Published online Oct 18, 2016. doi: 10.5312/wjo.v7.i10.670
Peer-review started: March 24, 2016
First decision: May 16, 2016
Revised: June 18, 2016
Accepted: July 29, 2016
Article in press: August 1, 2016
Published online: October 18, 2016
To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique.
In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured.
Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036).
We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle.
Core tip: We are presenting the results of repair of rare chronic tears of pectoralis major. This is one of the longest series of repair of chronic pectoralis major tears by corkscrew suture anchors with midterm follow-up. In chronic tears hardly any repairable length of the tendon is available and what available is largely musculotendinous unit. We used a new technique to prevent cutting through of sutures from retracted musculotendinous unit in chronic tears. We have obtained excellent results with this technique.