ShoulderAccuracy of magnetic resonance imaging in predicting the intraoperative tear characteristics of pectoralis major ruptures
Section snippets
Materials and methods
We performed a retrospective review of all patients undergoing surgical repair for pectoralis major tendon ruptures at our institution from 1997 to 2014. The inclusion criteria were an isolated primary pectoralis major injury, a preoperative MRI study, an operative note specifying the tear description according to the Tietjen classification,24 and available clinical records indicating clinical decision making of operative vs nonoperative management. Exclusion criteria included recurrent injury
Results
We identified 53 patients. All but 6 repairs were performed by upper extremity or sports medicine fellowship-trained surgeons with at least 3 years of experience. Thirty-six patients (all male) met the inclusion criteria. An incorrect shoulder protocol was used in 5 of the excluded patients, and the MRIs for 12 patients were deemed poor quality (premature humerus cutoff, motion artifact, or grainy quality).
Patients were an average age of 35.5 years (range, 19-59 years). The most common injury
Discussion
Pectoralis major ruptures are relatively uncommon injuries. Most published reports are case series with small sample sizes.12, 13, 17, 21, 25, 27 The 2 largest case series demonstrated the importance of early surgical treatment of these injuries.1, 8
Aärimaa et al1 retrospectively reviewed 33 patients undergoing operative treatment of complete or nearly complete pectoralis major ruptures, and good/excellent outcomes were achieved in 30 patients (91%). Subgroup analysis of this cohort revealed
Conclusion
Our data support the use of MRI in diagnosing the tear grade and location of pectoralis major tendon ruptures, particularly for acute, bone-tendon junction, and G3 tears. The diagnostic accuracy of MRI decreases when chronic tears are evaluated. MRI remains a useful adjunct in the diagnosis of pectoralis major ruptures and for guiding operative and nonoperative treatment.
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Cited by (0)
The University of Pittsburgh Institutional Review Board approved this study (IRB #PRO13040225).