Pectoralis Major Tendon Repair

Abstract

Objectives:Systematic reviews of the literature have identified 365 reported cases of Pectoralis Major Tendon (PMT) injuries. While surgical treatment has demonstrated improved outcomes compared to non-operative treatment, there is still relatively limited data on the functional outcome, return to sport and need for 2nd surgery in athletes following PMT repair. This study comprises the largest series of athletes following PMT repair reported to date. The Objective is to report on the functional outcomes, return to sport and need for 2nd surgery in a consecutive series of PMT tears.Methods:From 2009, 81 patients with PMT tears were enrolled in this prospective series. Baseline evaluation included patient demographics, mechanism of injury, physical examination and PMT specific MRI for confirmation of the diagnosis and analysis of the extent of injury. Each patient underwent surgical repair by the senior author utilizing a previously published surgical technique. Patients were then followed at 2 weeks, 6 weeks, 3 months and 6 months and further follow-up was conducted annually thereafter with functional outcome scores and adduction strength testing. The return to sport and incidence of 2nd surgery data were recorded. This study includes the first 40 athletes to reach the 2-year post-operative period.Results:All athletes were male, with an average age of 34.4 years (range 23-59). The patient cohort consisted of 4 professional NFL players and 36 recreational athletes. Average follow-up duration was 2.5 years (range 2 - 6.0 years). The most common mechanisms of injury occurred during the bench press (n=26) and contact sport participation (n=14). Sixteen injuries were complete avulsions involving both the clavicular and sternocostal heads, while 24 were isolated sternocostal head avulsions. Average pre-injury bench press of 396 lbs (range 170-500 lbs) was restored to 241 lbs post-operatively (range 140-550 lbs). Single Assessment Numeric Evaluation (SANE) scores averaged 93.6 (range 62-100) with an average overall patient satisfaction rated at 9.6 out of 10 (range 6-10). All athletes returned to their pre-injury level of activity at average 5.5 months post-op (range 4.5-6.5 months). Isokinetic evaluation assessing adduction strength revealed an average decrease of <11% (avg. 9.9%, range -18 - 41%) compared with the contralateral extremity. Application of the Bak criteria revealed 50% of athletes scored as excellent, 35% as good and 15% as fair. One athlete developed a pulmonary embolus 10 days post-op. Two athletes required a 2nd surgery (5%), both were re-injured within 3 weeks of surgery.Conclusion:As demonstrated in this consecutive series, which represents the largest cohort of PMT repairs reported to date, surgical repair resulted in 96% patient satisfaction, with 85% good to excellent restoration of function and adduction strength. The athletes returned to sport on average at 5.5 months post-operatively and the incidence of 2nd surgery was 5%.