Chronic bilateral pectoralis major ruptures and reconstruction with allograft

Naderi, Nasir M.; Funk, Lennard

doi:10.1016/j.injury.2009.08.028

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…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%

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

Nute

Kusnezov

Waterman

2019

Orthopaedic Journal of Sports Medicine

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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.

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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

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“…To the best of our knowledge, reports of bilateral, simultaneous PMTRs are exceedingly rare with only 5 cases described in the literature 29,[32][33][34][35] . Two reports described young male patients who sustained bilateral, simultaneous pectoralis tendon ruptures and underwent a staged suture-anchor and transosseous repair 6 weeks apart.…”

Section: Pectoralis Major Tendonmentioning

confidence: 97%

“…Rehabilitation featured active-assisted immobilization for 3 to 6 weeks followed by a progressive resistance program. Return to preinjury bench press was achieved at 12 months after his second procedure 34 .…”

Section: Shouldermentioning

confidence: 99%

Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity

et al. 2023

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Bilateral, simultaneous same-tendon injuries of the upper extremity are rarely encountered, yet their unique complexity poses a substantial challenge for treating orthopaedic surgeons.» In general, extremities with more tendon retraction should be repaired acutely while contralateral injuries can be treated in a staged or simultaneous manner depending on injury morphology, location, and anticipated functional impairment.» Combinations of accelerated and conventional rehabilitation protocols can be used for individual extremities to minimize the length of functional impairment.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A962).

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“…∥References 2, 3, 5, 7, 8, 10, 12, 16 -19, 23, 28, 31, 35, 37, 40, 42, 48, 50, 52, 54, 58, 59, 61, 62, 64 -67, 69, 70, 72, 77, 79 -84, 86, 87.…”

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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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Chronic bilateral pectoralis major ruptures and reconstruction with allograft

Cited by 4 publications

References 13 publications

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

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

Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity

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

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