Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review

Yu, James; Zhang, Cindy; Horner, Nolan S.; Ayeni, Olufemi R.; Leroux, Timothy; Alolabi, Bashar; Khan, Moin

doi:10.1177/1941738118818060

Cited by 29 publications

(53 citation statements)

References 43 publications

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“…4,21 Pooled data from a recent systematic review demonstrated 90% return to sport, 74% return to preinjury level of sport, and 95% return to work. 25 There is some discrepancy with respect to the present data; however, pooled analysis incorporates a great deal of heterogeneity from variable surgical technique, follow-up, and patient population. 25…”

Section: Discussionmentioning

confidence: 70%

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Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon

et al. 2019

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Background: The use of routine patient-reported outcomes after repair of the pectoralis major tendon (PMT) is often prone to the ceiling effect owing to the high functional demand of those who sustain this injury. Hypothesis: A significant number of patients are expected to fail to achieve return to preoperative activity after PMT repair despite achieving significant improvements in functional score. Study Design: Case series; Level of evidence, 4. Methods: A prospectively maintained institutional database was reviewed for all patients undergoing PMT repair from 2010 to 2016. Patients were surveyed with regard to pre- and postoperative participation in sports, level of intensity, maximum weight repetitions in exercises utilizing the PMT, and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Results: Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean ± SD follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 years (range, 24-61 years), and mean body mass index was 28.6 ± 3.5 kg/m2. The dominant side was affected in 20 of 44 cases. Acute repairs were performed in 30 cases and chronic in 14. There were statistically significant improvements in both ASES and SANE scores ( P < .001). Return to sport at any level was achieved by 43 of 44 (97.7%) patients, while 22 of 44 patients (50.0%) reported returning to sport at the same or better intensity as preinjury status. On average, there was a 23.3% ± 45.6% decrease in 1–repetition maximum (1RM) barbell bench press, 14.7% ± 62.3% decrease in 5–repetition maximum barbell bench press, 24.3% ± 21.8% decrease in 1RM dumbbell bench press, 35.7% ± 32.1% decrease in 1RM dumbbell fly, and 15.6% ± 39.8% decrease in consecutive push-ups able to be performed. Seventeen patients (38.6%) reported a degree of apprehension that affected their ability to lift weights. When all preoperative variables were accounted for, history of surgery to the contralateral shoulder (odds ratio, 0.600; 95% CI, 0.389-0.925) was associated with a decreased likelihood of returning to sport at the same or better level of intensity, while injury sustained during sport had a greater likelihood (odds ratio, 2.231; 95% CI, 1.234-4.031). Conclusion: Patients undergoing PMT repair should expect significant functional improvements and a low complication rate. Yet, only 50% are able to return to preoperative intensity of sport, and they will also have significant reductions in their ability to weight lift.

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Section: Discussionmentioning

confidence: 70%

“…25 There is some discrepancy with respect to the present data; however, pooled analysis incorporates a great deal of heterogeneity from variable surgical technique, follow-up, and patient population. 25…”

Section: Discussionmentioning

confidence: 70%

Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon

et al. 2019

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“…Operative treatment of PM tears is recommended for both complete and partial injuries in this population due to occupational requirements and has been reported to result in good clinical outcomes. 9,20,25 Various operative techniques are available for repair depending on the severity of the tear and the location of the tear within the musculotendinous unit. The ability of an MRI to accurately identify these characteristics would lead to improved patient counseling preoperatively as well as improved preoperative surgical planning.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging of Pectoralis Major Injuries in an Active Duty Military Cohort: Mechanism Affects Tear Location

Synovec

Shaw

Hattaway

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Pectoralis major (PM) tendon tears are common injuries in athletic patient populations, where operative repair is largely recommended for maximum functional recovery. The repair varies in difficulty and technique based on the location of the tear within the muscle-tendon unit. Magnetic resonance imagining (MRI) has been reported to be sensitive and specific for identifying the tear location, but the effect of injury mechanism on tear pattern has not been previously investigated. Purpose: To examine PM tears in a military patient population and assess the effect of injury mechanism (weightlifting vs high-energy trauma) on the tear pattern and accuracy of MRI interpretation. Study Design: Cohort study; Level of evidence, 3. Methods: Active duty military servicemembers undergoing operative repair of PM tendon tears with corresponding preoperative MRIs from 2 medical centers were identified. Two musculoskeletal fellowship–trained radiologists reviewed imaging studies, reporting the location of the tear within the muscle-tendon unit and the severity of the tear (sternal head vs clavicular head vs both). Radiographic findings were compared against intraoperative findings. Mechanism of injury and timing from injury to imaging and surgery were assessed to determine whether they affected the accuracy of MRI interpretations. Results: A total of 72 patients were included (mean ± SD age, 33.7 ± 7.0 years; 100% male). Mechanisms of injury consisted of 46 weightlifting injuries and 26 high-energy injuries. Interrater reliability was poor for tear location (kappa, 0.162; P = .003) but substantial for extent of tear (kappa, 0.637; P < .0001). MRI had a 51.3% sensitivity and 63.6% specificity for identifying complete tears. MRI had a sensitivity of 73.9% and specificity of 72.2% for avulsion injuries and sensitivity of 75% and specificity of 79.3% for musculotendinous injuries. Mechanism of injury had no effect on extent of the tear but did affect the location of the tear, with a higher rate of avulsion injuries in the high-energy mechanism cohort (81% vs 40%; P = .02). Conclusion: The mechanism of injury was found to significantly affect the location of tendon tears. A higher rate of avulsion injuries was found in high-energy injuries than weightlifting injuries. MRI appeared to be less sensitive and specific than previous reports for traumatic PM tendon injuries.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Shaw

Brown

Moreland

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Although the most common injury mechanism for pectoralis major (PM) tears is an eccentric loading mechanism typically caused by bench pressing, within the military, there is a unique injury mechanism associated with airborne operations. The results of operative repair for these parachute-induced PM tears have not been previously reported. Purpose/Hypothesis: To assess the functional outcomes in military servicemembers undergoing operative repair of parachute-induced PM tears. We hypothesized that functional recovery would be impaired with delayed surgical intervention. Study Design: Cohort study; Level of evidence, 3. Methods: Included were active duty military servicemembers who underwent operative repair for PM tears caused by a parachute-induced mechanism. Charts were reviewed to identify characteristic, injury, and surgical variables. Patients completed the functional outcome assessment with the Disabilities of the Arm, Shoulder and Hand (DASH) and the American Shoulder and Elbow Surgeons (ASES) questionnaires. Outcomes were compared between patients treated within 6 weeks of injury and those treated beyond 6 weeks. Results: Of the 68 identified PM tears, 25 were the result of parachute-induced mechanisms. A total of 13 patients consented and completed the functional outcome assessment. The mean patient age was 30.6 ± 6.4 years, and the mean follow-up period was 5.46 ± 1.26 years. Ten patients underwent repair within 6 weeks of injury, and the remaining 3 patients underwent repair at a mean of 338 days after injury (95% CI, -42.8 to 718.8 days), a significant difference between groups ( P = .006). All 13 patients were able to return to military duties at a mean of 6 months from injury. Patients treated within 6 weeks of injury had significantly higher functional outcomes (DASH score, 6.17 vs 26.67; P = .018; ASES score, 85.97 vs 49.5; P = .008), with greater strength performance compared with preinjury (bench press, 90.58% vs 38.95%; P = .0057; push-ups, 81.9% vs 23.8%; P = .023) compared with patients treated beyond 6 weeks of injury. Conclusion: Operative repair of parachute-induced PM tears within 6 weeks of injury provided a superior functional and strength recovery when compared with delayed surgical repair. Acute repair should be recommended for military servicemembers who experience this unique injury mechanism.

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Outcomes and Return to Sport After Pectoralis Major Tendon Repair: A Systematic Review

Cited by 29 publications

References 43 publications

Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon

Analysis of Return to Sport and Weight Training After Repair of the Pectoralis Major Tendon

Magnetic Resonance Imaging of Pectoralis Major Injuries in an Active Duty Military Cohort: Mechanism Affects Tear Location

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

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