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

Abstract

Objectives: The incidence of pectoralis major tendon tears is rising, and repair is generally considered, but there is a paucity of comparative data to demonstrate the superiority of operative treatment. We sought to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared to nonoperative treatment. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was completed using MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase and Web of Science databases. English-language studies were included with a minimum of 6 months average follow-up and 5 cases per study. Methodological Index for Nonrandomized Studies was utilized 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 using 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 was transformed using the Freeman-Tukey log-linear transformation for variance stabilization and then assessed using a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P<.05. Results: Twenty-three articles with 664 injuries met the inclusion criteria for comparison (Figure 1). All patients were male with 63.2% of injuries occurring during weight training, with an average age of 31.48 years and follow-up of 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment with a relative improvement of functional outcome by 0.70 (P=.027), full isometric strength by 77.07% (P<.001), isokinetic strength by 28.86% (P<.001) compared to the uninjured arm, cosmesis satisfaction by 13.79% (P=.037), and resting deformity by 98.85% (P<.001) (Table 1). There was an overall complication rate of 14.21%, including a 3.08% rate of rerupture, for operative treatment. Conclusion: Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment with an associated 14.21% complication rate. There was a statistically significant improvement in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity. [Figure: see text][Table: see text]

Reconstruction of Chronic, Retracted Pectoralis Major Tendon Tear With Achilles Tendon Allograft

“…There has been an increasing incidence of reported pectoralis major tears (PMT) in the last 20 years, likely due to an increased interest in weight training and athletics. 2 A 40% increase in incidence of this type of injury among NFL players in the last 22 years has been reported. 3 The typical mechanism involved in rupture of the pectoralis major is extension and external rotation of the muscle along with maximal contraction of muscle.…”

“…The treatment of PMT depends on the extent of the injury and physical demands of the patient. 2 Conservative line of management is indicated for contusions, partial tears, muscle intramuscular tears, and complete tears in low-demand patients. 2 Although the PM is not required for most activities in daily living, surgical management is indicated in the young and athletic patients to avoid loss of strength of muscle during adduction, forward flexion and internal rotation of the joint.…”

“… 2 Although the PM is not required for most activities in daily living, surgical management is indicated in the young and athletic patients to avoid loss of strength of muscle during adduction, forward flexion and internal rotation of the joint. 2 …”

“…The authors also concluded that for nonrepairable tears, reconstruction with graft augmentation appears to provide better isometric strength compared to nonoperative management. 2 …”

Parachute-Induced Pectoralis Major Tears in Military Servicemembers: What Is the Functional Recovery?

“…Functional outcomes and return to military duty rates after this surgery are excellent and in line with findings of large nonmilitary outcomes studies. 4,31 Nute et al 20 reported a 94% return to full duty rate and 5.4% reoperation rate in a large study of 257 military patients, while Balazs et al 3 reported a 95.3% return to full duty rate in a study of 214 military patients. We observed a similar trend in this study, with all 13 patients returning to full duty at a mean of 6 months after injury and only 1 patient indicating he was not satisfied.…”