Surgical Treatment of 40 Patients with Pectoralis Major Ruptures: Long-Term Outcomes

Abstract

The aim of the study — to develop a system for evaluation of treatment outcomes important for patients with pectoralis major ruptures. The system should include the outcome criteria that meet the patients’ expectations, and should allow the long-term outcomes evaluation. Material and Methods. The paper presents the long-term results of surgical treatment of 40 consecutive patients with pectoralis major ruptures. The results were evaluated in 65.3±17.5 months after surgery. Since pectoralis major rupture occurs mainly in people going in for sports at a quite high level (37 out of 40 people in our study), a new questionnaire was created for the results evaluation. In our opinion, the new set of questions takes into account the specific expectations for such category of patients and covers the important for them areas of treatment results. The already existing scales and questionnaires have been focused on assessing joint functions in patients with upper limb pathology in daily living conditions. Among the main areas of important results we identified the following items: restoration of sports activities, recovery of strength, absence of pain and discomfort, aesthetic results. Results. All the patients reported a complete absence of strength deficiency during everyday living activities. In 33 cases out of 37 the patients continued to go in for sports: at the same level — 18, with reduced load — 6, with improved results — 9. A subjective strength assessment in the patients continued exercising was in total 8.21±0.96. The outcomes in the group “improved results” (8.8±0.78) were better than in the group “at the same level” (8.1±0.96, p = 0.046) and in the group “reduced load” (7, 5±0.54, p = 0.0023). There were no differences between “improved results” and “reduced load” groups (p = 0.157). The reasons for the dynamics of sports results, which could be caused not only by the consequences of injury, were analyzed separately. The complete symmetry of the pectoralis muscles was achieved in 10 patients (25%), including 3 bodybuilders. In other cases, there remained a some degree asymmetry. The patients could notice it or ignore. We do not exclude the latent dissatisfaction of the patients with asymmetry, even when they report that it does not matter to them. Conclusion. The surgical treatment of pectoralis major tendon rupture allows the compete restoration of daily living activities. Although to that matter, these activities are practically preserved after the conservative treatment as well. The significance of the surgical treatment is in its ability to bring some additional benefits satisfying the patient’s other priorities: return to sport, maximum recovery of strength, aesthetic results. Our questionnaire don’t have a final point gradation, but allows to reflect the patient’s expectations, results and fears.