Biomechanical comparison of pectoralis major repair techniques: A systematic review and meta-regression

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Abstract
Background: There are many surgical techniques when repairing pectoralis major tears. However, there is no clear consensus on which repair technique is biomechanically superior. Our purpose was to perform a systematic review and meta-regression to evaluate the most biomechanically superior pectoralis major repair technique. Methods: We performed a systematic review and meta-regression of six human cadaveric biomechanical studies evaluating fixation techniques for pectoralis major repairs. The primary outcome was the ultimate failure load. Covariates included cadaveric age, bone mineral density, implants, suture, and stitch method. Meta-regression accounted for differences in variables. Results: Compared with Krackow/Bunnell stitch method, the modified Mason–Allen stitch demonstrated a decrease in ultimate failure load by 220.6 N (95% CI, −273.0 to −168.2; p = <0.001). No differences were found between Krackow/Bunnell and whipstitch. There was an increase in ultimate failure load when utilizing suture tape by 206.6 N (95% CI, 139.5–273.7, p < 0.001). Suture anchors had a decrease in ultimate failure load by 88.1 N (95% CI, −153.4 to −22.8, p = 0.008) when compared to transosseous sutures. No differences were found between transosseous sutures and unicortical buttons. Discussion: We found the combination of suture tape in a whipstitch or Krackow/Bunnell stitch utilizing transosseous sutures or unicortical buttons is the most biomechanically superior construct for pectoralis major repairs.

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