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.