Bak and colleagues pooled published pectoralis major ruptures with four of their own cases to examine cause, rupture site and mechanism, and what determined treatment outcome.
Meta‑analysis of 112 cases: 108 of about 150 published cases with usable data, plus 4 treated by the authors.
Methods
Design
Meta‑analysis of published cases plus the authors' own cases
Pooled case reports and two series, and the authors note successes are more likely to be published than failures
Search
Literature from 1941 to the end of 1998, about 150 reported cases
Included
108 literature cases with enough data for analysis
4 of the authors' own cases
Reports had to give age, sex, mechanism, injury setting, rupture type and location, treatment and outcome
Population
112 patients, all men
Median age 28 (range 16 to 67)
87 injured in sport and 17 at work
Comparison
Surgical vs conservative treatment
Surgery within 8 weeks vs surgery at 9 to 52 weeks
Outcomes
Treatment outcome by treatment type and timing
Outcome by rupture site and patient age
Key Findings
Surgical repair produced an excellent or good result in 88% of cases vs 27% with conservative treatment (p = 0.003), among 57 surgical and 15 conservative cases with outcome data.
When 9 delayed repairs after failed conservative care were counted as conservative failures, 90% of primary repairs vs 17% of conservative cases were excellent or good (p < 0.00000001).
Repair within 8 weeks gave more excellent results than later repair (26 of 45 vs 2 of 12, p = 0.01), although excellent or good results occurred in 40 of 45 vs 10 of 12.
Of 86 ruptures verified at surgery, 78 were complete, 56 were tendon avulsions at the humeral insertion and 21 were at the musculotendinous junction.
Outcome did not differ by rupture site, and the younger age of patients with excellent results did not reach significance (p = 0.07 and 0.08).
Musculotendinous junction ruptures were more frequent in work injuries (41%) than in sports injuries (31%), but the difference was not significant (p = 0.42).
Board pearl
Every reported pectoralis major rupture occurred in a man, most often during weight training, competitive lifting or wrestling with the arm abducted and externally rotated.
Authors' conclusion
Surgical treatment, preferably within the first 8 weeks after the injury, has a significantly better outcome than conservative treatment or delayed repair.
Bak and colleagues pooled published pectoralis major ruptures with four of their own cases to examine cause, rupture site and mechanism, and what determined treatment outcome.
Meta‑analysis of 112 cases: 108 of about 150 published cases with usable data, plus 4 treated by the authors.
Methods
Design
Meta‑analysis of published cases plus the authors' own cases
Pooled case reports and two series, and the authors note successes are more likely to be published than failures
Search
Literature from 1941 to the end of 1998, about 150 reported cases
Included
108 literature cases with enough data for analysis
4 of the authors' own cases
Reports had to give age, sex, mechanism, injury setting, rupture type and location, treatment and outcome
Population
112 patients, all men
Median age 28 (range 16 to 67)
87 injured in sport and 17 at work
Comparison
Surgical vs conservative treatment
Surgery within 8 weeks vs surgery at 9 to 52 weeks
Outcomes
Treatment outcome by treatment type and timing
Outcome by rupture site and patient age
Key Findings
Surgical repair produced an excellent or good result in 88% of cases vs 27% with conservative treatment (p = 0.003), among 57 surgical and 15 conservative cases with outcome data.
When 9 delayed repairs after failed conservative care were counted as conservative failures, 90% of primary repairs vs 17% of conservative cases were excellent or good (p < 0.00000001).
Repair within 8 weeks gave more excellent results than later repair (26 of 45 vs 2 of 12, p = 0.01), although excellent or good results occurred in 40 of 45 vs 10 of 12.
Of 86 ruptures verified at surgery, 78 were complete, 56 were tendon avulsions at the humeral insertion and 21 were at the musculotendinous junction.
Outcome did not differ by rupture site, and the younger age of patients with excellent results did not reach significance (p = 0.07 and 0.08).
Musculotendinous junction ruptures were more frequent in work injuries (41%) than in sports injuries (31%), but the difference was not significant (p = 0.42).
Board pearl
Every reported pectoralis major rupture occurred in a man, most often during weight training, competitive lifting or wrestling with the arm abducted and externally rotated.
Authors' conclusion
Surgical treatment, preferably within the first 8 weeks after the injury, has a significantly better outcome than conservative treatment or delayed repair.