Table 2.

Key Points, Tips, and Pitfalls

Key points

Pectoralis major tears typically occur from rapid eccentric loading, most commonly while performing bench press–type exercises.

Surgical repair yields superior results to nonoperative treatment in active individuals.

The anatomic insertion footprint is along the lateral ridge of the bicipital groove and measures 70 mm in length.

The pectoralis major muscle consists of 2 heads: sternal and clavicular. The sternal head inserts proximal and deep to the clavicular head. This relation must be restored to achieve optimum function.

Surgical tips

Use of a padded Mayo stand to support the operative extremity allows for greater control and exposure.

Use the distal 6-8 cm through the standard deltopectoral approach; however, center the incision slightly medially to allow for easier identification of the retracted tendon.

Use residual tendon to aid in identification of the pectoralis major insertion footprint; place unicortical buttons at the proximal and distal ends of the footprint.

Pass only 1 limb of the FiberWire and FiberTape through the button to allow ease of suture sliding.

First, tighten and secure the FiberWire limbs to reduce the tendon to the footprint; then tighten and secure the FiberTape.

Surgical pitfalls

Identify and retract the biceps tendon and sheath medially to prevent injury or impingement.

Remain lateral to the conjoined tendon on initial dissection and avoid aggressive over-retraction to prevent injury to the musculocutaneous nerve.

Inadequate mobilization of the pectoralis major muscle medially will not allow adequate excursion, resulting in postoperative stiffness and external rotation deficit.