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

Nute, Drew W.; Kusnezov, Nicholas; Waterman, Brian R.

doi:10.1177/2325967119878709

Cited by 6 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many servicemembers are also required to perform group-based daily physical fitness activities, which may include calisthenics, tactical exercises, and deployment simulations called field exercises. 16 Servicemembers who are unable to satisfy these physical requirements are either provided with a profile limiting their fitness activities or medically discharged from military service. 15 Medical discharge data were identified using a Physical Evaluation Board assessment to determine fit-for-duty status.…”

Section: Methodsmentioning

confidence: 99%

Primary Medial Patellofemoral Ligament Reconstruction in Military Servicemembers: Can We Reliably Restore Preinjury Function and Stability?

Moreland

Shaw

Burks

et al. 2021

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

Background: Medial patellofemoral ligament (MPFL) reconstruction for patellar instability is a commonly performed procedure with a reported high rate of return to preinjury activity. However, no previous study has assessed the functional outcomes of military servicemembers undergoing MPFL reconstruction. Hypothesis: Primary MPFL reconstruction confers patellar stability, but with limited return to preinjury function and ability to maintain unrestricted military active duty status. Study Design: Case series; Level of evidence, 4. Methods: Using the Management Analysis and Reporting Tool database, we conducted a retrospective review of active duty servicemembers throughout the US Department of Defense Health System who underwent primary MPFL reconstruction between 2012 and 2015. Demographic variables were recorded as well as ability to return to impact activities—defined as running, jumping, rucking with a load >40 pounds (18 kg), and returning to airborne operations—and to remain on active duty status. The rates of recurrent instability and the need for subsequent surgeries were identified and assessed for statistical significance using uni- and multivariate analyses. Patients were evaluated for a minimum of 2 years postoperatively. Results: Of the 213 patients who underwent primary MPFL reconstruction, including 34 with concomitant tibial tubercle osteotomy, 19 (8.9%) patients developed recurrent instability. The presence of bilateral patellar instability was associated with higher recurrence rate. Patients with bilateral instability comprised 47.3% of those with recurrence but only 24.9% of patients without recurrence ( P = .019). Impact activity restrictions were present in 57.6% of patients (n = 121), with 86 patients (52.1%) undergoing medical separation from the military. Patients who were prescribed activity restriction before surgery were significantly more likely to have postoperative activity restrictions (64.5%; P = .019), and junior enlisted servicemembers were more likely to be medically separated from service postoperatively than higher ranking senior enlisted members or officers. Conclusion: Only 42.4% of US military servicemembers undergoing primary MPFL reconstruction were able to return to unrestricted impact activity after surgery. Bilateral instability negatively affected return to impact activities. Military servicemembers, particularly junior enlisted members, should be counseled on this poor prognosis for a full return to unrestricted activity postoperatively.

show abstract

Section: Methodsmentioning

confidence: 99%

Primary Medial Patellofemoral Ligament Reconstruction in Military Servicemembers: Can We Reliably Restore Preinjury Function and Stability?

Moreland

Shaw

Burks

et al. 2021

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Among military personnel, 78% to 100% of patients were able to return to active duty, with the majority returning to active duty within 6 months of surgery. 7,34,35,37,41,44 In the present work, approximately 98% of patients returned to work; however, only 66.7% of those who had high-intensity occupations were able to return to that level. The military population differs significantly from the civilian population, as the result of its work culture of camaraderie and resilience.…”

Section: Discussionmentioning

confidence: 45%

Return to Work After Pectoralis Major Repair

Agarwalla

Gowd

Liu

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Pectoralis major repair (PMR) is an infrequent injury that occurs during resistance training, most commonly during the eccentric phase of muscle contraction. As the incidence of weight training continues to increase, it is important to understand the outcomes after PMR. Purpose: To evaluate the rate and duration of return to work in patients undergoing PMR. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients undergoing PMR from 2010 to 2016 at a single institution were retrospectively reviewed at a minimum of 1 year postoperatively. Patients completed a standardized and validated work questionnaire, as well as a visual analog scale for pain, American Shoulder and Elbow Surgeons survey, Single Assessment Numerical Evaluation, and a satisfaction survey. Results: Of the 60 eligible patients who had a PMR, 49 (81.7%) were contacted at the final follow-up. Of the 49 patients, 46 (93.9%) had been employed within 3 years before surgery (mean ± SD age, 40.4 ± 8.2 years; follow-up, 3.9 ± 2.8 years). Of these, 45 (97.8%) returned to work by 1.6 ± 2.1 months postoperatively, and 41 (89.1%) returned to the same level of occupational intensity. Patients who held sedentary, light-, medium-, or high-intensity occupations returned to work at a rate of 100.0%, 100.0%, 83.3%, and 66.7% by 0.8 ± 1.0, 0.8 ± 1.0, 1.3 ± 2.7, and 3.3 ± 2.7 months, respectively. Five of 6 patients (83.3%) with workers’ compensation returned to their previous occupations by 5.0 ± 1.6 months, while 100% of those without workers’ compensation returned to work by 1.1 ± 1.7 months ( P < .001). Overall, 44 patients (95.7%) were satisfied with the procedure, and 40 (87.0%) would have the operation again if presented the opportunity. A single patient (2.2%) required revision PMR. Conclusion: Approximately 98% of patients who underwent PMR returned to work by 1.6 ± 2.1 months postoperatively. Patients with higher-intensity occupations took longer to return to their preoperative levels of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.

show abstract

“…Multiple reconstruction grafts, including autografts and allografts, have been described. Hamstring and Achilles allograft are the most common graft choices that have been reported, although bone-patellar tendon-bone autograft, fascia lata allograft, dermal allograft, patellar tendon allograft, and semitendinosus allograft all have been used for reconstruction 6,16,110-117 . Fixation of the graft to the proximal aspect of the humerus for reconstruction has been reported with interference screws, cortical buttons, suture anchors, and bone tunnels 6,16,110-117 .…”

Section: Evolution Of Treatmentmentioning

confidence: 99%

“…Considerable advancements have occurred in the past few decades, which have led to an understanding of the anatomy of the PM tendon, the natural history of PM tears, and surgical repair and reconstruction techniques [5][6][7][8][9] . Despite improvements in our understanding of the etiology, pathology, diagnosis, and treatment of PM tendon tears, knowledge gaps exist and require further investigation.…”

mentioning

confidence: 99%

“…Despite improvements in our understanding of the etiology, pathology, diagnosis, and treatment of PM tendon tears, knowledge gaps exist and require further investigation. Indications for surgery, the ideal type of surgical repair or reconstruction technique, and the timing of surgery continue to be an ongoing debate [5][6][7][8][9] . This review article critically analyzes the current literature and presents evidence-based recommendations for the treatment of PM tendon tears.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Pectoralis Major Tendon Tear

Magone

Ben-Ari

Gyftopoulos³

et al. 2021

JBJS Reviews

View full text Add to dashboard Cite

Pectoralis major (PM) tendon tears are predominantly seen in young men, and the majority of tears occur as tendon avulsions involving the sternal head. Weightlifting, specifically bench-pressing, and sporting activities with eccentric overloading of the PM tendon are the 2 most common activities that result in PM injury.Early surgical repair or reconstruction should be offered to younger, active patients with a complete PM tear; the majority of the patients undergoing surgical repair achieve good-to-excellent outcomes.Nonsurgical treatment of a complete PM tear is an option but will result in cosmetic deformity and a deficit in adduction strength of the arm. Outcomes after nonsurgical treatment of complete PM tears are less satisfactory than those obtained after surgical treatment.Currently, there is no consensus on the chronological definition of PM tears (acute versus chronic), the critical time limit for performing surgical repair, the ideal fixation device (cortical button, bone tunnel, or suture anchors), the indications for allograft use, and the ideal rehabilitation protocol after treatment of PM tears.

show abstract

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

Cited by 6 publications

References 29 publications

Primary Medial Patellofemoral Ligament Reconstruction in Military Servicemembers: Can We Reliably Restore Preinjury Function and Stability?

Primary Medial Patellofemoral Ligament Reconstruction in Military Servicemembers: Can We Reliably Restore Preinjury Function and Stability?

Return to Work After Pectoralis Major Repair

Pectoralis Major Tendon Tear

Contact Info

Product

Resources

About