Keywords

1. Pectoralis Major Reconstruction
2. Tendon Repair Surgery
3. Shoulder Injury Recovery
4. Cadaveric Study Findings
5. Orthopedic Surgical Advances

The human anatomy is a complex web of interconnected tissues and structures, which when injured, require meticulously planned interventions to ensure quick and effective recovery. One such critical anatomical feature susceptible to injury, particularly among young, active individuals, is the pectoralis major tendon. A recent study by Jagiasi et al., published in the Journal of Clinical Orthopaedics and Trauma, provides an insightful exploration of the insertion anatomy of the pectoralis major tendon, which can significantly influence surgical repair strategies. The study, entitled “Insertion Anatomy of the Pectoralis Major Tendon” (DOI: 10.1016/j.jcot.2019.01.005), is a crucial milestone in understanding the precise dimensions of this essential tendon and its relationship with adjacent structures, paving the way for optimized surgical outcomes.

The research conducted by Jagiasi and colleagues involved a thorough examination of 10 fresh cadaveric shoulders. The average proximal to distal insertion width of the pectoralis major tendon was found to be 46 mm. Additionally, the average distance from the superior border of the tendon to the supero-medial tip of the greater tuberosity (GT) of the humerus was measured to be 48.5 mm. These measurements provided valuable insights into the surgical approach for pectoralis major tendon tears. The authors concluded that the superior border of the tendon should be repaired utilizing two anchors strategically placed at a 48.5 mm distance from the tip of the GT to cover the measured width of 46 mm.

Pectoralis major tendon tears present a challenging scenario for orthopedic surgeons due to the critical functional role the muscle and tendon play in upper extremity movement. As such, the knowledge of the mean width of the insertion anatomy becomes instrumental in pre-surgical planning and customized repair techniques. Research such as this by Jagiasi et al. is particularly relevant as it also contributes to the database of anatomical variations and their implications for clinical practice.

The findings of the study align with the body of existing literature on the complexities of pectoralis major tendon injuries. Previous works by Fung et al. (2009) and de Figueiredo et al. (2013) have established the anatomical footprint and three-dimensional architecture of this muscle-tendon unit, emphasizing the need for precise anatomical knowledge for successful repair (DOI: 10.1016/j.rboe.2013.12.009). Similarly, White et al. (2007 noted the incidence of major tendon ruptures within select populations, highlighting the importance of specialized treatment options (PubMed PMID: 17468380).

Interventions for repairing the pectoralis major tendon have evolved over the years, with several studies suggesting various techniques to optimize outcomes. For instance, Pochini et al. (2018) described the use of an adjustable cortical button in the surgical treatment of pectoralis major muscle rupture (PubMed PMID: 29367908; PubMed Central PMCID: PMC5771794). Such innovative approaches are indicative of the continuing advancements in the field, ensuring that these rather frequent injuries among young athletes can be addressed more effectively.

Outcomes following repair surgeries are a significant concern for both patients and physicians. Mooers et al. (2015) discussed the repercussions of suture-anchor repair of pectoralis major tears, asserting the potential for successful recovery and return to athletic activity (PubMed PMID: 26361438; PubMed Central PMCID: PMC4492126). This outcome-based approach to surgery is complemented by understanding the precise repair needs as identified through anatomical studies.

Moreover, serious pectoralis major muscle injuries sometimes require muscle transfers, as elucidated by Elhassan (2014) in his discussion of pectoralis major transfer in addressing scapula winging (PubMed PMID: 24480693). The need for such extensive procedures further underscores the importance of accurate anatomical mapping to prevent complications.

The work of Jagiasi et al. adds to the reference knowledge for orthopedic surgeons. Considering the likely variations in insertion anatomy among different patients, accurate, individualized assessments before surgical interventions are crucial. The research contributes to reducing the likelihood of malpositioning of the fixation points, which has been a concern in previous years. Injuries and inconsistencies in pectoralis major tendon anatomy, as reported by Carey and Owens (2010), warrant such investigative studies (PubMed PMID: 20055351).

To complement these technical insights, an understanding of the clinical results of surgical techniques is also valuable. Uchiyama et al. (2011) showcased promising clinical results using endobuttons for complete tendon tears of the pectoralis major muscle, suggesting diversity in treatment modality preferences (PubMed PMID: 21955511; PubMed Central PMCID: PMC3199274). Typically, such diversity in treatment options can be streamlined when there is a universal consensus on the foundational anatomy, much like what Jagiasi et al. have attempted to establish.

Mirroring the pursuits of previous studies like that of Murachovsky et al. (2008) and Torrens et al. (2008), who sought to identify reliable anatomical landmarks for humeral head placement in shoulder procedures, Jagiasi et al.’s work contributes to enhancing procedural accuracy and ultimately patient care (PubMed PMID: 27582906; PubMed Central PMCID: PMC4986656).

In conclusion, the anatomical insights provided by Jagiasi et al. (2019) regarding the insertion anatomy of the pectoralis major tendon are a valuable contribution to the orthopedic literature. They offer a clarified perspective that will undoubtedly aid in the planning and execution of pectoralis major tendon repairs. The findings have significant implications for young, active patients who often incur these injuries and rely on the expertise of orthopedic surgeons for a successful return to their active lifestyles.

References

1. Jagiasi Jairam D., Valavi Anisha S., Ubale Tushar V., Sahu Dipit. Insertion Anatomy of the Pectoralis Major Tendon. J Clin Orthop Trauma. 2019 May-Jun;10(3):541-543.
2. White D.W., Wenke J.C., Mosely D.S., Mountcastle S.B., Basamania C.J. Incidence of major tendon ruptures and anterior cruciate ligament tears in US Army soldiers. Am J Sports Med. 2007;35(8):1308–1314.
3. Pochini A.C., 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. 2018;53(1):60–66.
4. 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.
5. Elhassan B. Pectoralis major transfer for the management of scapula winging secondary to serratus anterior injury or paralysis. J Hand Surg. 2014;39(2):353–361.