Editor’s note: The following content was published in the AAOS Now Special Edition and distributed in June 2020. The content was originally scheduled for the AAOS Now Daily Edition, which publishes each year onsite at the AAOS Annual Meeting but this year’s meeting in March was canceled due to COVID-19. Despite the cancellation, members can access virtual content from the Annual Meeting by visiting the Academy’s Annual Meeting Virtual Experience webpage.
A study found that military patients who underwent primary repair of a chronic pectoralis major tear had excellent clinical outcomes, low risk of complications, and a high return to preoperative levels of recreational and military job activities. Nata Zwi Parnes, MD, of Tri-County Orthopedics and Carthage Area Hospital in West Carthage, N.Y., presented the study as part of the Annual Meeting Virtual Experience.
Pectoralis major tendon tears are prevalent among military members due to the high level of exercise and rigorous physical training sessions they perform, especially bench pressing, which is the typical mechanism of injury. However, the mobile lifestyle of the military does not always allow for this type of injury to be treated in the acute stage. If a pectoralis major tear is not surgically fixed within the first six weeks post-injury, repair of a chronic pectoralis major tear is typically performed.
“Working with a large military patient population, I am exposed to this uncommon yet severe injury more frequently,” Dr. Parnes told AAOS Now. “I saw the major impact of this chronic injury on my patients’ life and job activities and was motivated to help them and publish our findings for the benefit of surgeons who are less frequently exposed to this injury.”
Researchers retrospectively reviewed data collected on 14 male active-duty military patients who underwent a primary repair of a chronic pectoralis major tear and had a minimum of two years of follow-up (mean follow-up, 53.46 months; range, 24–88 months). Pre- and postoperative evaluations included range of motion; Bak classification; visual analog scale (VAS); Single Assessment Numerical Evaluation (SANE) score; Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score; and American Shoulder and Elbow Surgeons (ASES) shoulder score.
Using Bak classification, 93 percent of patients (n = 13) reported good or excellent results. Participants experienced improvements in all studied outcomes. Mean VAS score improved from 7.08 to 0.54 (P < 0.0001), and mean SANE score improved from 42.31 to 94.62 (P < 0.0001). The average Quick DASH score increased from 55.42 to 7.30 (P < 0.0001), and the average ASES score increased from 48.71 to 94.62 (P < 0.0001).
Patients did not experience any loss of motion after surgery in forward flexion, external rotation, or internal rotation. The average internal rotation muscle power increased from 4.15 to 4.92 (P < 0.0001).
One patient (7.1 percent) developed a keloid scar, tender to direct pressure postoperatively. Almost all patients (n = 13; 93 percent) returned to their preoperative levels of recreational and military job activities.
“There was no correlation between the time interval from injury to treatment and the final outcome,” said Dr. Parnes. “Even patients who had a very long time interval did very well functionally and cosmetically and had improvement of pain (longest interval was 48 months between injury and surgery).”
“Repair of pectoralis major tendon tears should be considered for all young, active patients regardless of the time interval from injury,” said Dr. Parnes.
The study is limited by its small patient population and retrospective design. The findings are limited to male military personnel, so they may not be generalizable to a wider patient population.
Dr. Parnes’ coauthors of Poster 440, “Primary Repair of Chronic Pectoralis Major Tears in Active Duty Military Patients,” are Hunter Czajkowski; Jeff Perrine, FNP-C; and Michael Joseph DeFranco, MD.
Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at firstname.lastname@example.org.