Risk of complications is low in acute injuries
Pectoralis major tendon ruptures are relatively uncommon and little information exists about the demographics of these injuries or the surgical outcomes of their repair. Study data presented at the 2017 annual meeting of the American Orthopaedic Society for Sports Medicine, however, indicate that surgical repair of acute pectoralis major tendon ruptures is associated with a low rate of re-rupture and a low risk of complications.

The researchers note that the study is the largest single series reporting the surgical treatment of these injuries.

"The literature is limited to several small case series and systematic reviews," they write. "The purpose of our study was to obtain more information on injury demographics and surgical outcomes to aid decision making with respect to diagnosis, preferred method of repair, and complications surrounding surgical treatment of acute and chronic tears."

Retrospective review
The researchers retrospectively reviewed pre- and postoperative chart and imaging data from 134 patients (133 males; 1 female; average age = 34 years) who had undergone surgery for treatment of acute or chronic pectoralis major tendon ruptures. All procedures had been performed at a multisurgeon, multicenter, community-based integrated healthcare system between 2008 and 2014.

Among the 134 patients, 18 percent of whom were laborers, the most common mechanisms of injury were weight lifting (62 percent), trauma (22 percent), and martial arts (7.5 percent). Overall, 76 percent of the ruptures were acute, 8 percent were subacute, and 16 percent were chronic. Most of the patients (92 percent) had sustained a complete tendon rupture.

The average time to surgery after injury was 10 weeks. Ruptures were surgically repaired using the following techniques:

• suture anchors (n = 54)
• sutures through bone tunnels (n = 44)
• suture button (n = 25)
• end-to-end suture repair (n = 10)
• biotenodesis screw (n =1)

Six patients required allograft augmentation at the time of surgery.

Low complication rate
The overall complication rate among the surgeries was 13 percent. Complications (Table 1) included the following:

• infections (n = 4)
• cosmetic wound concerns (n =5)
• transient neurapraxia (n =1)
• fractures (n = 2)
• postoperative frozen shoulders (n = 2)
• failed repair (n = 3)

Analysis of the correlation between surgical technique and complications revealed that surgical treatment with bone tunnels was associated with the highest complication rate (5 percent), followed by suture anchors (4.4 percent), end-to-end repair (2.2 percent), and suture button repair (0.74 percent).

According to the authors, the differences in complication rates among surgical methods were not statistically significant. However, the use of an implant was associated with a lower re-tear rate, a lower rate of fracture, and a lower rate of postoperative stiffness (P = 0.0782 for all), compared to surgery without an implant.

"We identified only three instances of failed repair, which is notable for a study group of this size," said corresponding coauthor Michelle T. Sugi, MD, MPH, of the Keck School of Medicine at the University of Southern California. "Moreover, of the 120 patients who were available at final follow-up at an average of 71 days postoperative, 114 patients (95 percent) were able to return to their occupations at full capacity."

Conclusions
Based on the results of the study, the authors conclude that surgical repair of these injuries can be performed safely with a low rate of re-rupture and a low risk of complications.

In addition, "Using a suture button had the lowest complication rate, and the use of an implant may potentially minimize complications," they write.

"We hope our research can contribute to a better understanding of who is affected by pectoralis major tendon ruptures, how to treat them, and how to address potential complications," Dr. Sugi said.               

Dr. Sugi's coauthors of "Surgical Treatment of Pectoralis Major Tendon Ruptures: A Retrospective Review of 134 Patients Tendon Ruptures" are Daniel Acevedo, MD, and Raffy Mirzayan, MD.

The authors' disclosure information can be accessed at www.aaos.org/disclosure.

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org.

Bottom Line

• The study evaluated outcomes of 134 patients who had undergone surgery for treatment of acute or chronic pectoralis major tendon ruptures.
• The researchers found that use of a suture button had the lowest complication rate among the surgical techniques evaluated, and the use of an implant may potentially minimize complications.
• Overall, the researchers conclude that surgery for pectoralis major tendon ruptures is associated with a low rate of re-rupture and a low risk of complications.