Repair of an Isolated Sternal Head Tear of the Myotendinous Junction of the Pectoralis Major Using Knotless Suture Anchors: Case Report and Literature Review

Although considered a relatively uncommon sports injury, publications on pectoralis major (PM) injuries have increased in the last couple of decades. Knowledge of the complex anatomy of the PM muscle is important in diagnosing, understanding the complexity of the injury, and determining the suitable modality of management of these injuries. Despite the increase in publications, there is no consensus on the superiority of any proposed surgical management. We present a case of a recreational body builder who presented to our clinics with a rare pattern of isolated musculotendinous junction of the lower fibers of the PM muscle and proposed a new technique of surgical management of such injuries using knotless suture anchors and running locked suture pattern in different directions. We then conducted a comprehensive review of literature of these injuries and presented a review on the pathophysiology, the various patterns of these injuries, and the available described modalities of surgical management. Understanding the complex anatomy of the PM, the various pattens of injury, and the aid of an MRI read by an expert musculoskeletal radiologist is crucial before managing these injuries. We believe that acute surgical repair of musculotendinous junction injuries using running Krackow/Brunnell locked configuration and the use of knotless suture and anchors will provide adequate and practicable surgical repair of these injuries.