The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

A Novel Surgical Technique and Narrative Review for Pectoralis Major Tendon Repair: Integration of Unicortical Button Fixation and DX Reinforcement Matrix Augmentation

Document Type : TECHNICAL NOTE

Authors
Timnit Gebray Tekie
Athanasios Kalogeropoulos
Georgios Togias
Ali Narvani
Mohamed Imam
Trauma and Orthopaedic Surgery, The Rowley Bristow Unit, Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, Surrey, United Kingdom
10.22038/abjs.2026.87034.3952
Abstract
Pectoralis major tendon (PMT) ruptures are increasingly seen in athletes, particularly weightlifters, often requiring surgical repair to restore function. Current surgical techniques may be limited by poor tendon quality or significant retraction. We present a novel approach combining unicortical button fixation with DX Reinforcement Matrix augmentation in a competitive weightlifter with a complete PMT rupture and contralateral pectoralis dysfunction. Intraoperatively, the tendon was augmented with a DX Matrix and fixed using a unicortical button to restore the anatomic footprint and reduce repair tension. The patient underwent structured rehabilitation and returned to full activity within six months. MRI at 12 months showed intact tendon healing at the anatomical footprint without graft failure or retraction. The Oxford Shoulder Score was 48 at six months, indicating high patient satisfaction. This technique is designed to provide a biomechanically robust and biologically supportive solution for complex PMT repairs and may improve outcomes, particularly in high-demand individuals. Further evaluation in larger cohorts is needed.
Level of evidence: V
Keywords
DX reinforcement matrix
Functional outcomes
Pectoralis major tendon rupture
Surgical repair
Tendon augmentation
Unicortical button fixation
Subjects
1.    Bodendorfer B, McCormick B, Wang D, et al. Treatment of pectoralis major tendon tears: A systematic review and meta-analysis of operative and nonoperative treatment. Orthop J Sports Med.2020;8(2):2325967119900813. doi: 10.1177/2325967119900813.
2.    Patissier P. Traité des maladies des artisans, et de celles qui résultent des diverses professions, d’après Ramazzini. Paris: J-B Baillière; 1822.
3.    Provencher MT, Handfield K, Boniquit NT, Reiff SN, Sekiya JK, Romeo AA. Injuries to the pectoralis major muscle: Diagnosis and management. Am J Sports Med. 2010;38(8):1693-705. doi: 10.1177/0363546509348051.
4.    Bodendorfer B, DeFroda MS, Shu BH, Knapik D, Yang D, Verma N. Incidence of pectoralis major injuries has increased 40% over the last 22 National Football League seasons. Arthrosc Sports Med Rehabil.2021;3(4):e1113-e1118. doi: 10.1016/j.asmr.2021.03.019.
5.    Bak K, Cameron EA, Henderson IJ. Rupture of the pectoralis major: a meta-analysis of 112 cases. Knee Surg Sports Traumatol Arthrosc.2000;8(2):113-9. doi: 10.1007/s001670050197.
6.    ElMaraghy AW, Devereaux MW. A systematic review and comprehensive classification of pectoralis major tears. J Shoulder Elbow Surg.2012;21(3):412-22. doi: 10.1016/j.jse.2011.04.035.
7.    Guity M, Sharafat Vaziri A, Shafiei H, Farhoud A.Surgical treatment of pectoralis major tendon rupture (outcome assessment). Asian J Sports Med. 2014;5(2):129-135.
8.    Merolla G, Paladini P, Artiaco S, Tos P, Lollino N, Porcellini G. Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years. Eur J Orthop Surg Traumatol.2015;25(1):91-8. doi: 10.1007/s00590-014-1451-y.
9.    Aaerimaa V, Rantanen J, Heikkil€a J, Helttula I, Orava S. Rupture of the pectoralis major muscle. Am J Sports Med.2004;32(5):1256-62. doi: 10.1177/0363546503261137.
10.  Rabuck SJ, Lynch JL, Guo X, et al. Biomechanical comparison of 3 methods to repair pectoralis major ruptures. Am J Sports Med.2012;40(7):1635-40. doi: 10.1177/0363546512449291.
11.  Sherman SL, Lin EC, Verma NN, et al. Biomechanical analysis of the pectoralis major tendon and comparison of techniques for tendoosseous repair. Am J Sports Med.2012;40(8):1887-94. doi: 10.1177/0363546512452849.
12.  Oliva F, Via AG, Kiritsi O, et al. Surgical repair of muscle laceration: biomechanical properties at 6 years follow-up. Muscles Ligaments Tendons J.2014;3(4):313-7.
13.  Edgar CM, Singh H, Obopilwe E, et al. Pectoralis major repair: a biomechanical analysis of modern repair configurations versus traditional repair configuration. Am J Sports Med.2017;45(12):2858-2863. doi: 10.1177/0363546517716175.
14.  Hart ND, Lindsey DP, McAdams TR. Pectoralis major tendon rupture: a biomechanical analysis of repair techniques. J Orthop Res.2011;29(11):1783-7. doi: 10.1002/jor.21438.
15.  Omae H, Steinmann SP, Zhao C, et al. Biomechanical effect of rotator cuff augmentation with an acellular dermal matrix graft: a cadaver study. Clin Biomech (Bristol).2012;27(8):789-92. doi: 10.1016/j.clinbiomech.2012.05.001.
 
16.  Mirzayan R, Conroy C, Sethi P. Distal biceps repair with acellular dermal graft augmentation. Tech Should Elb Surg. 2015;16:89–93.
17.  Cooper JD, Sethi PM, Mirzayan R. Pectoralis major tendon repair with acellular dermal matrix augmentation. Tech Shoulder Elbow Surg. 2017;18:141-4.
18.  Neumann JA, Klein CM, van Eck CF, Rahmi H, Itamura JM. Outcomes after dermal allograft reconstruction of chronic or subacute pectoralis major tendon ruptures. Orthop J Sports Med.2018;6(1):2325967117745834. doi: 10.1177/2325967117745834.
19.  Butt U, Mehta S, Funk L, Monga P. Pectoralis major ruptures: a review of current management. J Shoulder Elbow Surg.2015;24(4):655-62. doi: 10.1016/j.jse.2014.10.024.
20.  Meyer DC, Wiesser K, Farshad M, Gerber C. Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair. Am J Sports Med.2012;40(10):2242-7. doi: 10.1177/0363546512457587.
21.  Gupton M, Johnson JE. Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2019;7(2):2325967118824551. doi:10.1177/2325967118824551.
22.  Barber FA, Burns JP, Deutsch A, et al. A prospective, randomized evaluation of acellular human dermal matrix augmentation of arthroscopic rotator cuff repair. Arthroscopy.2012;28(1):8-15. doi: 10.1016/j.arthro.2011.06.038.
The Archives of Bone and Joint Surgery
Volume 14, Issue 8
August 2026
Pages 550-557

  • Receive Date 11 September 2025
  • Revise Date 23 May 2026
  • Accept Date 17 May 2026