Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-analysis of Operative and Nonoperative Treatment.

Autor:	Bodendorfer BM; Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA., McCormick BP; Georgetown University School of Medicine, Washington, DC, USA., Wang DX; Georgetown University School of Medicine, Washington, DC, USA., Looney AM; Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA., Conroy CM; Georgetown University School of Medicine, Washington, DC, USA., Fryar CM; Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, USA., Kotler JA; Bone & Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA., Ferris WJ; Georgetown University School of Medicine, Washington, DC, USA., Postma WF; Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA., Chang ES; Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, USA.
Jazyk:	angličtina
Zdroj:	Orthopaedic journal of sports medicine [Orthop J Sports Med] 2020 Feb 06; Vol. 8 (2), pp. 2325967119900813. Date of Electronic Publication: 2020 Feb 06 (Print Publication: 2020).
DOI:	10.1177/2325967119900813
Abstrakt:	Background: The incidence of pectoralis major tendon tears is increasing, and repair is generally considered; however, a paucity of comparative data are available to demonstrate the superiority of operative treatment. Purpose/hypothesis: The purpose of this study is to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared with nonoperative treatment. Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of the literature was completed by use of MEDLINE, SPORTDiscus, CINAHL, Cochrane, EMBASE, and Web of Science databases. We included English-language studies that had a minimum of 6 months of average follow-up and 5 cases per study. The MINORS (Methodological Index for Non-Randomized Studies) was used to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect sizes were calculated from random-effects models. Continuous variables were assessed by use of mixed-model analysis, with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data were transformed via the Freeman-Tukey log-linear transformation for variance stabilization and then assessed through use of a mixed model with a study level random effect and subsequently back-transformed. Significance was set at P < .05. Results: A total of 23 articles with 664 injuries met the inclusion criteria for comparison. All patients were male, with an average age of 31.48 years; 63.2% of injuries occurred during weight training, and the average follow-up was 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment, with relative improvements of functional outcome by 23.33% (0.70 improvement by Bak criteria which is scored 1-4; P = .027), full isometric strength 77.07% ( P < .001), isokinetic strength 28.86% ( P < .001) compared with the uninjured arm, cosmesis satisfaction 13.79% ( P = .037), and resting deformity 98.85% ( P < .001). The overall complication rate for operative treatment was 14.21%, including a 3.08% rate of rerupture. Conclusion: Pectoralis major tendon repair resulted in significantly superior outcomes compared with nonoperative treatment, with an associated 14.21% complication rate. Statistically significant improvements were noted in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: W.F.P. has received educational support from Arthrex and hospitality payments from Smith & Nephew. E.S.C. has received educational support from Arthrex, Smith & Nephew, and Supreme Orthopedic Systems. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. (© The Author(s) 2020.)
Databáze:	MEDLINE
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