Open reinsertion of the pectoralis major muscle using autologous cells

Rationale: Ruptures of the pectoralis major muscle have become increasingly common in clinical practice in recent years, due to the popularization of power sports among the young population. The main treatment method for this injury is surgical restoration of the point of fixation of the pectoralis major tendon (MPT) to the anatomical attachment site. This allows you to restore the strength of movement in the shoulder, as well as eliminate a cosmetic defect.

However, a fairly large percentage of patients with such trauma seek medical help in a timely manner, which entails the risk of not achieving the expected result and leads to technical difficulties intraoperatively.

Purpose of the study: We propose our technique for restoring the SBMS in case of traumatic avulsions based on the conducted preclinical and clinical research on the restoration of ruptures using decortication of the SBMS refixation zone and the introduction of autologous cells into the SBMS area. As well as supplementing the rehabilitation protocol with physiotherapeutic treatment (PTL) - laser therapy in Superficial pain mode.

Materials and methods: From 2010 to 2018. Surgical treatment was performed on 52 male patients aged 19 to 49 years (average age 29.77±6.34). All patients underwent open reinsertion of the pectoralis major tendon using the proposed surgical technique, as well as the introduction of autologous cells into the tendon area.

Conclusion:The use of the proposed technique for reinsertion of the pectoralis major tendon with local injection of autologous cells showed earlier recovery of patients, as evidenced by the indicators of rating scales and questionnaires. A restorative multidisciplinary approach aſter suturing the pectoralis major tendon using autologous cells shows a clear advantage in the speed of restoration of function of the damaged segment.

1. Magnussen R.A., Jacobi M., Servien E. Pectoralis major rupture In: Kerkhoff GMMJ, Servien E, eds. Acute Muscle Injuries. New York: Springer; 2014:93-103.

2. Patissier P., Ramazzini B. Traité des Maladies des Artisans, et de Celles qui Résultent des Diverses Professions, d’après Ramazzini. Paris: J-B Ballière 1822; 162-164. France

3. McKelvey D. Subcutaneous rupture of the pectoralis major muscle. Br Med J. 1928;2:611-614.

4. Kavalersky GM, Sereda АP, Nikiforov DA, Koshelev IM, Kapyshev SV. [Ruptures of the pectoralis major muscle and it’s tendon: review of the literature and our experience in the treatment Travmatologiya i ortopediya Rossii. 2015; (2): 117-131. [in Russian]

5. ElMaraghy A.W., Devereaux M.W. A systematic review and comprehensive classification of pectoralis major tears. J of Shoulder and Elbow Surg. 2012;21(3):412-422. doi: 10.1016/j.jse.2011.04.035

6. Kavalersky GM, Sereda АP, Nikiforov DA, Koshelev IM, Kapyshev SV. [Ruptures of the pectoralis major muscle and it’s tendon: review of the literature and our experience in the treatment Travmatologiya i ortopediya Rossii. 2015; (2): 117-131. [in Russian]

7. Beloosesky Y., Grinblat J., Weiss A., et al. Pectoralis major rupture in elderly patients A Clinical Study of 13 Patients. Clin Orthop Relat Res 2003; 413:164-9. doi: 10.1097/01.blo.0000076803.53006.12

8. McIntire S., Boujie L., Leasiolagi J. Pectoralis Major Injury During Basic Airborne Training. J Spec Oper Med. 2016 fall;16(3):11-14.

9. Uchiyama Y., Miyazaki S., Tamaki T., Shimpuku E., Handa A., Omi H., Mochida J. Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 2011;3:20. doi: 10.1186/1758-2555-3-20

10. Bosch G., van Schie H.T., de Groot M.W., Cadby J.A., van de Lest C.H., Barneveld A., van Weeren P.R. Effects of platelet-rich plasma on the quality of repair of mechanically induced core lesions in equine superficial digital flexor tendons: a placebo-controlled experimental study. J Orthop Res 2010; 28(2):211-217. doi:10.1002/jor.20980.

11. Baverel L., Messedi K., Piétu G., Crenn V., Gouin F. Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograſt and Fixation with an Interference Screw. A Case Report. Case Reports in Orthopedics. Volume 2017, Article ID 2095407. DOI: 10.1155/2017/2095407

12. Zvijac J.E., Schurhoff M.R., Hechtman K.S., Uribe J.W. Pectoralis major tears: correlation of magnetic resonance imaging and treatment strategies. Am J Sports Med. 2006;34:289-294. doi: 10.1177/0363546505279573

13. Connell D.A., Potter H.G., Sherman M.F., Wickiewicz T.L. Injuries of pectoralis major muscle: Evaluation with MRI imaging. Radiology 1999; 210:785-791. doi: 10.1148/radiology.210.3.r99fe43785

14. Bennett N.T., Schultz G.S. Growth factors and wound healing: Biochemical properties of growth factors and their receptors. Am J Surg 1993; 165:728-737. doi: 10.1016/s0002-9610(05)80797-4

15. Bak K., Cameron E.A., Henderson I.J. Rupture of the pectoralis major: A meta-analysis of 112 cases. Knee Surg Sports Traumatol Arthrosc. 2000;8:113-119. doi: 10.1007/s001670050197

16. Tietjen R. Closed injuries of the pectoralis major muscle. J Trauma. 1980;20(3):262-264. doi: 10.1097/00005373-198003000-00015

17. Guity M., Vaziri A.S., Shafiei H., Farhoud A. Surgical treatment of pectoralis major tendon rupture (outcome assessment). Asian J Sports Med. 2014;5(2):129-135.

18. Cordasco F.A., Mahony G.T., Tsouris N., Degen R.M. Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes.

19. Pochini A.С., Rodrigues M.S.B., Yamashita L., Belangero P.S., Andreoli C.V., Ejnisman B. Surgical treatment of pectoralis major muscle rupture with adjustable cortical button. Rev Bras Ortop. 2017;53(1):60-66. doi: 10.1016/j.rboe.2017.11.005.

20. Kircher J., Ziskoven C., Patzer T., Zaps D., Bittersohl B., Krauspe R. Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal. Open Access J Sports Med. 2010 Oct 11;1:201-5. doi: 10.2147/OAJSM.S9066

21. Orava S., Sorasto A., Aalto K., Kvist H. Total rupture of the pectoralis major muscle in athletes. Int J Sports Med 1984; 5:272-274. doi: 10.1055/s-2008-1025919

22. Mooers B.R., Westermann R.W., Wolf B.R. Outcomes Following Suture-Anchor Repair of Pectoralis Major Tears: A Case Series and Review of the Literature. Iowa Orthop J. 2015;35:8-12.

23. Rockwood Jr C. A. et al. The shoulder 4th ed. – Elsevier Health Sciences, ISBN: 978-1-4160-3427-82009, 1709 p. 2009.

24. Gupton M., Johnson J.E. Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2019 Feb 7;7(2):2325967118824551. doi: 10.1177/2325967118824551

25. Allahverdi A., Sharifi D., Takhtfooladi M.A., Hesaraki S., Khansari M., Dorbeh S.S. Evaluation of low-level laser therapy, platelet-rich plasma, and their combination on the healing of Achilles tendon in rabbits. Lasers Med Sci 2015; 30:1305-1313 DOI 10.1007/s10103-015-1733-6.

26. Barbosa D., de Souza R.A., de Carvalho W.R., Xavier M., de Carvalho P.K., Cunha T.C., Arisawa E.Â., Silveira L. Jr, Villaverde A.B. Low-level laser therapy combined with platelet-rich plasma on the healing calcaneal tendon: a histological study in a rat model. Lasers Med Sci 2013; 28(6):1489-1494. doi:10.1007/s10103-012-1241-x.

27. Molloy T., Wang Y., Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med 2003; 33(5):381-394. doi: 10.2165/00007256-200333050-00004

28. Everts P.A., Knape J.T., Weibrich G., Schonberger J.P.A.M., Hoff-mann J.J.H.L., Overdevest E.P., Box H.A., van Zundert A. Platelet-rich plasma and platelet gel: A review. JECT 2006;38:174-187.

29. Marx R.E., Carlson E.R., Eichstaedt R.M., Schimmele S.R., Strauss J.E., Georgeff K.R. Platelet-rich plasma: Growth factor enhancement for bone graſts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:638-646. doi: 10.1016/s1079-2104(98)90029-4

30. Simonov, R. A., Samoilov, A. S., & Rylova, N. V. (2023). EFFEKTIVNOST’’ AUTOLOGIChNOI PLAZMY, OBOGAShchENNOI TROMBOTsITAMI, V LEChENII POVREZhDENIYa SUKhOZhILIYa NADKOLENNIKA: OBZOR INOSTRANNOI LITERATURY. Sovremennye voprosy biomeditsiny, 7(4), 224-235

31. Biryukov, K., OL’’ShEVSKII, D., Varanitskii, G., & ROMANOVSKII, E. (2023). Nash OPYT Lecheniya RAZRYVA Sukhozhiliya BOL’’ShOI GRUDNOI Myshtsy. Moskva, 2023;15:26-28

32. Stefanou N, Karamanis N, Bompou E, Vasdeki D, Mellos T, Dailiana ZH. Pectoralis major rupture in body builders: a case series including anabolic steroid use. BMC Musculoskelet Disord. 2023 Apr 4;24(1):264. doi: 10.1186/s12891-023-06382-1. PMID: 37016399; PMCID: PMC10071695.

33. Whittamore, T., & Funk, L.. Surgical repair and rehabilitation of a ruptured pectoralis major muscle in a professional footballer–A case report. Journal of Bodywork and Movement Therapies, 2023;36:291-299. DOI:10.1016/j.jbmt.2023.04.089