Mapping the Existing Return-to-Sport Criteria After Pectoralis Major Tendon Injury in Different Sports: A Scoping Review for Getting Back to the Game

Abstract

Context:

It is estimated that only 50% of athletes who sustain pectoralis major tendon injuries return to sport (RTS) despite successful treatment. This limited RTS rate may be due to absence of standardized RTS criteria for such patients. Evidence suggests a significant heterogeneity in RTS guidance across various studies, leading to inconsistency in clinical advice.

Objective:

To examine the existing RTS criteria used in pectoralis major tendon injury in different sporting populations.

Data Sources:

A comprehensive literature search with defined keywords was conducted in electronic databases including PubMed, Scopus, EBSCO (via CINAHL complete), Web of Science, Embase, and grey literature (e.g., Opengrey.com) to include studies published from inception until May 2024.

Study Selection:

Studies investigating the RTS outcome after pectoralis major injury managed surgically and/or conservatively in various sporting athletes were included. All studies included were in English language.

Study Design:

Scoping review.

Level of Evidence:

Level 4.

Data extraction:

Details of population age, sex, type of sports, injury mechanism (contact/noncontact), management technique, rehabilitation protocol, outcomes assessed, RTS criteria used, mean RTS duration, number of athletes returned to play, athletes reaching preinjury performance level, and re-injury rate were extracted.

Results:

The literature search identified 1707 studies; 39 studies were included for the final review. A total of 1129 injured athletes (1 female were recorded from the included studies with a mean age of 30.1 years. Regarding RTS criteria, no established criterion for this injury exists in the literature. Strength assessment, range of motion, functional outcomes, and pain were the measures used most in clearing the athlete to continue sport.

Conclusion:

Despite the increasing number of athletes sustaining this injury, current evidence reports marked variability in RTS recommendations, with no universally accepted or validated criteria identified. Therefore, for now, both objective and subjective parameters should be used to aid RTS decision making.