Table 1.

Pearls, Pitfalls and Risks, Key Points, Indications, and Contraindications

Pearls

During drilling of the unicortical drill hole, the drill is slightly angled with respect to the humeral cortex to provide sufficient room in the intramedullary canal and thus aid in flipping the button.

Before repair fixation, the arm is placed into an adducted, neutral position.

The sternocostal head is repaired first, followed by the clavicular head. The sternocostal head insertion is posterior-superior relative to the clavicular head insertion.

A C-arm is used to confirm the final and correct positioning of the buttons.

Pitfalls and risks

An insufficient amount of bone bridge between each button placement site can increase the risk of fracture.

Implant cost is a consideration when using the cortical button method.

Cortical buttons may lead to metal artifact on postoperative magnetic resonance imaging studies.

Key points

In athletes and laborers, operative management of pectoralis major ruptures has been shown to have significant clinical benefits over nonoperative management.

Our technique uses a tendon-to-bone repair with tension button fixation at the footprint.

Bone trough fixation can lead to a higher propensity to fracture, which is a smaller risk with the cortical button technique.

The patient may return to collision sports at a minimum of 6 months after surgery, predicated on reaching each of the rehabilitation benchmarks, including sport- and position-specific components.

Indications

Insertional or intrasubstance pectoralis major tendon ruptures

Higher-demand individuals (athletes and laborers)

Cosmetic deformity of axillary fold

Contraindications

Pectoralis major muscle strains

Low-demand individuals (elderly persons, non-laborers, or sedentary individuals)

Comorbid factors that obviate the need for elective surgery