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Pectoralis Major Reconstruction in Athletes

Authors: L Funk, R Badge, K Roney

References: The Annual Meeting of the Israel Society of Sports Medicine. 11-12 June 2008.

Pectoralis major is one of the most common tendon ruptures in strength-training athletes. The reported incidence is increasing. The single most common cause of rupture of the
pectoralis major muscle has been the bench press exercise, with 29% of the reported cases citing it as the  cause. Injury to the pectoralis major muscle is usually caused by a sudden forceful overload of the maximally contracted muscle.

Most patients are able to return to normal activities of daily living without surgical repair, but non-operative treatment has been shown to lead to significant loss of strength of adduction in flexion. Isokinetic testing has shown that strength returns to 99% of that of the uninjured side in patients treated surgically versus only 56% in patients treated non-operatively [Hanna, 2001].

Studies have shown that patients who have had their pectoralis major muscle repaired had fewer problems with pain, had subjective and objective improvement in strength, and were happier with their outcome when compared with patients who had not had a repair [Schepsis, 2000; Bak, 2000]. A meta-analysis of the literature on pectoralis major muscle injuries revealed that patients repaired surgically had 88% excellent or good results compared with 27% for patients treated non-operatively [Bak, 2000]. Bak et al. conclude "" If the cases reported in the literature over the past 20 years are representative of the typical pectoralis muscle rupture, there seems to be no indication for non-surgical management of this lesion."

There seems to be no difference if the rupture is repaired immediately or several months after the injury [Kretler, 1989; Verfaille, 1996; Wolfe, 1992; Schepsis, 2000], although some studies do show better results if the repair is performed within 8 weeks of the injury.

There are many published repair techniques, including bone sutures, screws, staples and suture anchors. All have had good results. The development in suture technology and suture anchors has led to high strength sutures and anchors with properties that enhance healing.

We have reviewed our results of repairs performed over a three-year period.
In this presentation, we will present our technique using modern materials, accelerated rehabilitation program and results in weight training strength athletes.  


References:
• Kretzler HH Jr, Richardson AB: Rupture of the pectoralis major muscle. Am J Sports Med 17: 453-458, 1989
• Verfaille SM, Claes T: Bony avulsion of the pectoralis major muscle. J Shoulder Elbow Surg 5: 327-329, 1996
• Wolfe SW, Wickiewicz TL, Cavanaugh JT: Ruptures of the pectoralis major muscle: An anatomic and clinical analysis. Am J Sports Med 20: 587-593, 1992
• Hanna CM, Glenny AB, Stanley SN, Caughey MA: Pectoralis major tears: Comparison of surgical and conservative treatment. Br J Sports Med 2001;35: 202-206.
• Bak K, Cameron EA, Henderson IJ: Rupture of the pectoralis major: A metaanalysis of 112 cases. Knee Surg Sports Traumatol Arthrosc 2000;8:113-119.

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