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Pectoralis major transosseous equivalent repair with knotless anchors: Technical note and literature review.

Samitier GS, Marcano AI, Farmer KW - Int J Shoulder Surg (2015 Jan-Mar)

Bottom Line: Transosseous suture repair allows for docking the tendon into a trough at its anatomic insertion, but risks cortical breakage during suture passing.Our experience has confirmed the value and potential advantages of anchors for a secure fixation.To describe a variation of repair using knotless suture anchors and a burred trough to dock the tendon into its anatomic insertion.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.

ABSTRACT

Introduction: Rupture of the pectoralis major (PM) tendon was initially described almost 2 centuries ago, but most of the reported injuries have occurred within the last 30 years. Options for repair have varied widely. The most common methods for repair depend on either transosseous sutures or suture anchors for fixation. Transosseous suture repair allows for docking the tendon into a trough at its anatomic insertion, but risks cortical breakage during suture passing. Our experience has confirmed the value and potential advantages of anchors for a secure fixation.

Aims: To describe a variation of repair using knotless suture anchors and a burred trough to dock the tendon into its anatomic insertion.

Conclusion: We describe a technique of a transosseous equivalent PM repair technique. To our knowledge, this is the first paper describing such a repair technique for PM rupture.

No MeSH data available.


Related in: MedlinePlus

Insertion of one of the knotless Swivelock© 5.5 anchor previously loaded with one of the #2 fiber wire© (Arthrex, Inc. Naples, FL, USA) sutures from the pectoralis major tendon
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Figure 2: Insertion of one of the knotless Swivelock© 5.5 anchor previously loaded with one of the #2 fiber wire© (Arthrex, Inc. Naples, FL, USA) sutures from the pectoralis major tendon

Mentions: A modified and inferiorly positioned deltopectoral incision about 4 cm in length is done. The cephalic vein is displaced laterally, and dissection is carried until the conjoined tendon is identified. With blunt dissection medially, the torn tendon is identified. Often, a large seroma is encountered around the tendon. The tendon is usually retracted medially. Occasionally, a thin veil of tissue/fascia still attached to the humeral insertion. We first bluntly dissect superficially as well as posteriorly to the ruptured heads until a 360° release is obtained. Two, number 2 ultra-resistant Fiber wire (Arthrex, Inc., Naples, FL, USA) locked sutures are placed within the bulk of the muscle tendon unit in a Krackow fashion to be able to bring this back to the insertion point without undue tension. A cortical trough is created just lateral to the biceps tendon using a small round burr. The trough is created approximated 2 cm in length, and to a depth where the cancellous bone just becomes apparent. After creating the trough, pilot holes are punched and tapped for two Peek Swivelock 5.5-mm anchors (Arthrex, Inc., Naples, FL, USA) [Figure 1]. One anchor is placed in the superior portion of the trough, and one is placed in the inferior portion of the trough. The previously placed sutures are passed into the corresponding anchor (superior sutures in the superior anchor, inferior sutures in the inferior anchor) [Figure 2]. The eyelets are passed into the pilot holes, with tension on the sutures. As the eyelets are placed into the humerus, the edge of the tendon is effectively docked in the trough. The PEEK anchors are screwed into lock the eyelets and sutures.


Pectoralis major transosseous equivalent repair with knotless anchors: Technical note and literature review.

Samitier GS, Marcano AI, Farmer KW - Int J Shoulder Surg (2015 Jan-Mar)

Insertion of one of the knotless Swivelock© 5.5 anchor previously loaded with one of the #2 fiber wire© (Arthrex, Inc. Naples, FL, USA) sutures from the pectoralis major tendon
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325386&req=5

Figure 2: Insertion of one of the knotless Swivelock© 5.5 anchor previously loaded with one of the #2 fiber wire© (Arthrex, Inc. Naples, FL, USA) sutures from the pectoralis major tendon
Mentions: A modified and inferiorly positioned deltopectoral incision about 4 cm in length is done. The cephalic vein is displaced laterally, and dissection is carried until the conjoined tendon is identified. With blunt dissection medially, the torn tendon is identified. Often, a large seroma is encountered around the tendon. The tendon is usually retracted medially. Occasionally, a thin veil of tissue/fascia still attached to the humeral insertion. We first bluntly dissect superficially as well as posteriorly to the ruptured heads until a 360° release is obtained. Two, number 2 ultra-resistant Fiber wire (Arthrex, Inc., Naples, FL, USA) locked sutures are placed within the bulk of the muscle tendon unit in a Krackow fashion to be able to bring this back to the insertion point without undue tension. A cortical trough is created just lateral to the biceps tendon using a small round burr. The trough is created approximated 2 cm in length, and to a depth where the cancellous bone just becomes apparent. After creating the trough, pilot holes are punched and tapped for two Peek Swivelock 5.5-mm anchors (Arthrex, Inc., Naples, FL, USA) [Figure 1]. One anchor is placed in the superior portion of the trough, and one is placed in the inferior portion of the trough. The previously placed sutures are passed into the corresponding anchor (superior sutures in the superior anchor, inferior sutures in the inferior anchor) [Figure 2]. The eyelets are passed into the pilot holes, with tension on the sutures. As the eyelets are placed into the humerus, the edge of the tendon is effectively docked in the trough. The PEEK anchors are screwed into lock the eyelets and sutures.

Bottom Line: Transosseous suture repair allows for docking the tendon into a trough at its anatomic insertion, but risks cortical breakage during suture passing.Our experience has confirmed the value and potential advantages of anchors for a secure fixation.To describe a variation of repair using knotless suture anchors and a burred trough to dock the tendon into its anatomic insertion.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA.

ABSTRACT

Introduction: Rupture of the pectoralis major (PM) tendon was initially described almost 2 centuries ago, but most of the reported injuries have occurred within the last 30 years. Options for repair have varied widely. The most common methods for repair depend on either transosseous sutures or suture anchors for fixation. Transosseous suture repair allows for docking the tendon into a trough at its anatomic insertion, but risks cortical breakage during suture passing. Our experience has confirmed the value and potential advantages of anchors for a secure fixation.

Aims: To describe a variation of repair using knotless suture anchors and a burred trough to dock the tendon into its anatomic insertion.

Conclusion: We describe a technique of a transosseous equivalent PM repair technique. To our knowledge, this is the first paper describing such a repair technique for PM rupture.

No MeSH data available.


Related in: MedlinePlus