Pectoralis Major Tendon Tears: Pectoralis Major Tendon Repair With Metal Buttons and Sutures

Pectoralis Major Tendon Tears: Pectoralis Major Tendon Repair With Metal Buttons and Sutures

This surgical video demonstrates a pectoralis major tendon repair to treat a pectoralis major tendon tear. Here, we see the left side of the chest and shoulder. The surgeon has already marked out where the incision will be made above the armpit. The surgeon begins by cutting through the skin and soft tissue to access the pectoralis major muscle. Metal retractors are used to hold the skin incision open during the procedure.

The surgeon continues to cut through the surrounding soft tissue and uses another metal retractor to move muscle out of the way. The surgeon then uses their hand to release scar tissue from the surface of the pectoralis major muscle and uses an instrument to grab the free end of the torn tendon. The surgeon then uses a curved needle to pass sutures through the end of the tendon, creating 3 separate sets of sutures with 2 suture ends. All ends of the sutures exit out of the top of the tendon.

Next, the surgeon moves the deltoid muscle of the shoulder out of the way to find the humerus or upper arm bone. The surgeon uses a burr to shave down the surface of the humerus bone to improve the ability of the tendon to heal back to the bone. Then, the surgeon uses a drill to make 3 small holes in the top of the humerus. Two suture ends from 1 set of sutures are threaded through a small metal button, which is inserted into 1 of the drilled holes. The surgeon pulls on the suture ends to fully secure the metal button into the hole.

The same steps are repeated for the other sets of sutures and 2 metal buttons. Once all the metal buttons are firmly secured into the humerus, the surgeon alternates pulling on the 2 suture ends from each set of sutures to gradually pull the pectoralis major tendon close to the bone. Once the tendon is secured to the bone, the surgeon ties knots with each set of sutures. The excess sutures will be cut off, and the surgeon will close the skin incision with additional sutures. The pectoralis major tendon repair is now complete.