Chronic Pec Tear Reconstruction with Achilles Allograft

This video features Dr. Grant Garcia demonstrating a highly complex open surgery for a chronic pectoralis major tendon tear reconstruction using an Achilles tendon allograft.

Acute pectoralis major tears (common in weightlifters performing bench presses) can usually be repaired by pulling the native tendon back to the arm bone. However, in chronic cases, the muscle belly severely contracts, scars down, and undergoes atrophy. Because the remaining native tissue cannot stretch far enough to reach its original footprint on the humerus without tearing, an Achilles allograft is required to bridge the massive structural gap.

The complex reconstruction is executed through these primary surgical phases:

• Surgical Exposure & Neurological Protection: An open anterior incision is made through the deltopectoral interval. Dr. Garcia carefully dissects down to locate the retracted, scarred pectoralis major muscle belly, taking great care to identify and protect the cephalic vein and the nearby brachial plexus nerve branches.
• Extensive Tissue Mobilization: The chronic muscle mass is bound down by dense scar tissue to the chest wall. Dr. Garcia uses blunt and sharp dissection to completely release these deep fascial adhesions, mobilizing the muscle as much as safely possible to restore dynamic excursion.
• Achilles Allograft Preparation & Splicing: On the back table, a fresh-frozen Achilles tendon allograft is tailored. The soft-tissue tendon portion of the graft is split or thinned to match the dimensions of the patient’s pectoralis muscle belly. High-strength sutures are woven through the graft using a Krakow whip-stitch technique. Dr. Garcia then securely splices and sews this allograft directly onto the edge of the chronic, retracted pectoralis major muscle, effectively lengthening the construct.
• Humerus Footprint Preparation: Dr. Garcia exposes the lateral lip of the bicipital groove on the humerus—the native insertion footprint of the pec major. A burr or rasp is used to remove cortical bone down to a raw, bleeding bed to guarantee optimal biological bone-to-graft healing.
• Cortical Button and Anchor Fixation: To anchor the calcaneal bone block or heavy suture tails of the allograft extension to the arm bone, unicortical or bicortical drill holes are created in the humerus. Dr. Garcia passes the heavy graft sutures through cortical buttons (or utilizes heavy-duty knotless anchors) to compress the new Achilles tendon extension firmly flat against the bone bed under high tension.

The final inspection demonstrates excellent structural restoration. The Achilles allograft perfectly bridges the previous tissue void, restoring the natural cosmetic contour of the chest wall and establishing the robust mechanical tension necessary for the patient to regain internal rotation and horizontal adduction power.