Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes

Cordasco, Frank A.; Mahony, Gregory T.; Tsouris, Nicholas; Degen, Ryan M.

doi:10.1016/j.jse.2016.07.018

Cited by 48 publications

(55 citation statements)

References 15 publications

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“…Older studies more frequently used bone tunnels, 18,28,30 while recent studies more commonly reported the use of cortical button fixation. 6,16,27 The majority of pectoralis major ruptures reported in the literature were complete tears, with 59% (242/413) of ruptures in this review described as complete, while 41% (171/413) were partial tears. Pectoralis major ruptures more frequently occurred at the sternal head than the clavicular head, with 55% (187/341) of cases reporting a rupture of both sternal and clavicular heads, 44% (149/341) involving only the sternal head, and 1% (5/341) affecting only the clavicular head; 47% (175/372) of ruptures were at the humeral insertion, 41% (154/372) of ruptures were at the musculotendinous junction, 8% (28/372) of tears were intratendinous, 3% (12/372) were at the muscle belly, less than 1% (2/372) of ruptures included a bony avulsion of the tendon, and less than 1% (1/372) of ruptures occurred at the sternal origin.…”

Section: Surgical Technique Chronicity Injury Location and Extentmentioning

confidence: 73%

Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review

Zhang

Horner

et al. 2018

Sports Health: A Multidisciplinary Approach

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Context:Pectoralis major tendon ruptures are becoming increasingly common due to the growing prevalence of active lifestyles. Studies investigating the efficacy of pectoralis major tendon repair have limited sample sizes and offer mixed results, while existing reviews do not explore postoperative activity outcomes for patients.Objective:To summarize and synthesize the clinical outcomes and rate of return to activity after isolated pectoralis major tendon repair.Data Sources:Four databases (MEDLINE, EMBASE, PubMed, and CINAHL) were searched from database inception through March 7, 2018.Study Selection:Studies reporting outcomes of isolated pectoralis major tendon repair for pectoralis major tendon rupture were included.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Data including patient demographics, intervention details, and clinical outcomes were extracted. The methodological quality of included studies was evaluated.Results:Of 2332 retrieved articles, 18 studies were included, with a total of 536 patients. A majority (90%; 134/149) of patients undergoing pectoralis major tendon repair successfully returned to sport at a mean 6.1 ± 1.7 months postsurgery, of which 74% (95/128) successfully returned to their preinjury level of sport. The majority (95%; 269/284) of patients returned to work at a mean 6.9 ± 1 months. Postsurgically, 81% (83/102) of patients experienced complete pain relief after the surgery, and 19% (21/109) had cosmetic complaints after pectoralis major repair. Of the 10 studies that reported complications, 18% (75/423) of patients had postoperative complications, including reruptures and wound infections; 7% (30/423) of patients required reoperation for their complications.Conclusion:Pectoralis major tendon repair is an effective treatment that results in a high rate of return to sport and work, pain relief, and improved cosmetic appearance, albeit with a significant rate of complication. The evidence supporting all outcomes was limited by the rarity of the injury, the variable surgical techniques, and outcome assessment criteria.

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Section: Surgical Technique Chronicity Injury Location and Extentmentioning

confidence: 73%

Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review

Zhang

Horner

et al. 2018

Sports Health: A Multidisciplinary Approach

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“…Pectoralis major tendon ruptures are uncommon injuries that, until the mid-twentieth century, were primarily vocational injuries [1][2][3][4]. The recent increase is most likely attributable to increased use of anabolic steroids and increased participation in contact sports and weight-training activities [5][6][7][8]. Most reports have been limited to either case reports/series or small single surgeon cohorts.…”

Section: Discussionmentioning

confidence: 99%

“…Most reports have been limited to either case reports/series or small single surgeon cohorts. More recently, larger case series have been reported [1][2][3]8]. The pectoralis major is at risk during any activity in which the arm is extended and externally rotated while under maximal contraction.…”

Section: Discussionmentioning

confidence: 99%

Distal Pectoralis Major Tear

M¹,

Chafik²,

Elibrahimi³

et al. 2017

JCR

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Background: Rupture of the pectoralis major muscle is an uncommon injury. We report a total pectoralis major tear, treated successfully with the anchor technique suture. Case Report: A 31 years old, right-hand-dominant male presented with pain in shoulder joint following bench-press using weights. He was originally diagnosed as having shoulder sprain. Three weeks later, magnetic resonance imaging (MRI) confirmed total rupture of the pectoral major muscle tendon. Restoration of continuity was achieved by anchors suture technique. Conclusion: The rupture of the pectoralis major muscle remains an exceptional traumatic pathology of the athlete. The diagnosis is often ignored in the acute phase. MRI remains the diagnostic tool of choice. The early surgical repair allows total functional recovery.

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“…25,45 In the studies reviewed, we found different time frames for classifying repairs as acute or chronic; acute repair was classified as <3 weeks, 1,15 <6 weeks, 20,36,56,85 or <8 weeks. 6,9,77 For consistency in this analysis, any repair ≤8 weeks was considered an acute repair.…”

Section: Methodsmentioning

confidence: 99%

Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis

Gupton

Johnson

2019

Orthopaedic Journal of Sports Medicine

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Background:Pectoralis major muscle (PMM) tendon ruptures are becoming more common. Multiple techniques for fixation of the avulsed tendon to its humeral insertion have been described. None of these techniques has been reviewed to compare outcomes in efforts to establish a first-line surgical technique.Purpose:To systematically review and analyze the data available in the literature to establish a clinically superior surgical technique and time frame in which surgery should occur.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature review was conducted. Only studies reporting the surgical techniques and outcomes of PMM repair were included. Data including patient age, injury mechanism, type and extent of the rupture, time from injury to surgery, surgical technique, outcome including complications, steroid use, location and year of publication, and activity level were extracted from the included studies. Statistical and descriptive analyses were conducted on the available literature.Results:Of 259 cases from studies that provided the timing of repair, 72.6% (n = 188) were repaired acutely, while the remaining were repaired more than 8 weeks after the injury. There was no statistical difference found in the outcomes of these repairs. There were 265 cases included in the statistical analysis comparing the outcomes of surgical techniques. The odds of an excellent/good outcome were significantly better for the transosseous suture (TOS) compared with the unicortical button (UCB) technique (odds ratio [OR], 6.28 [95% CI, 1.37-28.75]; P = .018) and also for the suture anchor (SA) compared with the UCB technique (OR, 3.40 [95% CI, 1.06-10.85]; P = .039). The odds of an excellent/good outcome were not significantly different when comparing the TOS, SA, and TOS with trough techniques to one another. The probability of complications was highest with the TOS with trough technique (12.0%), although the odds of having a complication were not statistically significant for any single technique compared with the others.Conclusion:The low quality of evidence available limited this review. There were no significant differences observed in the outcomes of PMM repair based on the timing of repair. The TOS and SA techniques had statistically significantly greater odds of resulting in an excellent/good outcome compared with the UCB technique, but 1 study that contributed to this analysis may have statistically skewed the results for the UCB technique. Therefore, all 3 surgical techniques are accepted options, and the best technique is that with which the surgeon is most proficient and comfortable. Comparative research with a greater level of evidence is needed to determine a definitive first-line surgical technique.

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Pectoralis major tendon tears: functional outcomes and return to sport in a consecutive series of 40 athletes

Cited by 48 publications

References 15 publications

Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review

Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review

Distal Pectoralis Major Tear

Surgical Treatment of Pectoralis Major Muscle Ruptures: A Systematic Review and Meta-analysis

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