean age of 36.5 ± 9.2 years. Chronic tears (>6 weeks old) accounted for 63.6% of surgical cases, and 96% (n = 100) of tears occurred at or between the musculotendinous junction and tendinous insertion. A partial-thickness, complete-width tear of the posterior tendon layer at this same location was the most common tear pattern identified. Conclusion: PM ruptures occurred almost exclusively at or between the musculotendinous junction and tendinous insertion, with predominant involvement of the posterior tendon layer. Chronic tears can be safely treated with primary repair in the vast majority of cases.

scholarly journals Pectoralis Major Rupture in Military Academy Athletes

2019 ◽  
Vol 7 (7) ◽  
pp. 232596711986015
Author(s):  
Andrew G. Chan ◽  
George C. Balazs ◽  
Chad A. Haley ◽  
Matthew A. Posner ◽  
John-Paul H. Rue ◽  
...  
Keyword(s):  
Case Series ◽  
Pectoralis Major ◽  
Common Mechanism ◽  
Study Cohort ◽  
Naval Academy ◽  
Military Academy ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Musculotendinous Junction ◽  
Bony Avulsion

Background: Pectoralis major ruptures are rare injuries that can occur at several parts of the muscle. Little is known of the pathoanatomic process and performance following pectoralis major ruptures in young athletes. Purpose/Hypothesis: The objective of this study was to describe a series of pectoralis major ruptures in military academy athletes at the US Military Academy and US Naval Academy. We hypothesized that military academy athletes will demonstrate a different rupture location than previously reported in older patients. Study Design: Case series; Level of evidence, 4. Methods: A retrospective case series was performed by analyzing all electronic medical records and imaging software for consecutive pectoralis major ruptures undergoing surgical repair within the student population at 2 military academies. The primary outcome of interest was rupture pattern and location. We also assessed functional recovery following surgery by analyzing push-up performance on the biannual Army Physical Fitness Test and Navy Physical Readiness Test. Results: From 2005 to 2017, a total of 19 cases of pectoralis major ruptures occurred in military academy cadets. Patients ranged in age from 19 to 23 years, with a mean age of 20 years. All injuries occurred during sports activity, with bench press as the most common mechanism of injury (n = 10; 53%). The most common rupture location was the musculotendinous junction (n = 10; 53%), followed by pectoralis major tendon insertion (n = 8; 42%), and only 1 bony avulsion was noted. Physical activity performance following the rupture was negatively affected. The mean ± SD number of push-ups preinjury was 73.20 ± 12.10, which decreased following injury and surgery (66.50 ± 11.98; P = .037). Conclusion: Military academy athletes in our study cohort demonstrated a different type of rupture location than has been reported in older cohorts, with the majority experiencing tearing at a location other than the tendon itself. Performance was also negatively affected immediately following repair, but moderate improvement was observed as time from surgery increased.

scholarly journals The Relevant Anatomy of the Biceps Tendon When Performing Tenodesis in Filipino Cadaveric Specimens

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Martin Louie Bangcoy ◽  
Charles Abraham Villamin ◽  
Chino Ervin Tayag ◽  
Patrick Henry Lorenzo
Keyword(s):  
Biceps Tendon ◽  
Initial Point ◽  
Pectoralis Major ◽  
Biceps Tenodesis ◽  
Bicipital Groove ◽  
Simple Method ◽  
Musculotendinous Junction ◽  
The Mean ◽  
Inferior Border ◽  
Superior Border

Background: Biceps tenodesis is a technique frequently performed in shoulder surgeries. Various techniques have been described, but there is no consensus on which technique restores the length-tension relationship. Restoration of the physiologic length-tension relationship has been correlated to better functional outcomes, such as decreased incidence of residual pain or weakness of the biceps. The objective of this study was to measure the anatomic relationship of the origin of the biceps tendon with its zones in the upper extremity. This would provide an anatomic guide or an acceptable placement of the tenodesis to reestablish good biceps tension during surgery. Methods: The study used nine adult cadavers (five males, four females) from the [withheld for blinded review]. Nine shoulder specimens were dissected and markers were placed at five points along each biceps tendon: (1) Labral origin (LO) (2) Superior bicipital groove (SBG) (3) Superior border of the pectoralis tendon (SBPMT) (4) Musculotendinous junction (MTJ) and (5) Inferior border of the pectoralis tendon (IBPMT). Using the origin of the tendon as the initial point of reference, measurements were made to the four subsequent sites. The humeral length was recorded by measuring the distance between the greater tuberosity and the lateral epicondyle as well as the tendon diameter at the articular surface. Results: The intraclass correlation coefficient was excellent across all measures. A total of nine cadavers were included. Mean age of patients was 66.33 years old, ranging from 52-82 years old. These were composed of five male and four female cadavers. The mean tendon length was 24.83mm ± 4.32 from the origin to the superior border of the bicipital groove, 73.50mm ± 6.96 to the Superior Border Pectoralis Major Tendon, 100.89mm ± 6.88 to the Musculotendinous Junction, and 111.11mm ± 7.45 to the Inferior Border Pectoralis Major Tendon. The mean tendon diameter at the articular origin was 6.44mm ± 1.76. Conclusion: This study provided measurement guidelines that could restore the natural length-tension relationship during biceps tenodesis using the interference screw technique in Filipinos. A simple method of restoring a normal length-tension relationship is by doing tenodesis close to the articular origin and creating a bone socket of approximately 25mm in depth, using the superior border of the bicipital groove as a landmark.

A Case of Large Calcifying Fibroma of Tendo-achilles Managed by En-block Resection and Tendon Reconstruction

2021 ◽  
Vol 60 (1) ◽  
pp. 167-171
Author(s):  
Mohammed Sadiq ◽  
Mohammed Nayeemuddin ◽  
Mohammed Wajid Hussain
Keyword(s):  
Tendon Reconstruction

Two Stage Flexor Tendon Reconstruction

2014 ◽  
Vol 30 (S 01) ◽  
Author(s):  
George Zaher ◽  
Raafat Gohar ◽  
Ashraf El-Sebaie
Keyword(s):  
Flexor Tendon ◽  
Two Stage ◽  
Tendon Reconstruction

Egyedi műtéti megoldás fiatal férfi betegen manubriumresectio után Grade II chondrosarcomában

2012 ◽  
Vol 65 (6) ◽  
pp. 430-432
Author(s):  
Ákos Kocsis ◽  
László Agócs ◽  
Szilárd Kostic ◽  
Klára Török ◽  
Miklós Molnár ◽  
...  
Keyword(s):  
Pectoralis Major ◽  
Manubrium Sterni ◽  
Grade Ii

Absztrakt Bevezetés: A primer malignus csontdaganatok kb. 30%-a chondrosarcoma, leginkább az elülső mellkasfalon jelentkeznek. Azoknak a betegeknek, akik megfelelő sebészi kezelést kapnak, 97%-os a 10 éves túlélési rátájuk. Ezenfelül fontos a terhelhetőség és a légzési funkció megőrzése, nem utolsósorban pedig az esztétikai eredmény. Beteg: A szerzők egy 44 éves férfi beteg esetét ismertetik, aki sportmasszőrként dolgozott, és a manubrium sterni Grade II chondrosarcomája miatt került műtétre. A beavatkozás során a sternum érintett része szélesen az épben kimetszésre került, a helyreállítás során a Dual Mesht bal oldali pectoralis major lebennyel fedték, valamint egyedi megoldásként a semitendinosus és -gracilis izmok inát felhasználva fixáltak két claviculát egymáshoz, ezáltal nagyfokú stabilitást adva a mellkasfalnak, és -visszaadva a felső végtag, illetve a vállöv terhelhetőségét. Eredmény: Eseménytelen posztoperatív szak után a beteg hamar felépült, és gyorsan visszatérhetett korábbi, a vállövet jelentősen igénybe vevő munkájához. Következtetés: A szerzők nem találtak hasonló műtéti eljárást az irodalomban, és ajánlják alkalmazását hasonló esetekben.

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