Endobutton Versus Suture Anchor Fixation for Pectoralis Major Tendon Repair: A Systematic Review of Clinical and Biomechanical Outcomes

Background: Pectoralis Major Tendon (PMT) ruptures are increasingly common.Surgical repair using either Endobutton (cortical button) or suture anchor fixation is standard, but a synthesis of high-quality evidence comparing these techniques is lacking.This systematic review aims to compare the clinical outcomes, biomechanical performance, and complication profiles of Endobutton versus suture anchor fixation for PMT repair.Methods: A systematic search was conducted following PRISMA guidelines across MEDLINE, EMBASE, PubMed, EMCARE, CINAHL, and the NHS Knowledge & Library Hub for studies published between 2015-2025.Studies reporting on clinical outcomes (e.g., functional scores, return-to-sport), biomechanical data, or complications for acute/chronic PMT repairs with Endobutton or suture anchors were included.The methodological quality of included studies was assessed using the MINORS tool.Results: Twenty-three studies met the inclusion criteria, comprising 4 biomechanical studies, 16 clinical case series/cohorts, and 3 systematic reviews.Meta-analysis was not feasible due to heterogeneity; a narrative synthesis was performed.Clinical outcomes (e.g., ASES, Constant scores) and return-to-sport rates (>85%) were excellent and comparable between groups.Biomechanical studies demonstrated equivalence in ultimate load-to-failure and stiffness between techniques, though constructs augmented with suture tape showed superior strength.The overall complication rate was low (5-14%), with a trend towards lower rates for Endobutton (4%) versus suture anchor (7%) repairs, though not statistically significant.Conclusion: Both Endobutton and suture anchor fixation techniques for PMT repair yield excellent and equivalent functional outcomes, high rates of return to activity, and low complication rates.The choice of technique can be individualized based on surgeon expertise, patient factors, and resource availability, as no single method demonstrates clear superiority.