Pectoralis major muscle rupture: more than 440 cases already reported. A review of the recent literature

Tomcovcík, L; Morochovič, Radoslav; Resutík, Richard

doi:10.1007/s00590-011-0820-z

Cited by 4 publications

(8 citation statements)

References 37 publications

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“…Type IIID tears that involved both sternal and clavicular heads (74%) were the most common type and extent of tears in the results of this review, which is consistent with the types of PMM ruptures that have been reported historically. 6,25,45,60,77 Weight lifting, specifically bench-press variations, and contact sports are the most reported causes of PMM tendon ruptures in the literature, and the findings of this review also confirmed this, with contact sports, the bench press, and other variations of weight lifting responsible for over 80% of ruptures. 6,45,77 Anabolic steroid use had been listed as a risk factor for PMM ruptures because of the increased muscle strength disproportionate to the strength of the tendon, making it more susceptible to injury.…”

Section: Discussionsupporting

confidence: 75%

“…6,25,45,60,77 Weight lifting, specifically bench-press variations, and contact sports are the most reported causes of PMM tendon ruptures in the literature, and the findings of this review also confirmed this, with contact sports, the bench press, and other variations of weight lifting responsible for over 80% of ruptures. 6,45,77 Anabolic steroid use had been listed as a risk factor for PMM ruptures because of the increased muscle strength disproportionate to the strength of the tendon, making it more susceptible to injury. 1,6,25,45,56,57 Many of the previously published articles do not formally mention steroid use in patients; in the current review, it was reported in 12 of the 63 included studies.…”

Section: Discussionsupporting

confidence: 75%

“…The results of this review showed that patients suffering from PMM ruptures were all male with a mean age of 30.4 years, which agrees with the demographics that have been previously reported in the literature. 6,20,25,41,45,77 Table 6 lists details from the included articles.…”

Section: Discussionmentioning

confidence: 99%

“…25,45 In the studies reviewed, we found different time frames for classifying repairs as acute or chronic; acute repair was classified as <3 weeks, 1,15 <6 weeks, 20,36,56,85 or <8 weeks. 6,9,77 For consistency in this analysis, any repair ≤8 weeks was considered an acute repair.…”

Section: Methodsmentioning

confidence: 99%

“…25,60 There are limited reports of barbed bone staples and cancellous screws with spiked washers for fixation. 19,27,45,77,86 In some cases, with significant tendon damage or retraction, an allograft or autograft may be used in conjunction with one of the aforementioned fixation techniques. 45 Direct suturing of tendon ends has been performed for intratendinous type IIIC tears if there is sufficient healthy tissue attached to the insertion.…”

Section: Methodsmentioning

confidence: 99%

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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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