Pectoralis Major Rupture in Military Academy Athletes

BACKGROUND: Pectoralis major ruptures are rare injuries that can occur at several parts of the muscle. Little is known of the pathoanatomic process and performance following pectoralis major ruptures in young athletes. PURPOSE/HYPOTHESIS: The objective of this study was to describe a series of pectoralis major ruptures in military academy athletes at the US Military Academy and US Naval Academy. We hypothesized that military academy athletes will demonstrate a different rupture location than previously reported in older patients. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective case series was performed by analyzing all electronic medical records and imaging software for consecutive pectoralis major ruptures undergoing surgical repair within the student population at 2 military academies. The primary outcome of interest was rupture pattern and location. We also assessed functional recovery following surgery by analyzing push-up performance on the biannual Army Physical Fitness Test and Navy Physical Readiness Test. RESULTS: From 2005 to 2017, a total of 19 cases of pectoralis major ruptures occurred in military academy cadets. Patients ranged in age from 19 to 23 years, with a mean age of 20 years. All injuries occurred during sports activity, with bench press as the most common mechanism of injury (n = 10; 53%). The most common rupture location was the musculotendinous junction (n = 10; 53%), followed by pectoralis major tendon insertion (n = 8; 42%), and only 1 bony avulsion was noted. Physical activity performance following the rupture was negatively affected. The mean ± SD number of push-ups preinjury was 73.20 ± 12.10, which decreased following injury and surgery (66.50 ± 11.98; P = .037). CONCLUSION: Military academy athletes in our study cohort demonstrated a different type of rupture location than has been reported in older cohorts, with the majority experiencing tearing at a location other than the tendon itself. Performance was also negatively affected immediately following repair, but moderate improvement was observed as time from surgery increased.