Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-Analysis of Operative and Nonoperative Treatment

Abstract

Objectives:The incidence of pectoralis major tendon tears is rising, and repair is generally considered, but there is a paucity of comparative data to demonstrate the superiority of operative treatment. We sought to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared to nonoperative treatment.Methods:In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was completed using MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase and Web of Science databases. English-language studies were included with a minimum of 6 months average follow-up and 5 cases per study. Methodological Index for Nonrandomized Studies was utilized to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect-sizes were calculated from random effects models. Continuous variables were assessed using mixed model analysis with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data was transformed using the Freeman-Tukey log-linear transformation for variance stabilization and then assessed using a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P<.05.Results:Twenty-three articles with 664 injuries met the inclusion criteria for comparison (Figure 1). All patients were male with 63.2% of injuries occurring during weight training, with an average age of 31.48 years and follow-up of 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment with a relative improvement of functional outcome by 0.70 (P=.027), full isometric strength by 77.07% (P<.001), isokinetic strength by 28.86% (P<.001) compared to the uninjured arm, cosmesis satisfaction by 13.79% (P=.037), and resting deformity by 98.85% (P<.001) (Table 1). There was an overall complication rate of 14.21%, including a 3.08% rate of rerupture, for operative treatment.Conclusion:Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment with an associated 14.21% complication rate. There was a statistically significant improvement in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity.Figure 1.Table 1.Comparison of Outcomes between Operative and Nonoperative TreatmentOutcome MeasurementOperativeNo.NonoperativeNo.P-valueFunctional Outcome Score3.66; SE=0.15CI=3.36-3.954672.96, SE=0.28CI=2.41-3.5039<0.027Full ROM97.09%CI=84.17%-100%9398.53%CI=72.30%-100%140.862Full Isometric Strength97.50%CI=88.09%-100%6120.43%CI=0%-58.07%9<0.001Isokinetic Strength Change(-)8.64%; SE=5.35CI=(-)19.12%-(+)1.85%95(-)37.50%; SE=6.28;CI=(-)49.81%-(-)25.19%35<0.001Cosmesis: Resting Deformity1.15%CI=0%-9.43%38100%CI=70.23-100%6<0.001Cosmesis: Satisfaction91.60%CI=86.63%-94.18%46577.81%CI=60.03%-92.17%390.037