Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years

Merolla, Giovanni; Paladini, Paolo; Artiaco, Stefano; Tos, Pierluigi; Lollino, Nicola; Porcellini, Giuseppe

doi:10.1007/s00590-014-1451-y

Cited by 27 publications

(32 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The first reported case of injury to the pectoralis major tendon (PMT) involved heavy lifting, although the injury was caused by hoisting a large side of beef off a meat hook instead of a maximum lift on the bench press. 33 Widely viewed as rare injuries, 16,26,29,31,45 PMT tears appear to be increasing in incidence, likely a result of increased interest in weight training and participation in athletic pursuits. 3,4,8,10,26 Contemporary injuries to the PMT typically occur during exercise or training, mostly during the eccentric phase of bench press exercises.…”

mentioning

confidence: 99%

Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment

Bodendorfer

McCormick

Wang

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The incidence of pectoralis major tendon tears is increasing, and repair is generally considered; however, a paucity of comparative data are available to demonstrate the superiority of operative treatment. Purpose/Hypothesis: The purpose of this study is to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared with nonoperative treatment. Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of the literature was completed by use of MEDLINE, SPORTDiscus, CINAHL, Cochrane, EMBASE, and Web of Science databases. We included English-language studies that had a minimum of 6 months of average follow-up and 5 cases per study. The MINORS (Methodological Index for Non-Randomized Studies) was used to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect sizes were calculated from random-effects models. Continuous variables were assessed by use of mixed-model analysis, with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data were transformed via the Freeman-Tukey log-linear transformation for variance stabilization and then assessed through use of a mixed model with a study level random effect and subsequently back-transformed. Significance was set at P < .05. Results: A total of 23 articles with 664 injuries met the inclusion criteria for comparison. All patients were male, with an average age of 31.48 years; 63.2% of injuries occurred during weight training, and the average follow-up was 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment, with relative improvements of functional outcome by 23.33% (0.70 improvement by Bak criteria which is scored 1-4; P = .027), full isometric strength 77.07% ( P < .001), isokinetic strength 28.86% ( P < .001) compared with the uninjured arm, cosmesis satisfaction 13.79% ( P = .037), and resting deformity 98.85% ( P < .001). The overall complication rate for operative treatment was 14.21%, including a 3.08% rate of rerupture. Conclusion: Pectoralis major tendon repair resulted in significantly superior outcomes compared with nonoperative treatment, with an associated 14.21% complication rate. Statistically significant improvements were noted in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity.

show abstract

mentioning

confidence: 99%

Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment

Bodendorfer

McCormick

Wang

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

show abstract

“…This is consistent with previous studies following allograft reconstruction. 8,10,14,18,19,24,31 In a study of 6 patients who underwent PMT reconstruction with allograft, de Castro Pochini et al 8 reported that all patients returned to weight lifting, and 100% of patients exhibited good to excellent outcomes via the Bak criteria. 4 Our study’s outcomes with the Bak criteria fall short of this mark, with 56% excellent outcomes; however, this number likely underrepresents our actual rate of excellent outcomes, as patients who experienced rerupture or required any additional surgery were automatically classified as having poor outcomes, even though they were able to return to full preinjury levels of occupational function.…”

Section: Discussionmentioning

confidence: 99%

“…In their study on active duty military servicemen, Zacchilli et al 31 reported that only 1 of their 3 patients who underwent allograft PMT reconstruction returned to full bench press strength postoperatively. Merolla et al 18 reported that patients undergoing PMT reconstruction experienced statistically significant decreases in strength of internal rotation with isometric strength measurements as compared with those who underwent primary repair. It is imperative that expected outcomes, including a significant loss of bench press strength, be discussed with patients during preoperative counseling, given that this was one of the most common and significant postoperative complaints.…”

Section: Discussionmentioning

confidence: 99%

Functional Outcomes and Complications Following Pectoralis Major Tendon Allograft Reconstruction in a Military Population

Nute

Kusnezov

Waterman

2019

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background:There are limited data available regarding outcomes following pectoralis major tendon (PMT) reconstruction with allograft.Purpose:To evaluate the functional outcomes and complication profile following PMT reconstruction with allograft in a military population.Study Design:Case series; Level of evidence, 4.Methods:All active duty military personnel who underwent PMT allograft reconstruction between 2008 and 2013 were identified. Demographics, injury characteristics, and surgical technique were recorded from the electronic medical record. Self-reported pain scores and manual strength were evaluated pre- and postoperatively, as recorded in physician electronic medical record notes, in addition to the ability and degree to which each patient was able to return to function. Standardized outcome measures included the Bak criteria; visual analog scale for pain; Disabilities of the Arm, Shoulder and Hand (DASH) score; American Shoulder and Elbow Surgeons (ASES) score; and 36-Item Short Form Health Survey (SF-36). Complications, including rerupture and reoperation, were additionally recorded.Results:Nine male patients (mean ± SD age, 35.7 ± 5.8 years) underwent allograft PMT reconstruction. Mean improvement in self-reported pain score at a mean 53.5 months (range, 31.1-110.9 months) was 2.1 ± 1.3 points (P = .08). Improvements in manual strength during forward flexion (0.5 ± 0.7; P = .03), adduction (0.6 ± 0.6; P = .01), and internal rotation (0.5 ± 0.7; P = .03) were significant. Seven patients (78%) returned to full preinjury level of occupational function, and 88% returned to performing the bench press, although maximum weight decreased by a self-reported mean of 141.3 lb. According to the Bak criteria, 5 (56%) patients had excellent outcomes, 2 (22%) had fair outcomes, and 2 (22%) had poor outcomes. Mean visual analog scale for pain (1.9 ± 2.8), DASH (10.8 ± 17.4), ASES (88.1 ± 20.3), and SF-36 scores (96.3% ± 6.9%) were obtained for the 8 patients available at final follow-up. Complications included 2 cases (22%) of persistent shoulder pain leading to military separation, 1 rerupture (11%), and 1 (11%) surgical scar revision.Conclusion:While allograft reconstruction is a reliable option to decrease pain and improve function in patients with tears not amenable to primary repair, patients should be educated about the risk profile and fitness limitations after surgery.

show abstract

“…However, a graft is required when extensive surgical release of the PM belly muscle does not allow direct repair [ 15 ]. Fascia lata or Achilles tendon allografts are widely used for reconstruction of PM tendon [ 10 , 19 , 35 , 36 ]. Allografts avoid donor-site morbidity and can be easily tailored to fill the gap.…”

Section: Discussionmentioning

confidence: 99%

Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw

Baverel

Messedi

Piétu

et al. 2017

Case Reports in Orthopedics

View full text Add to dashboard Cite

Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. We report an open reconstruction technique and its outcomes in a case of chronic and retracted PM tear. At the last follow-up (12 months), the patient was pain-free, with a visual analogic scale at 0 all the time. He was very satisfied concerning the cosmetic and clinical results. The constant score was 93%, the SST value 95%, and the Quick DASH score 4.5. MRI performed one year postoperatively confirmed the continuity between PM tendon and graft, even if the aspect of the distal tendon seemed to be thinner than normal PM tendon. The excellent clinical outcomes at one-year follow-up suggest that PM tear with major tendon retraction can be reliably reconstructed with hamstring autograft, using a bioabsorbable screw to optimize the fixation device. This technique has proven its simplicity and efficiency to fill the gap.

show abstract

Surgical repair of acute and chronic pectoralis major tendon rupture: clinical and ultrasound outcomes at a mean follow-up of 5 years

Abstract: Prompt surgical repair ensures satisfactory outcomes in patients with complete PM rupture; however, delayed allograft repair provides good results with only slight strength impairment. Fresh insights are provided on the role of US in evaluating PM anatomy and tendon attachment to bone.

Cited by 27 publications

References 29 publications

Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment

Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment

Functional Outcomes and Complications Following Pectoralis Major Tendon Allograft Reconstruction in a Military Population

Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw

Contact Info

Product

Resources

About