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

Abstract

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.

Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes

“…The risk of bias in individual studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS), a validated instrument to discern the methodological quality of nonrandomized studies 40 that has demonstrated utility in previous similar meta-analyses. 5,7,8 Two authors with extensive research experience (A.M.L., B.M.B.) analyzed the 8 MINORS domains for noncomparative studies for each of the 21 articles and assigned a point value according to the MINORS system.…”

Performance and Survivorship of National Football League Players with Pectoralis Major Injuries

“…Previous studies have examined functional outcome, with respect to percent of pre-injury bench-press, in the general population. 2,14,26,[45][46][47] Others have also reported excellent outcomes after PM injuries undergoing operative treatment in active-duty United States military personnel and military academy students. [48][49][50][51] Recently, Liu et al 26 demonstrated significantly reduced PM strength after PM injury at a mean 2-year follow-up, which is consistent with previous studies.…”

“…[48][49][50][51] Recently, Liu et al 26 demonstrated significantly reduced PM strength after PM injury at a mean 2-year follow-up, which is consistent with previous studies. 2,45,52 A prior study demonstrated that up to 40% of surgically treated recreational athletes had a greater than 20% deficiency of isokinetic strength when compared to the uninjured contralateral side. 15 This persistent loss of strength following operative treatment may explain the performance decrease following injury in some NFL players, especially for defensive players who need to tackle.…”

“…1,[3][4][5][6][7][8][9][10][11][12][13] Recent evidence supports repair over nonoperative management for complete PM tears, with operatively treated patients demonstrating superior functional outcomes, strength, and cosmesis when compared to those treated conservatively. 1,2,4,[14][15][16][17] However, there remains a role for nonoperative management and physical therapy for athletes with lower grade PM strains and partial tears; however, comparative studies are lacking. 1,15,16 The PM muscle is a fan-shaped muscle over the anterior thorax with 2 distinct heads: a sternocostal head and clavicular head.…”

“…25 Current evidence favors surgical repair of some partial (grade II) and most complete (grade III) PM injuries at the tendinous insertion or musculotendinous junction or when the patient is unable to accept the resulting deformity or weakness. 2,6,26,27 In the NFL, PM injuries are infrequently reported. However, an increase in the incidence of PM injuries in the NFL has recently been reported over the past several seasons.…”