Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 9, pp 2617–2623 | Cite as

Pectoralis major tendon repair: a biomechanical study of suture button versus transosseous suture techniques

  • William Thomas
  • Sabina Gheduzzi
  • Iain Packham



Pectoralis major tendon avulsion injury benefits from surgical repair. The technique used and speed of rehabilitation in this demanding population remains subject to debate. We performed a biomechanical study comparing suture button (Pec Button™, Arthrex, Naples, FL) with a transosseous suture technique (FibreWire, Arthrex, Naples, FL).


Freshly slaughtered porcine humeri were prepared to model a single transosseous suture or suture button repair. A static, tensile load to failure experiment and a cyclic, tensile load experiment to model standard (10,000 cycles) and accelerated rehabilitation (20,000 cycles) philosophies were tested. The mode of failure, yield and ultimate failure load, extension (clinical failure >10 mm) and the resistance to cyclic loading was measured.


The mode of failure was suture fracture in all the static load experiments with 10/11 occurring as the suture passed through the button and 7/11 as the suture passed through the bone tunnels. There was a significant difference in yield load, favouring transosseous suture [p = 0.009, suture button (SB) 673.0 N (647.2–691.7 N), transosseous suture (TOS) 855.0 N (750.0–891.4 N)] and median extension, favouring suture button [p = 0.009, SB 8.8 mm (5.0–12.4 mm), TOS 15.2 mm (13.2–17.1 mm)]. 2/3 transosseous suture and 0/3 suture buttons failed before completing 20,000 cycles. The difference in mean number of cycles completed was non-significant. The difference in mean extension was 5.1 mm (SB 6.7 mm, TOS 11.7 mm).


Both techniques show advantages. The difference in extension is likely to be more clinically relevant than load tolerated at failure, which is well above physiological levels. The findings do not support an accelerated rehabilitation model.


Pectoralis major repair Transosseous suture Pec button Rehabilitation 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Antosh IJ, Grassbaugh JA, Parada SA, Arrington ED (2009) Pectoralis major tendon repairs in the active-duty population. Am J Ortho (Belle Mead, N.J.) 38(1):26–30Google Scholar
  2. 2.
    Aärimaa V, Rantanen J, Heikkilä J, Helttula I, Orava S (2004) Rupture of the pectoralis major muscle. Am J Sports Med 32(5):1256–1262CrossRefPubMedGoogle Scholar
  3. 3.
    Bak K, Cameron EA, Henderson IJP (2000) Rupture of the pectoralis major: a meta-analysis of 112 cases. Knee Surgery Sports Traumatol Arthrosc 8(2):113–119CrossRefGoogle Scholar
  4. 4.
    Beloosesky Y, Grinblat J, Weiss A, Rosenberg PH, Weisbort M, Hendel D (2003) Pectoralis major rupture in elderly patients: a clinical study of 13 patients. Clin Orthop Relat Res 413:164–169CrossRefPubMedGoogle Scholar
  5. 5.
    Beloosesky Y, Hendel D, Weiss A, Rosenberg PH, Grinblat J (2001) Rupture of the pectoralis major muscle in nursing home residents. Am J Med 111(3):233–235CrossRefPubMedGoogle Scholar
  6. 6.
    Egan TM, Hall H (1987) Avulsion of the pectoralis major tendon in a weight lifter—repair using a barbed staple. Can J Surg 30(6):434–435PubMedGoogle Scholar
  7. 7.
    Fleury AM, Silva AC, Pochini A, Ejnisman B, Lira CA, Andrade MS (2011) Isokinetic muscle assessment after treatment of pectoralis major muscle rupture using surgical or non-surgical procedures. Clinics (Sao Paulo) 66(2):313–320CrossRefGoogle Scholar
  8. 8.
    Hart ND, Lindsey DP, McAdams TR (2011) Pectoralis major tendon rupture: a biomechanical analysis of repair techniques. J Orthop Res 29(11):1783–1787CrossRefPubMedGoogle Scholar
  9. 9.
    Hrdlicka A (1932) The principle dimensions, absolute and relative, of the humerus in the white race. Am J Phys Anthropol XVI:431–450CrossRefGoogle Scholar
  10. 10.
    Kakwani RG, Matthews JJ, Kumar KM, Pimpalnerkar A, Mohtadi N (2007) Rupture of the pectoralis major muscle: surgical treatment in athletes. Int Orthop 31(2):159–163PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Kettler M, Lunger J, Kuhn V, Mutschler W, Tingart MJ (2007) Failure strengths in distal biceps tendon repair. Am J Sports Med 35(9):1544–1548CrossRefPubMedGoogle Scholar
  12. 12.
    Kretzler HH, Richardson AB (1989) Rupture of the pectoralis major muscle. Am J Sports Med 17(4):453–458CrossRefPubMedGoogle Scholar
  13. 13.
    Liu J, Wu JJ, Chang CY, Chou YH, Lo WH (1992) Avulsion of the pectoralis major tendon. Am J Sports Med 20(3):366–368CrossRefPubMedGoogle Scholar
  14. 14.
    Lorbach O, Bachelier F, Vees J, Kohn D, Pape D (2008) Cyclic loading of rotator cuff reconstructions: single-row repair with modified suture configurations versus double-row repair. Am J Sports Med 36(8):1504–1510CrossRefPubMedGoogle Scholar
  15. 15.
    Manske RC, Prohaska D (2007) Pectoralis major tendon repair post surgical rehabilitation. N Am J Sports Phys Ther 2(1):22–33PubMedCentralPubMedGoogle Scholar
  16. 16.
    McEntire JE, Hess WE, Coleman S (1972) Rupture of the pectoralis major muscle. A report of eleven injuries and review of fifty-six. J Bone Joint Surg Am 54(5):1040–1046PubMedGoogle Scholar
  17. 17.
    Pavlik A, Csépai D, Berkes I (1998) Surgical treatment of pectoralis major rupture in athletes. Knee Surg Sports Traumatol Arthrosc 6(2):129–133CrossRefPubMedGoogle Scholar
  18. 18.
    Rabuck SJ, Lynch JL, Guo X et al (2012) Biomechanical comparison of 3 methods to repair pectoralis major ruptures. Am J Sports Med 40(7):1635–1640CrossRefPubMedGoogle Scholar
  19. 19.
    Rijnberg WJ, van Linge B (1993) Rupture of the pectoralis major muscle in body-builders. Arch Orthop Trauma Surg 112(2):104–105CrossRefPubMedGoogle Scholar
  20. 20.
    Savage E, Hurren CJ, Slader S, Khan LA, Sutti A, Page RS (2012) Bending and abrasion fatigue of common suture materials used in arthroscopic and open orthopedic surgery. J Orthop Res 31(1):132–138CrossRefPubMedGoogle Scholar
  21. 21.
    Schepsis AA, Grafe MW, Jones HP, Lemos MJ (2000) Rupture of the pectoralis major muscle—outcome after repair of acute and chronic injuries. Am J Sports Med 28(1):9–15PubMedGoogle Scholar
  22. 22.
    Schnaser E, Noel C, Gobezie R (2010) A new technique for repairing pectoralis major muscle injuries with cortical button fixation. Tech Shoulder Surg 11(3):81–84CrossRefGoogle Scholar
  23. 23.
    Silverstein JA, Goldberg B, Wolin P (2011) Proximal humerus shaft fracture after pectoralis major tendon rupture repair. Orthopedics 34(6):481Google Scholar
  24. 24.
    Sonnabend DH, Howlett CR, Young AA (2010) Histological evaluation of repair of the rotator cuff in a primate model. J Bone Joint Surg Br 92(4):586–594CrossRefPubMedGoogle Scholar
  25. 25.
    Tingart MJ, Apreleva M, von Stechow D, Zurakowski D, Warner JJ (2003) The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br 85(4):611–617CrossRefPubMedGoogle Scholar
  26. 26.
    Uchiyama Y, Miyazaki S, Tamaki T et al (2011) Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases. Sports Med Arthrosc Rehabil Ther Technol 3:20PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Wolfe SW, Wickiewicz TL, Cavanaugh JT (1992) Ruptures of the pectoralis major muscle. An anatomic and clinical analysis. Am J Sports Med 20(5):587–593CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Exeter Shoulder and Elbow Team, Princess Elizabeth Orthopaedic CentreRoyal Devon and Exeter HospitalExeterUK
  2. 2.Orthopaedic DepartmentAvon Orthopaedic CenterBristolUK
  3. 3.Department of Mechanical Engineering, Centre for Orthopaedic BiomechanicsUniversity of BathBathUK

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