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

Abstract

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.

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

“…In a large recent meta-analysis of 20 articles with 384 patients, Bodendorfer et al 5 reported that functional outcomes and cosmetic satisfaction were significantly superior in acute versus chronic repairs. However, Gupton and Johnson 10 reported no differences between acute and chronic repairs in another similar study of 259 patients. Our findings would support previous studies in that acute repair resulted in better functional outcomes and return of strength than chronic repair in an active, young, high-demand population.…”

Reconstruction of Subacute Pectoralis Major Tendon Rupture from CrossFit Injury: Case Report and Literature Review

“…Pectoralis major tendon ruptures are rare injuries but have been increasing in prevalence with the rising popularity of weight training and lifelong fitness [1,2,6]. Most commonly, rupture of this tendon occurs in males between the ages of 20-40 years-old and often happens while performing the bench press, a popular exercise for many weightlifters [1,2,6]. In this case, the inciting incident was not the bench press or any other less-commonly reported mechanism, but rather unusual in that it was associated with an exercise performed during a CrossFit workout.…”

“…The pectoralis major muscle is a large, broadbased muscle of the upper extremity responsible for adduction, internal rotation and elevation of the glenohumeral joint [1]. The muscle's two portions, the sternocostal head and the clavicular head, combine together then twist to form a common tendon that inserts lateral to the bicipital groove on the proximal humerus.…”

“…Classically, rupture of the pectoralis major tendon involves the sternocostal contribution of the tendon and more commonly seen in bodybuilders and weight lifters [2]. The most implicated exercise in pectoralis major tendon rupture is the bench press as it places the muscle in a position of maximal tension when it is eccentrically loaded, extended, and externally rotated [1]. Other cited mechanisms of injury in the literature include contact sports such as football and wrestling [1].…”

“…The most implicated exercise in pectoralis major tendon rupture is the bench press as it places the muscle in a position of maximal tension when it is eccentrically loaded, extended, and externally rotated [1]. Other cited mechanisms of injury in the literature include contact sports such as football and wrestling [1]. CrossFit, or high intensity variable functional training, is a relatively new discipline in fitness that combines plyometric movements, such as Introduction: Pectoralis major tendon ruptures are uncommon injuries that are most commonly seen in active males between 20-40 years of age.…”