title: Outcomes Following Suture-Anchor Repair of Pectoralis Major Tears: A Case Series and Review of the Literature.
abstract: BACKGROUND
  Rupture of the pectoralis major muscle (PMM) is an uncommon injury that occurs during physical exercise and high-impact contact sports; it may result in pain, weakness, and disability. Surgical repair is currently the preferred treatment of PMM rupture. Our study assesses subjective and functional outcomes of patients following repair of acute and chronic PMM ruptures.
  
  
  METHODS
  Retrospective review identified twenty patients who underwent PMM repair by the senior author (BRW) between 2003 and 2011. Injury and surgical data was reviewed for all 20 patients. Six patients were assessed minimum 1-year post operatively for clinical outcomes, (SF-36, DASH, and ASES), physical exam (ROM & cosmesis), and Cybex isokinetic strength testing.
  
  
  RESULTS
  All patients were men with an average age of 30 years (range 20-55) at time of injury. The average time from injury to surgical repair was 3.8 months (range <1-28 months), and average follow up was 16.5 months (range 0-99). The majority of patients suffered injury while bench pressing (12/20; 60%) or wrestling (3/20; 15%). The most common intra-operative findings were partial sternal tears (9/20; 45%) followed by complete sternal tears (4/20; 20%). Six (30%) of twenty patients consented for on-site follow-up and clinical assessment. Average preoperative physical component scores from SF-36 improved from 43 (range 37.8-52.7) to 53.1 (range 48.1-55.8) at follow up. Average preoperative DASH scores decreased from 74 points (range 68.7-83.3) to 5.3 points (range 1.7-8.3) at follow-up. Average pre-operative ASES scores improved from 82.8 points (range 71.7-96.7) to 96.7 points (range 91.7-98.3) at follow up. Average isokinetic strength deficiency in horizontal adduction at 60°/s was 15% (range 16%-29%) and average at 120°/s was 9% (range 2%-21%). According to the Bak criteria, overall results were excellent in two patients (33%), good in two (33%), while two (33%) had a fair result.
  
  
  CONCLUSIONS
  Surgical repair of PMM rupture by suture anchor fixation provides high patient satisfaction and predictable return of strength, cosmesis, and overall function. Suture anchor fixation produced similar clinical outcomes and return of strength when compared to other surgical repair methods. Our results demonstrate isokinetic strength deficiency similar to historical results.
  
  
  METHODS
  Level 4: Retrospective Case Series.
authors.affiliation: University of Iowa Hospitals and Clinics , Iowa City, IA , USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Mooers
authors.affiliation: University of Iowa Hospitals and Clinics , Iowa City, IA , USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Westermann
authors.affiliation: University of Iowa Hospitals and Clinics , Iowa City, IA , USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wolf
mesh_terms: D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D010147:Pain Measurement; D010369:Pectoralis Muscles / Q000293:injuries* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012421:Rupture / Q000601:surgery; D012494:Sampling Studies; D053441:Suture Anchors; D016896:Treatment Outcome; D055815:Young Adult