Everything pectoralis major: from repair to transfer

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Anatomy

Background:

• Pectoralis major ruptures are increasingly diagnosed in young males due to heightened activity and anabolic steroid use.
• Both acute and chronic pectoralis major ruptures necessitate understanding for effective management.
• Unrecognized chronic ruptures can lead to deformity and functional disability if untreated.

Purpose of the Study:

• To review the diagnosis and management of acute and chronic pectoralis major ruptures.
• To outline indications for nonoperative and operative treatment strategies.
• To enhance reader comprehension of pectoralis major rupture management.

Main Methods:

• Systematic literature review using electronic databases.
• Inclusion of case reports, systematic reviews, and prospective/retrospective studies.
• Search terms included 'pectoralis major rupture,' 'repair,' 'tendon transfer,' and 'nonoperative treatment.'

Main Results:

• Nonoperative treatment is suitable for patients with comorbidities, older age, incomplete tears, or irreparable damage, often resulting in strength loss but full range of motion.
• Surgical repair before 6 weeks post-injury shows superior outcomes compared to later repairs (6-8 weeks).
• Delayed repairs (>8 weeks) may require grafts (autograft/allograft) and yield better strength and satisfaction than nonoperative care.

Conclusions:

• Nonoperative management is reserved for specific patient groups and injury severities.
• Early surgical intervention for pectoralis major ruptures is associated with improved functional outcomes.
• Pectoralis tendon transfer is an option for specific cases with rotator cuff issues, though outcomes can be variable.