Return to Functional Activity After Pectoralis Major Surgical Treatment: A Comprehensive Review

Pectoralis major is a strong, thick, and fan-shaped muscle that takes origination from the chest bone and medial part of the collarbone while passing to the arm; fibers converge in a U-shaped manner and insert onto the lateral lip of the bicipital groove of the humerus near the bicep tendon. The pectoralis major tendon is 3-5 cm thick and 40 mm wide. The pectoralis major tendon is powerful and useful for shoulder function; it plays a vital role in shoulder adduction and assists in internal rotation and humerus flexion. Injuries to the pectoralis major tendon are rare but are gaining popularity because of more competitive sports. Pectoralis major injuries are most commonly seen in men aged 20 to 40, particularly during weightlifting, but they can also occur in sports like wrestling, boxing, and water skiing. Considering the recently increased burden of pectoralis major rupture cases, mainly due to competitive sports activities, this study aims to provide hindsight on the ability of athletes to return to sports, work, and patient satisfaction postoperatively. This report closely adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting on systematic reviews. Computerized literature searches between 2014 and July 2024 were performed on Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane. PubMed indexing terms and functions, such as Boolean operators "AND" and "OR," were used to create search strings, combining synonyms, controlled vocabulary, and keywords. The following keywords were used: "pectoralis major," "repair," "outcome," and "complications". Studies returned from initial databases were independently reviewed by two reviewers. The articles were included as per the eligibility criteria listed above. Any discrepancies in the selection of the articles were resolved by a third reviewer. During the entire study selection, the references and texts were screened to exclude any overlapping participants. This review indicates that surgical repair of pectoralis major ruptures generally yields positive outcomes, with high return-to-sport rates and patient satisfaction. However, the lack of standardized definitions and postoperative protocols may contribute to inconsistencies across studies. Complications were rare, though they remain a consideration in surgical planning and patient counseling. The review highlights successful pectoralis major repair as achievable with various surgical techniques, especially tendon-to-bone fixation methods, contributing to promising rates of return to sport and work. The incidence of complications such as re-rupture, infection, and persistent weakness was reported as the total number of events along with the percentage of participants experiencing each complication.