Objectives: Outcomes following repair of the pectoralis major muscle (PMM) is often prone to the ceiling effect due to the high functional demand of those that sustain this injury. A thorough evaluation of return to exercise and sport is beneficial to set patient expectations. Methods: A prospectively maintained institutional database was retrospectively reviewed for all patients undergoing PMM repair since 2010 with minimum 24-month follow-up. Patients were surveyed over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell bench press, dumbbell bench press, dumbbell fly, and consecutive push-ups. American shoulder and elbow (ASES) and single assessment numeric evaluation (SANE) scores were also collected preoperatively and at final follow-up. Results: Forty-four patients (73.3%) were available for final follow-up. All patients were male. Mean follow-up was 51.1 ± 24.1 months. Mean age was 39.6 ± 8.8 and mean BMI was 28.6 ± 3.5. The dominant side was affected in 20/44 cases. The injury mechanism was reported to be during weightlifting in 59.1%, during sport in 20.5%, during work in 13.6%, and during accidental trauma in 6.8% of patients. There were statistically significant improvements in both ASES and SANE (p<0.001, respectively). Return to sport at any level was achieved by 43/44 (97.7%) patients, while 22/44 patients (50.0%) reported returning to sport at same or better intensity as pre-injury status. On average, there was a 23.3 ± 45.6% decrease in 1RM barbell bench press, 14.7 ± 62.3% decrease in 5RM barbell bench press, 24.3 ± 21.8% decrease in 1RM dumbbell bench press, 35.7 ± 32.1% decrease in 1RM dumbbell fly, and 15.6 ± 39.8% decrease in consecutive push-ups able to be performed (Figure 1). Seventeen patients (38.6%) reported degree of apprehension that affected their ability to lift weights. When accounting for all preoperative variables, history of surgery to the opposite shoulder (OR: 0.600, 95% CI: 0.389, 0.925) and acute repairs (OR: 0.745, 95% CI: 0.559, 0.993) were associated with decreased likelihood to return to sport at same or better level of intensity. Injury sustained during sport was associated with greater likelihood of returning to sport at same or better level (OR: 2.231, 95% CI: 0.389, 0.925) (Table 1). Conclusion: Patients undergoing repair of the PMM are expected to have significant improvements in function of the shoulder. Yet, roughly 50% achieve return to preoperative intensity of sport and there are significant reductions in ability to weightlift. Patients should be counseled to appropriately set expectation prior to surgery and rehabilitation. [Figure: see text][Table: see text]
Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-Analysis of Operative and Nonoperative Treatment