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Mid-Term Complications and Re-operation Rates Following Pectoralis Major Tendon Repair in the Young Active Population

      Introduction

      We sought to determine the functional outcomes, complications, and reoperation rates in a cohort of young highly-active individuals undergoing pectoralis major repair.

      Methods

      All patients with pectoralis major rupture undergoing surgical repair were isolated from the Military Health System. Demographic variables, injury characteristics (e.g. location, mechanism, chronicity), and surgical technique were recorded. Self-reported pain scale (SRPS, i.e. 0-10), range of motion, and strength were tracked. Rates of complications, functional outcomes, return to duty, re-rupture, and re-operation were also recorded. Primary endpoints of interest included clinical failure (i.e. inability to return to military function), surgical failure, and presence of major or minor complications. Variables associated with failure were evaluated using t-test and chi-square univariate analysis.

      Results

      257 patients underwent pectoralis major repair with mean follow-up of 47.8±17.1 months(range: 24.1–89.5). The average age was 31.5±7.2 years and all patients were male. 89 (35%) patients were injured during combat deployments, and bench press was the predominant mechanism of injury(n=158;61.5%). Complete ruptures of sternocostal and clavicular heads occurred in 120(51%), and 109(50%) of the tears occurred at the myotendinous junction. Average SRPS improved from 3.1±1.5 to 0.5±1.1 at final follow-up. There were 45 minor complications (37 patients), most commonly persistent anterior shoulder pain (n=19;7%). 42 major complications occurred in 32 patients, including 15 re-ruptures in 14 patients (5.8%). 242 patients (94%) were able to return to full military duty and 34% of patients deployed after surgical repair. Insertional (36%) and myotendinous (36%) disruptions were associated with greater risk of surgical failure(p=0.0014), and myotendinous tears accounted for 54% of total failures(p=0.073). Furthermore, increasing body mass index and psychiatric comorbidity were associated with greater risk of clinical(p=0.0002; p=0.0169) and total failure(p=0.0097;p=0.016), respectively.

      Conclusion

      In the largest study to date, 94% of patients are able to return to full military duty after primary pectoralis major repair and 5.8% experience re-rupture.