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Pectoralis Major Repair

72 citationsUpdated Oct 2026
Illustration: Pectoralis Major Repair

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Pectoralis major tears predominantly occur at the myotendinous junction [6]. Surgical repair is the treatment of choice for young, active patients requiring full strength restoration [9], and is specifically recommended for total and near-total ruptures in athletes or those with vocational demands for maximum strength [3, 22, 35]. Early anatomic repair yields the best results for these injuries [3], while allograft reconstruction serves as a viable option for chronic ruptures where direct repair is not feasible [16]. Although conservative management does not result in complete loss of strength [10], objective testing demonstrates that surgical repair provides greater recovery of peak torque and work performed than nonoperative management [1].

Operative treatment results in significantly superior functional outcomes and cosmesis satisfaction compared to nonoperative care, with a trend toward higher proportions of patients being pain-free [11, 13]. Patients treated operatively for acute or chronic ruptures fare significantly better than those managed nonoperatively, with no statistically significant difference in outcomes between acute and chronic operative groups [15]. Anatomic repair using unicortical button fixation and suture tape is a preferred technique due to its reproducibility and reliability [2]. Early surgical repair combined with accelerated rehabilitation allows for reliable restoration of shoulder function and early return to sports [14].

The procedure is associated with a 97.8% rate of return to work, with a mean time to return of 1.6 months [4]. Repair is effective in achieving high rates of return to sport and work, pain relief, and improved cosmetic appearance [12]. However, this benefit is accompanied by a 14.21% complication rate [8, 13]. Despite this, surgical repair can be performed safely with a low re-rupture rate and low risk of complications [33]. Successful repair has been documented even 13 years after the initial injury [5].

Anatomy & Pathophysiology

Muscle Architecture and Tendon Anatomy

The pectoralis major consists of an unsegmented clavicular head and upper and lower sternal heads that collectively comprise 6 to 7 segments [107]. The tendon is formed by anterior and posterior layers that fuse laterally before inserting into the lateral ridge of the intertubercular groove of the humerus [107]. The clavicular head and upper sternal head segments contribute to the anterior tendon layer, coursing inferolaterally, while the lower sternal head segments form the posterior layer, coursing superolaterally [107]. There is no twisting at the muscular or tendinous layers; instead, the contributing segments are wider medially and narrower laterally in a splayed-out orientation [107]. The distal tendon exhibits a 'U' shape, with the anterior layer comprising the clavicular head and, to a lesser extent, the sternal head, and the posterior layer comprising the sternal head; these layers fuse proximal to the distal humeral attachment [29]. The muscle inserts on the humeral shaft and displaces it medially [62]. Due to its anterior tendinous insertion onto the lateral wall of the bicipital groove, the pectoralis major powers adduction and internal rotation [69]. The tendon forms the roof of the distal continuation of the bicipital tunnel, a closed space extending proximally to the glenohumeral joint [69]. A soft tissue sheath consistently covers the long head of the biceps tendon to the level of the proximal margin of the pectoralis major tendon and contributes to the roof of this tunnel [66].

Injury Mechanisms and Pathophysiology

Pectoralis major rupture is uncommon, though its incidence has increased over the last 20 years [107], and it probably occurs much more frequently than reported [17]. Rupture occurs within the muscle belly, by avulsion of the tendinous insertion, or by separation of the musculotendinous junction [17]. The majority of tears occur at the myotendinous junction [6], a trend potentially reflecting changes in population-wide physical activities [24]. Myotendinous junction tears are occurring more frequently [6]. Injuries typically result from an eccentric mechanism, most commonly during the bench press weightlifting maneuver [107]. Mechanisms of injury include direct trauma, excessive athletic stress, or attempts to prevent falls [17]. In a series of 40 athletes undergoing surgical repair, bench press and contact sport participation were the most common mechanisms [25]. Tears most commonly begin in the lower sternal head, where fibers are shortest and placed in maximal stretch when the shoulder is in abduction, external rotation, and extension [107]. Significantly heavy and often eccentric loads can propagate a tear proximally to varying degrees [107]. Rupture is presumed to be caused by trauma to a normal tendon, as degeneration that almost invariably precedes tendon rupture does not usually occur in this muscle [55].

Biomechanical Function

The pectoralis major is an intrinsic muscle that controls the glenohumeral joint [75]. Restoration of dynamic external and internal couple forces maintains the humeral head in the center of rotation [34]. In shoulders with massive rotator cuff tear, the pectoralis major and latissimus dorsi muscles have increased importance [114]. In these cases, the pectoralis major and latissimus dorsi are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures [89].

Classification

Tietjen: The Tietjen classification is a functional system for pectoralis major injuries [40]. Type I involves a sprain or contusion [40]. Type 3-dimensional is defined as complete tears at the tendon level [36].

Bak: The Bak criteria are used to evaluate outcomes in pectoralis major tendon tears, categorizing results as excellent, good, or fair [25]. These criteria are also used to compare outcomes between surgical and nonoperative treatment in athletes with total pectoralis major ruptures [35].

Tietjen and Bak: This classification has been modified to address isolated tears of the sternocostal head of the pectoralis major muscle [20].

Contemporary Injury Classification: A contemporary injury classification system has been proposed that includes injury timing, injury location, and standardized terminology addressing tear extent to reflect musculotendinous morphology [103].

Other Considerations: Pectoralis major ruptures can occur within the muscle belly, by avulsion of the tendinous insertion, or by separation of the musculotendinous junction [17]. The majority of pectoralis major tears occur at the myotendinous junction, potentially reflecting changes in population-wide physical activities [24]. The distal pectoralis major tendon has a 'U' shape comprised of an anterior layer (clavicular head and, to a lesser extent, sternal head) and a posterior layer (sternal head) that fuse proximal to the distal tendon attachment on the humerus [29].

Clinical Presentation

Diagnosis and Assessment

Diagnosis of pectoralis major tears relies primarily on history and physical examination, with MRI serving as the modality of choice when confirmatory imaging is required or graft reconstruction is being considered [41]. The Pectoralis Major Index (PMI) technique provides a simple, quantifiable, and accurate clinical diagnostic test for structurally significant tears [19]. Additionally, the Cruciform Test is a simple and reproducible diagnostic tool with potential as a clinical indicator of both pectoralis major rupture and successful repair [54]. Discrepancies exist between intraoperative and radiographic assessments of partial pectoralis major tears [6].

Ruptures occur most commonly at the tendon insertion (65%) and musculotendinous junction (27%) [90]. The rupture occurs within the muscle belly, by avulsion of its tendinous insertion or separation of its musculotendinous junction [17]. Mechanisms of injury include direct trauma, excessive athletic stress, or attempts to prevent falls [17]. In a series of 40 athletes, bench press and contact sport participation were the most common mechanisms for pectoralis major tendon tears [25]. Rupture of the pectoralis major muscle probably occurs much more frequently than reports would indicate [17]. The total number of pectoralis major ruptures has drastically risen from 10 cases between 2000-2010 to 55 cases from 2010-2017 in NFL players [45]. There have been no previous reports of pectoralis major rupture occurring in women in the age group described in a specific case report [28].

Clinical Findings and Complications

Rupture of the pectoralis major muscle can result in ossification within the muscle, presenting as a tender lump [52]. Compartment syndrome secondary to acute pectoralis major tendon rupture is a recognized complication that requires prompt recognition and decompression [26]. This injury combination, pectoralis major repair combined with arthroscopic posterior labral repair, is rare but can occur in young athletes who experience high-energy trauma to the shoulder [43].

Post-surgical complications include persistent shoulder pain, present in 2.6% to 7.8% of patients following surgical treatment [41]. Residual cosmetic deformity is a notable complication of surgical treatment for pectoralis major tears [41]. In a series of 40 athletes, most patients in the fair outcome group reported cosmetic concerns, and removing cosmesis from the assessment improved the proportion of excellent outcomes from 37% to 46% [25]. Isokinetic strength evaluation in a series of 40 athletes revealed an average decrease of 9.9% following repair [25].

Investigations

Clinical Examination

The provided evidence base for this section does not contain specific clinical examination findings or physical examination maneuvers for pectoralis major repair.

Imaging

Plain radiography: Standardized plain films are almost always sufficient to garner the information needed for shoulder evaluation [51]. Initially, all patients are usually asked to have AP and lateral plain radiographs of the shoulder related to their chief report [86]. These images are often the only required studies needed for assessing acute shoulder trauma, including fractures or dislocations [86]. Arthritis, calcific tendinitis, and osteolysis of the distal clavicle can be observed on plain radiograph [86]. The standard shoulder series should include orthogonal views of the shoulder, including a true AP view in the scapular plane, an AP view, an axillary view, and a scapular Y view [87]. The first key radiographic view is the anteroposterior (AP) in the plane of the scapula taken so that the x-ray beam passes through the glenohumeral joint [51]. The true AP view in the scapular plane visualizes anterior greater tuberosity in profile [87]. The second key radiographic view is the axillary view taken with the arm in the functional position of elevation in the plane of the scapula and oriented so that both the spinoglenoid notch and the scapular neck are visible [51]. The axillary view is referred to as the “truth view” because it demonstrates the glenohumeral relationships in the functional position of elevation [51]. The axillary view is necessary in evaluation of glenohumeral joint instability and enables determination of the humeral head position in the glenoid fossa [87]. The AP view visualizes the posterior aspect of the greater tuberosity and the lesser tuberosity in profile [87]. The scapular Y view provides visualization of the coracoacromial arch and can reveal coracoacromial spurs [87]. At least two X-ray views should be obtained for shoulder imaging: an anteroposterior in the plane of the glenoid and an axillary projection with the arm in abduction to show the relationship of the humeral head to the glenoid [79]. The acromiohumeral distance is normally 7 to 14 mm [87]. The width of the glenoid humeral joint space should be symmetric superiorly and inferiorly [87]. The coracoclavicular distance is normally 1.1 to 1.3 cm [87]. Neer classified acromial morphology as follows: type I (flat), type II (curved), and type III (hooked) [87]. Type III acromial morphology has been shown to have a correlation with the presence of rotator cuff disease; however, no direct causal relationship has been demonstrated [87]. Proper radiographic technique is as important as proper surgical technique to achieve the desired outcome [51].

MRI: MRI is the modality of choice for evaluating the rotator cuff, biceps, and subacromial/subdeltoid bursa [86]. MRI is accurate for diagnosing the tear grade and location of pectoralis major tendon ruptures, particularly for acute, tendon-bone, and G3 tears [100]. Axial T2-weighted MRI of the shoulder and chest can show a complete tear of the pectoralis major tendon [87]. T2-weighted MRI provides better visualization of full thickness rotator cuff tears [86]. Magnetic resonance imaging (MRI) is useful to identify osteonecrosis of the humeral head, or a bone tumour [79]. MRI can identify labral tears and rotator cuff tears, although the accuracy for these latter two is enhanced by combining the scan with arthrography [79]. Traditional magnetic resonance imaging (MRI) is utilized for evaluation of soft tissues, which can be performed with high contrast and spatial resolution [84]. The acquired multi-planar imaging allows for the detailed evaluation of the glenoid, labrum, joint capsule, and rotator cuff in different planes [84]. Magnetic resonance (MR) accuracy in identifying labral and rotator cuff tears in the literature ranges from 70% to 100% [84]. New anatomic descriptions of the distal pectoralis major tendon detail a 'U' shape of the distal tendon comprised of an anterior layer (the clavicular head and, to a lesser extent, the sternal head) and a posterior layer (the sternal head), which fuse proximal (i.e., medial) to the distal tendon attachment on the humerus [29]. T1-weighted MRI can reveal Hill-Sachs lesions and is often used with magnetic resonance (MR) arthrograms to provide a more detailed picture of the joint surfaces [86]. With standard MRI or MRA, the shoulder is routinely positioned in neutral or partial external rotation but other alternative positions can be used to increase the sensitivity for detecting labroligamentous injuries [84]. Abduction and external rotation (ABER) of the arm is an alternative position that is utilized to increase the sensitivity and specificity for detecting anteroinferior labroligamentous injury [84]. Limited ROM or pain may prohibit patients from performing the ABER provocative maneuver [84]. Schreinemachers et al. retrospectively compared the accuracy of MRA and MRA in the ABER position for the detection and characterization of anteroinferior labroligamentous lesions with arthroscopic evaluation as the standard [84]. The authors found that full routine MRI or MRA examination had similar accuracy as the ABER sequence in evaluating the anteroinferior labral–ligamentous complex [84]. Tian et al. performed a similar study evaluating the added value of the ABER position and found that the sensitivity of MRA with the ABER position for detecting anteroinferior labral lesions was significantly higher than that of the MRA in neutral position [84]. Tian et al. found that MRA with the ABER position was more effective in identifying Perthes lesions [84].

MR Arthrography: MR arthrography (MRA) refers to MRI of a joint that has been injected with an intra-articular contrast agent such as diluted gadolinium or saline solution [84]. By distending the joint capsule, the cartilage, ligaments, and labrum are outlined with contrast, increasing the sensitivity for detecting tears and other lesions [84]. In the acute dislocation setting, a joint effusion with distension of the joint may outline these structures similarly, making the arthrogram unnecessary [84]. MRA has proven utility by increasing both sensitivity and specificity in detecting injuries to the capsulolabral–ligamentous complex as compared to traditional MRI [84]. In a meta-analysis of the diagnostic test accuracy of MRA compared to MRI for the detection of glenoid labral injuries, Smith et al. evaluated 6 studies including 4,667 shoulders [84]. They found greater diagnostic test accuracy for MRA over MRI in the detection of glenoid labral lesions (MRA sensitivity 88% and specificity 93% vs. MRI sensitivity 76% and specificity 87%) [84]. MR arthrography is considered the benchmark for evaluation for labral tears and rarely is indicated for evaluation of rotator cuff pathology [86]. Arthrography involves injection of contrast agent in conjunction with either an MRI or CT scan, enhancing imaging of the joint to enable better identification of normal structures and pathology involving the joint surfaces [86]. MRAs can also demonstrate a patulous capsule on the coronal, sagittal, and axial imaging in patients with multidirectional instability (MDI) [84]. MRAs can be helpful in evaluating lesions of the rotator interval and other associated findings as well that may ultimately affect the eventual surgical plan [84]. The presence of glenoid dysplasia, increased capsular cross-sectional area, and increased glenoid retroversion have all been found to be associated with increased posterior labral tears and symptomatic instability [84]. Parada et al. also demonstrated that glenoid retroversion was significantly increased in patients with symptomatic posterior labral tears but there was no significant association between instability and increased humeral head subluxation [84]. Often, patients with MDI will present to the orthopedic surgeon already having had an MRI or MRA and so these studies should be reviewed [84]. Clinicians should keep in mind, however, that the diagnosis of MDI is a clinical one, and as such, the need for expensive and/or invasive imaging should be weighed against the information that will be gained from these studies [84].

CT: Computed tomography (CT) is helpful for planning fracture surgery and shoulder joint replacement [79]. CT imaging is frequently used to evaluate fractures of the shoulder, to assess for bony lesions in recurrent instability cases, or for preoperative templating for shoulder arthritis [86]. CT with three-dimensional reconstructions is the advanced imaging study of choice for determining the extent of glenoid bone loss in the setting of shoulder instability [87]. CT scans have the disadvantage of being taken with the arm in the adducted position [51]. When MRI or MR arthrography is contraindicated (eg, pacemaker, vascular clips), CT arthrography is indicated [86].

Ultrasonography: Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [86]. Ultrasonography can provide immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [86]. Ultrasonography is highly operator dependent and is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [86]. Ultrasonography is a simple and accurate test for identifying rotator cuff tears and calcific tendinitis [79]. Ultrasonography can also be used to measure the subacromial space and detect atrophy of rotator cuff muscles [86]. As a result of providing images in real-time, ultrasonography can evaluate impingement in various positions and motions [86].

Other Considerations: The purpose of imaging of the shoulder is to help establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition of the shoulder to the patient [51]. Unless a specific research protocol is in place, the temptation to “overimage” should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [51].

Treatment

Non-Operative

Conservative therapy is recommended specifically for ruptures of the muscle fibers, whereas early surgical repair is indicated for distal tendinous injuries [17].

Operative

Indications: Pectoralis major tendon repair yields significantly superior outcomes compared to nonoperative treatment [8]. Patients treated operatively for acute or chronic pectoralis major ruptures fared significantly better than those treated nonoperatively [15]. Anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes [44]. Surgical repair is important to restore complete function and contour, especially in young athletes [10]. Repair of complete pectoralis muscle ruptures is recommended for active patients who require maximum strength in vocational or avocational activities [22].

Timing: Acute repair of pectoralis major tendon tears results in significantly superior functional outcomes and cosmesis satisfaction compared to delayed repair [11]. However, there is no statistically significant difference in outcomes between acute and chronic operative groups for pectoralis major ruptures [15]. Early surgical repair of distal pectoralis major tendon ruptures combined with an accelerated rehabilitation protocol provides reliable restoration of shoulder function and strength [14].

Surgical Approach / Technique: The authors recommend a preferred technique for pectoralis major repair that provides a reproducible and reliable anatomic repair with positive clinical outcomes [2]. The authors propose a new classification of pectoralis major injury and present a biomechanically sound repair technique for isolated tears of the sternocostal head with favorable outcomes [20]. Surgical repair of the distal end of the pectoralis major tendon was performed in 10 male athletes using the Tietjan classification for management [36]. The pectoralis major tendon inserts along the lateral border of the bicipital groove, with the distal footprint ending at the superior insertion of the latissimus dorsi [111]. The average dimensions of the pectoralis major footprint are 73 mm in length and 3 mm in width [111]. The pectoralis major footprint is located approximately 4 cm distal to the greater tuberosity on the lateral lip of the bicipital groove and measures approximately 70 mm (proximal to distal) × 1.4 mm (medial to lateral) [110]. Surgical repair should ideally reapproximate the musculotendinous twist proximal to the bony insertion site, where the sternal limb inserts proximal and deep to the clavicular limb [110].

Implant Selection: Bone trough repair of the pectoralis major tendon was biomechanically stronger than suture anchor repair [47]. Repair of pectoralis major tendon ruptures using intramedullary suture anchors has high rates of return to duty, patient satisfaction, and patient-reported outcomes [48]. Patients with pectoralis major tendons repaired with a tensioned cortical button technique had excellent results [124].

Adjuncts: Augmentation of pectoralis major tendon repair with an acellular dermal matrix significantly increases the ultimate load to failure compared to standard repair [56]. Augmentation of pectoralis major tendon repair with an acellular dermal matrix achieves biomechanical properties equivalent to the native tendon [56]. The authors describe a safe and reproducible technique for acute pectoralis major reconstruction with semitendinosus augmentation [23].

Outcomes: Pectoralis major repair results in a 97.8% rate of return to work with a mean time to return of 1.6 months [4]. Pectoralis major tendon repair is associated with a 14.21% complication rate [8]. Pectoralis major tendon repair results in a high rate of return to sport and work, pain relief, and improved cosmetic appearance, albeit with a significant rate of complication [12]. Full-thickness ruptures of the pectoralis major muscle belly have been treated surgically with good to excellent results [32].

Chronic and Irreparable Ruptures: Repair of a pectoralis major muscle rupture was successfully performed 13 years after the initial injury [5]. Delayed surgical repair of pectoralis major ruptures is technically feasible, and the use of fascial allograft to augment the repair can successfully treat chronic ruptures without compromising the final result [93]. Dermal allograft reconstruction was performed for a chronic pectoralis major tear classified as C/2/FC where adequate tendon substance could not be identified for primary repair [58]. Pectoralis major tendon reconstruction using an iliotibial band autograft was planned for a chronic tear where the tendinous portion was essentially absent beyond the muscle [59]. Dermal allograft reconstruction of chronic or subacute pectoralis major tendon ruptures involved wrapping the tendon and muscle belly with an appropriately sized dermal allograft sutured in a Krackow pattern [60]. In cases of severe retraction and complete tearing of both sternal and clavicular heads during dermal allograft reconstruction, two allografts were used [60].

Salvage Procedures and Adjuncts: As a salvage procedure, pectoralis major tendon transfer provides good results in most cases for irreparable anterosuperior rotator cuff tears [7]. Transfer of the pectoralis major has a much longer track record compared to other transfers for subscapularis tears [38]. Prompt recognition and decompression of pectoral/upper arm compartment syndrome, followed by delayed pectoralis major tendon repair, can result in a successful return to normal function [26]. Open pectoralis major repair combined with arthroscopic posterior labral repair is a rare injury combination that can occur in young athletes who experience high-energy trauma to the shoulder [43].

Complications

Overall Complication Rates: The reported complication rate for surgical treatment of pectoralis major tears ranges from 4.6% to 32.3% [41]. In acute settings, complication rates range between 4.8% and 10.6% [41], whereas in chronic settings, rates range between 1.9% and 4.2% [41]. One study of 257 cases reported a 32.3% complication rate, describing 42 minor and 41 major complications requiring surgical intervention [41]. Chronic repair is more difficult due to scarring and blurring of tissue planes, likely contributing to higher complication rates [41]. While some literature suggests pectoralis major tendon repair is associated with a significant rate of complication [12], other data indicate that surgical repair can be performed with a low risk of complications [33] and that patients should expect a low complication rate [122].

Rerupture: Pectoralis major rerupture rates in the literature range from 2.9% to 5.4% [41]. In a study of the young active population, 5.8% of patients experience re-rupture following primary pectoralis major repair [42].

Pain and Stiffness: Persistent shoulder pain is present in 2.6% to 7.8% of patients following pectoralis major repair [41]. Adhesive capsulitis of the shoulder is also a notable complication [41].

Wound Complications: Additional notable complications include wound infection, postoperative hematoma, and residual cosmetic deformity [41]. In the setting of postoperative infection, suspicion for the involvement of Cutibacterium acnes should remain high given the proximity of the surgical incision to the axillary fold [41].

Other Considerations: In a systematic review comparing pectoralis major transfer and latissimus dorsi transfer for irreparable subscapularis tears, the failure rate was 12.9% in the pectoralis major transfer group [108]. The overall complication rate in this group was 15.11% [108]. Specific complications reported in the pectoralis major transfer group for irreparable subscapularis tears include hematoma, recurrent anterior instability, supraspinatus and infraspinatus rerupture, mechanical conflict of the coracoid process with the humeral head, deep venous thrombosis of the axillary vein, seromas, superficial infections, and transient musculocutaneous nerve neurapraxia [108]. Graft failure rates were greater in cohorts using only the sternocostal head of the pectoralis major tendon for subscapularis transfer [31].

Recovery

Light activity (weeks): The evidence provided does not specify a distinct week-range for light activity such as desk work or driving.

Full activity (months): Patients undergoing pectoralis major repair achieve a high rate of return to work, with a mean time to return of 1.6 months [4]. Early surgical repair of distal pectoralis major tendon ruptures combined with an accelerated rehabilitation protocol allows for an early return to sports and functional activity [14]. Pectoralis major tendon repair is an effective treatment that results in a high rate of return to sport and work [12].

Complete recovery / outcome plateau (months): The provided evidence does not specify a distinct month-range for the complete recovery or outcome plateau phase.

Rehabilitation protocol: An accelerated rehabilitation protocol is utilized following early surgical repair of distal pectoralis major tendon ruptures to provide reliable restoration of shoulder function and strength [14].

Functional milestones: Surgical repair of a clinical tear of the pectoralis major results in greater recovery of peak torque and work performed than conservative management [1]. Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment [8]. Acute repair of pectoralis major tendon tears resulted in significantly superior functional outcomes and cosmesis satisfaction, with a trend toward a higher proportion of patients who were pain-free [11]. Patients undergoing repair of the pectoralis major muscle are expected to have significant improvements in function of the shoulder [37].

Other Considerations: In the largest study to date, 94% of patients are able to return to full military duty after primary pectoralis major repair [42]. Repair of the pectoralis major tendon ruptures using intramedullary suture anchors has high rates of return to duty, patient satisfaction, and patient-reported outcomes [48].

Key Evidence

  • [L3] Objective strength testing shows that surgical repair of a clinical tear of the pectoralis major results in greater recovery of peak torque and work performed than conservative management. [1] (10.1136/bjsm.35.3.202)
  • [Paper] The authors recommend their preferred technique for pectoralis major repair as it provides a reproducible and reliable anatomic repair with positive clinical outcomes. [2] (10.1016/j.eats.2017.02.002)
  • [L4] Early surgical treatment by anatomic repair gives the best results in the treatment of total and near-total ruptures of the pectoralis major muscle. [3] (10.1177/0363546503261137)
  • [L4] Pectoralis major repair results in a high rate of return to work (97.8%) with a mean time to return of 1.6 months. [4] (10.1177/23259671211045635)
  • [L4] Repair of a pectoralis major muscle rupture was successfully performed 13 years after the initial injury. [5] (10.1177/03635465000280021901)
  • [L4] The majority of pectoralis major tears occurred at the myotendinous junction. [6] (10.1016/j.jseint.2023.06.019)
  • [L3] As a salvage procedure, the pectoralis major tendon transfer provides good results in most cases. [7] (10.1016/j.jse.2011.01.023)
  • [L1] Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment with an associated 14.21% complication rate. [8] (10.1177/2325967120s00411)
  • [Paper] Most authors now agree that surgical repair of pectoralis major tendon tears is the treatment of choice in order to regain full strength in the young, active patient. [9] (10.1097/00132589-200209000-00004)
  • [L1] Acute repair of pectoralis major tendon tears resulted in significantly superior functional outcomes and cosmesis satisfaction with a trend toward a higher proportion of patients who were pain-free. [11] (10.1177/0363546520904402)
  • [L4] Pectoralis major tendon repair is an effective treatment that results in a high rate of return to sport and work, pain relief, and improved cosmetic appearance, albeit with a significant rate of complication. [12] (10.1177/1941738118818060)
  • [L1] Pectoralis major tendon repair resulted in significantly superior outcomes compared with nonoperative treatment, with an associated 14.21% complication rate. [13] (10.1177/2325967119900813)
  • [L4] Early surgical repair of distal pectoralis major tendon ruptures and an accelerated rehabilitation protocol provide reliable restoration of shoulder function and strength, allowing an early return to sports and functional activity. [14] (10.1007/s00264-006-0171-2)
  • [L3] Patients treated operatively for acute or chronic pectoralis major ruptures fared significantly better than those treated nonoperatively, with no statistically significant difference in outcomes between acute and chronic operative groups. [15] (10.1177/03635465000280012701)
  • [L4] Allograft reconstruction is a useful technique for chronic pectoralis major ruptures where direct repair is not possible, allowing patients to return to preinjury occupation levels. [16] (10.1177/1758573217741319)
  • [L2] Pectoralis major transfer results in improvement for patients with an irreparable subscapularis tear with or without an associated reparable supraspinatus tear. [18] (10.2106/00004623-200310000-00012)
  • [L2] The PMI technique is a simple, quantifiable, and accurate clinical diagnostic test for structurally significant pectoralis major tears. [19] (10.1177/2325967113516729)
  • [L4] The authors propose a new classification of pectoralis major injury and present a biomechanically sound repair technique for isolated tears of the sternocostal head with favorable outcomes. [20] (10.1016/j.jse.2019.11.024)
  • [L4] The authors recommend repair of complete pectoralis muscle ruptures in active patients who require maximum strength in vocational or avocational activities. [22] (10.1177/036354659202000517)
  • [L4] The authors describe a safe and reproducible technique for acute pectoralis major reconstruction with semitendinosus augmentation, hoping it provides a treatment rationale for surgeons caring for athletes with favorable outcomes. [23] (10.1016/j.xrrt.2025.06.003)
  • [L4] The majority of pectoralis major tears occurred at the myotendinous junction, potentially reflecting changes in population-wide physical activities. [24] (10.1177/2325967123s00348)
  • [L4] [25] (10.1016/j.jse.2016.07.018)
  • [L4] Our case demonstrates that prompt recognition and decompression of pectoral/upper arm compartment syndrome, followed by delayed pectoralis major tendon repair, can result in a successful return to normal function. [26] (10.1016/j.jse.2014.10.023)
  • [L5] Use of the pectoralis minor tendon as a local source of autograft tissue in acromioclavicular joint reconstruction is both feasible and potentially advantageous. [27] (10.1016/j.jse.2006.09.007)
  • [L5] There have been no previous reports of pectoralis major rupture occurring in women in this age group. [28] (10.5435/jaaosglobal-d-19-00030)
  • [L5] New anatomic descriptions of the distal pectoralis major tendon detail a ' U ' shape of the distal tendon comprised of anterior layer (the clavicular head and, to a lesser extent, the sternal head) and posterior layer (the sternal head), which fuse proximal (i.e., medial) to the distal tendon attachment on the humerus. [29] (10.1007/s00256-014-1990-7)
  • [L4] However, graft failure rates were greater in cohorts using only the sternocostal head of the pectoralis major tendon, while all other outcomes were similar. [31] (10.1016/j.xrrt.2025.100600)
  • [L4] Full-thickness ruptures of the pectoralis major muscle belly are rare and have been treated surgically with good to excellent results reported. [32] (10.1016/j.jses.2019.10.006)
  • [L4] Surgical repair of pectoralis major tendon ruptures can be performed safely with a low re-rupture rate and low risk of complications. [33] (10.1177/2325967117s00242)
  • [Paper] Restoration of the dynamic external and internal couple forces maintains the humeral head in the center of rotation. [34] (10.1007/s00064-021-00760-5)
  • [L2] Total ruptures of the pectoralis major muscle exhibit better outcomes with surgical treatment than with nonoperative treatment based on the Bak criteria in athletes. [35] (10.1177/0363546513506556)
  • [L4] [36] (10.1097/bte.0b013e3181c99156)
  • [L3] Patients undergoing repair of the PMM are expected to have significant improvements in function of the shoulder. [37] (10.1177/2325967119s00252)
  • [L4] Transfer of the pectoralis major has a much longer track record. [38] (10.1007/s12178-020-09674-4)
  • [L4] [40] (10.1177/0363546505279573)
  • [L5] [41] (10.5435/jaaos-d-21-00541)
  • [L3] In the largest study to date, 94% of patients are able to return to full military duty after primary pectoralis major repair and 5.8% experience re-rupture. [42] (10.1016/j.arthro.2016.03.068)
  • [L4] This injury combination is rare but can occur in young athletes who experience high-energy trauma to the shoulder. [43] (10.1016/j.eats.2025.103730)
  • [L4] In summary, anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes. [44] (10.2147/oajsm.s9066)
  • [L4] The total number of pectoralis major ruptures has drastically risen from 10 cases between 2000-2010 to 55 cases from 2010-2017. [45] (10.1177/2325967119s00396)
  • [L5] Bone trough repair of the pectoralis major tendon was stronger than suture anchor repair. [47] (10.1177/0363546512449291)
  • [L4] Repair of the pectoralis major tendon ruptures using intramedullary suture anchors has high rates of return to duty, patient satisfaction, and patient-reported outcomes. [48] (10.1016/j.jse.2024.04.029)
  • [L5] Rupture of the pectoralis major muscle can result in ossification within the muscle, presenting as a tender lump. [52] (10.1016/0020-1383(88)90050-2)
  • [L4] The Cruciform Test is a simple and reproducible diagnostic tool that has potential as a clinical indicator of both pectoralis major rupture and successful repair. [54] (10.1177/17585732211058457)
  • [L5] Augmentation of pectoralis major tendon repair with an acellular dermal matrix significantly increases the ultimate load to failure compared to standard repair and achieves biomechanical properties equivalent to the native tendon. [56] (10.1016/j.jse.2019.09.020)
  • [L4] [58] (10.1016/j.jse.2013.06.021)
  • [L4] [59] (10.1016/j.xrrt.2021.05.002)
  • [L4] [60] (10.1177/2325967117745834)
  • [L5] In massive rotator cuff tear, the pectoralis major and latissimus dorsi muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures. [89] (10.1016/j.jse.2013.11.030)
  • [L4] [90] (10.1016/j.jses.2019.08.007)
  • [L4] Delayed surgical repair of pectoralis major ruptures is technically feasible, and the use of fascial allograft to augment the repair can successfully treat chronic ruptures without compromising the final result. [93] (10.1067/mse.2003.128200)
  • [L3] MRI is accurate for diagnosing the tear grade and location of pectoralis major tendon ruptures, particularly for acute, tendon-bone, and G3 tears. [100] (10.1016/j.jse.2015.08.037)
  • [L4] A contemporary injury classification system is proposed that includes injury timing, injury location, and standardized terminology addressing tear extent to more accurately reflect the musculotendinous morphology of PM injuries and better inform surgical management, rehabilitation, and research. [103] (10.1016/j.jse.2011.04.035)
  • [L4] [107] (10.1016/j.xrrt.2025.07.019)
  • [L4] [108] (10.1177/03635465211018216)
  • [Paper] [110] (10.1016/j.eats.2012.05.003)
  • [Paper] [111] (10.1016/j.eats.2020.02.023)
  • [L5] The findings from this study suggest the increased importance of PM and LD in shoulders with massive rotator cuff tear. [114] (10.1016/j.jse.2007.02.036)
  • [L4] Patients undergoing PMT repair should expect significant functional improvements and a low complication rate. [122] (10.1177/0363546519851506)
  • [Paper] Patients with pectoralis major tendons repaired with the proposed tensioned cortical button technique had excellent results. [124] (10.1016/j.eats.2013.08.014)

See Also

References

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