Open Pectoralis Major Repair: Endobutton Fixation

Background: Rupture of the pectoralis major is most commonly seen with eccentric contraction mechanisms, and surgical options in the setting of acute tear include direct repair, endocortical buttons, suture anchors, and transosseous tunnel fixation. This technique video will detail repair using a unicortical endobutton fixation construct. Indications: Surgical repair is indicated for acute, complete pectoralis major tears; incomplete tears involving rupture of the sternal head with intact clavicular head; and tears in the young, active, high-demand demographic. Delay in diagnosis increases the risk of tendon retraction and fatty atrophy. Recent literature has shown that acute repair is superior to chronic repair in functional outcome, pain relief, and overall cosmesis. Technique Description: A beach-chair position and a deltopectoral approach are used to identify and mobilize the torn and retracted sternal head of the pectoralis major. A No. 2 SutureTape is then passed through the disrupted sternal head in a Krackow fashion to allow for a 6-strand repair. Two of the suture strands are then shuttled through the endocortical button. A drill is used to create a corticectomy for endobutton placement, which is secured into place by sequentially tightening each limb. Two additional endobuttons are placed in a similar fashion to complete the construct. Results: Outcomes studies regarding patients with pectoralis major tendon ruptures who underwent endocortical button fixation reveal that 83% of patients had good or excellent outcomes in a recent systematic review. Another study showed no significant difference in functional outcomes, return to activity, or complication rate with endocortical button fixation compared with other mechanisms of fixation. Discussion/Conclusion: Unicortical endobutton fixation can provide another fixation strategy for acute pectoralis major tears in young, active high-demand individuals. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Graphical Abstract This is a visual representation of the abstract.