Is there surgical reattachment of the pectoralis (pectoralis) major muscle?

From the Guidelines

Surgical reattachment of the pectoralis major muscle is not directly addressed in the provided evidence, but it is implied that surgical treatment of clavicle fractures can help prevent malunions and nonunions that may affect the pectoralis major muscle. The provided evidence focuses on the treatment of clavicle fractures, and while it mentions the pull of the pectoralis major muscle, it does not specifically discuss surgical reattachment of this muscle 1. However, it is known that the pectoralis major muscle plays a crucial role in shoulder function, and injuries to this muscle can significantly impact morbidity, mortality, and quality of life. In general, surgical repair of the pectoralis major muscle is possible and is typically recommended for complete tears or ruptures, especially in young, active individuals who desire to return to high-level activities. The goal of surgical repair is to restore muscle function, alleviate pain, and improve cosmetic appearance. Key considerations in the decision to pursue surgical repair include the severity of the injury, the patient's overall health and activity level, and the potential risks and benefits of surgery. It is essential to consult with an orthopedic specialist to determine the best course of treatment for a specific injury, taking into account the individual's unique circumstances and priorities. In the context of clavicle fractures, surgical treatment may be necessary to prevent complications that could affect the pectoralis major muscle, such as malunions or nonunions, which can have adverse effects on strength and function of the shoulder 1. Ultimately, the decision to pursue surgical treatment should be based on a thorough evaluation of the individual's condition and a discussion of the potential benefits and risks of surgery. The most recent and highest quality evidence suggests that surgical treatment of clavicle fractures can provide improved short-term patient-reported outcomes and reduced rates of nonunion or symptomatic malunion compared to nonsurgical treatment 1. This evidence supports the use of surgical treatment for clavicle fractures, which may indirectly benefit the pectoralis major muscle by preventing complications that could affect its function. However, more research is needed to specifically address the topic of surgical reattachment of the pectoralis major muscle. Some key points to consider when evaluating the evidence include:

• The severity of the injury and the potential impact on the pectoralis major muscle
• The patient's overall health and activity level
• The potential risks and benefits of surgery
• The individual's unique circumstances and priorities
• The most recent and highest quality evidence available.

From the Research

Surgical Reattachment of the Pectoralis Major Muscle

• The pectoralis major muscle can be surgically reattached, as evidenced by various studies 2, 3, 4, 5, 6.
• Surgical reattachment is often recommended for acute ruptures, especially in young, active patients, to obtain good or excellent cosmetic and functional outcomes 2, 4, 6.
• Different surgical techniques have been described, including bone tunnel and suture anchor repair techniques, as well as the use of cortical buttons for tendon stump-to-bone fixation 3, 5.
• Studies have shown that surgical repair can result in satisfactory cosmetic and functional outcomes, with patients able to return to sports activity at their preoperative level 4, 5, 6.
• The use of suture anchor fixation has been shown to provide high patient satisfaction and predictable return of strength, cosmesis, and overall function 5.
• Early diagnosis and surgical intervention are essential to obtain a satisfactory functional outcome, with acute surgical repair (<6 weeks) recommended for optimal results 2, 6.

Indications and Outcomes

• Surgical reattachment is typically indicated for complete ruptures of the pectoralis major muscle, especially in athletes who participate in high-impact sports and weightlifting 4, 6.
• Outcomes following surgical repair have been reported to be excellent or good in the majority of cases, with patients experiencing significant improvements in strength, cosmesis, and overall function 4, 5, 6.
• Isokinetic strength deficiency has been reported to be similar to historical results, with average deficiencies ranging from 9% to 15% 5.
• The Bak criteria have been used to evaluate outcomes, with overall results reported as excellent, good, or fair 5.

Comparison of Surgical and Nonsurgical Treatment

• Studies have compared the outcomes of surgical and nonsurgical treatment for total rupture of the pectoralis major muscle in athletes, with clear evidence showing superior outcomes after surgical repair 6.
• Surgical repair has been shown to result in better cosmesis, better functional results, regaining of muscle power, and return to sports compared with conservative treatment 6.
• Anatomic surgical repair is currently considered the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes 6.