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Park N, Surucu S, Mahatme R, Kardestuncer K, Patel S, Jimenez A. Endoscopic Repair of Partial Gluteus Medius Tear: Staple Configuration With Suture Anchors. Arthrosc Tech 2024; 13:102929. [PMID: 38835474 PMCID: PMC11144733 DOI: 10.1016/j.eats.2024.102929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/23/2023] [Indexed: 06/06/2024] Open
Abstract
Tears of the gluteus medius and minimus have emerged as significant contributors to lateral hip pain and functional impairment. Surgical intervention reliably delivers pain alleviation and ability to return to activities. Nevertheless, conventional open procedures entail substantial incisions, extensive tissue damage, and protracted recovery. Endoscopic approaches have provided minimally invasive alternative strategies. This Technical Note details a method for addressing partial gluteus medius tears by recreating the hip abductor tendon insertion footprint and employing a bioinductive patch to promote wound healing.
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Affiliation(s)
- Nancy Park
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Serkan Surucu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Ronak Mahatme
- Department of Orthopedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | | | - Seema Patel
- Department of Orthopedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Andrew Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
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Ortiz-Declet V, Chen AW, Maldonado DR, Yuen LC, Mu B, Domb BG. Diagnostic accuracy of a new clinical test (resisted internal rotation) for detection of gluteus medius tears. J Hip Preserv Surg 2019; 6:398-405. [PMID: 32015892 PMCID: PMC6990389 DOI: 10.1093/jhps/hnz046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/23/2019] [Accepted: 10/03/2019] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination for detection of gluteus medius (GM) tears. A case group of 50 patients undergoing arthroscopy with GM repair was compared with a control group of 50 patients undergoing arthroscopy who had no peritrochanteric symptoms. Both groups were examined clinically, had magnetic resonance imaging studies performed and underwent arthroscopic surgery. Recorded clinical examinations included abnormal gait (Trendelenburg), tenderness to palpation of the greater trochanter, resisted abduction and the test being studied, resisted internal rotation. For all clinical tests, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rates were calculated and compared with the arthroscopic and MRI data for the case group, and the MRI data for the control group. The resisted internal rotation test had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 88% in the detection of GM tears, with a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of Trendelenburg gait, showed inferior rates. Trendelenburg gait had a higher specificity, but much lower sensitivity. The resisted internal rotation test aides in the detection of GM pathology. Due to the good results of the resisted internal rotation test in all the diagnostic parameters, we recommend incorporating it on the physical exam of patients with hip pain.
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Affiliation(s)
- Victor Ortiz-Declet
- Department of Orthopaedics, Kayal Orthopedics, 250 Old Hook Road, Westwood, NJ 07675, USA
| | - Austin W Chen
- Department of Orthopaedics, Boulder Center for Orthopedics, 4740 Pearl Parkway, Boulder, CO 80301, USA
| | - David R Maldonado
- Department of Orthopaedics, American Hip Institute, 999 E Touhy Ave Suite 450, Des Plaines, IL 60018, USA
| | - Leslie C Yuen
- Department of Medicine, Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Brian Mu
- Department of Medicine, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064, USA
| | - Benjamin G Domb
- Department of Orthopaedics, American Hip Institute, 999 E Touhy Ave Suite 450, Des Plaines, IL 60018, USA
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Seo KH, Lee JY, Yoon K, Do JG, Park HJ, Lee SY, Park YS, Lee YT. Long-term outcome of low-energy extracorporeal shockwave therapy on gluteal tendinopathy documented by magnetic resonance imaging. PLoS One 2018; 13:e0197460. [PMID: 30016333 PMCID: PMC6050036 DOI: 10.1371/journal.pone.0197460] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022] Open
Abstract
Background Previous outcome studies for extracorporeal shock wave therapy (ESWT) have included clinically diagnosed greater trochanteric pain syndrome (GTPS). The purpose of this study is to investigate outcome of ESWT on GTPS with gluteal tendinopathy documented by magnetic resonance imaging (MRI). Methods Medical records of 38 consecutive patients were retrospectively reviewed, who underwent ESWT for GTPS with MRI-documented gluteal tendinopathy (> 6 months). ESWT was conducted (1/week) when the Roles-Maudsley score (RMS) showed “Poor” or “Fair” grade after conservative treatment until RMS had reached “Good” or “Excellent” grade (treatment success) or until 12 treatments had been applied. Numeric rating scale (NRS) and RMS were evaluated before, 1 week after (immediate follow-up) and mean 27 months after ESWT program (long-term follow-up). Success rate was calculated at each follow-up point. Results Initial NRS (5.9 ± 1.6) significantly decreased at immediate (2.5 ± 1.5, p< 0.01) and long-term follow-up (3.3 ± 3.0, p< 0.01), respectively. Success rates were 83.3% (immediate) and 55.6% (long-term), respectively. There was no correlation among age, symptom duration and NRS. Conclusion Low-energy ESWT can be an effective treatment for pain relief in chronic GTPS with MRI-documented gluteal tendinopathy. However, its long-term effect appears to decrease with time.
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Affiliation(s)
- Kyoung-Ho Seo
- Department of Physical Medicine & Rehabilitation, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Joon-Youn Lee
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungjae Yoon
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Geol Do
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee-Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Sook Park
- Department of Physical & Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon-si, Gyeongsangnam-do, Republic of Korea
| | - Yong-Taek Lee
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: ,
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Lee JJ, Harrison JR, Boachie-Adjei K, Vargas E, Moley PJ. Platelet-Rich Plasma Injections With Needle Tenotomy for Gluteus Medius Tendinopathy: A Registry Study With Prospective Follow-up. Orthop J Sports Med 2016; 4:2325967116671692. [PMID: 27868077 PMCID: PMC5105294 DOI: 10.1177/2325967116671692] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Gluteal tendinopathy is a prevalent condition that can be associated with significant pain and disability. To date, no studies have prospectively assessed the efficacy of intratendinous platelet-rich plasma (PRP) injections as a minimally invasive treatment for gluteus medius tendinopathy. PURPOSE To prospectively assess the efficacy of intratendinous PRP injections as treatment for chronic recalcitrant gluteus medius tendinopathy. STUDY DESIGN Case series; Level of evidence, 4. METHODS During the study period between July 2011 and November 2015, data were collected from the Hospital for Special Surgery Center for Hip Preservation Outcomes Registry on participants who underwent ultrasound-guided intratendinous PRP injections for recalcitrant gluteus medius tendinosis and/or partial tears of the tendon associated with moderate to severe lateral hip pain for longer than 3 months. All participants were assessed pre- and postinjection with 4 outcome measures: modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living subscale (HOS-ADL), Hip Outcome Score-Sport-Specific subscale (HOS-Sport), and the International Hip Outcome Tool-33 (iHOT-33). Demographic data, including age, sex, height, weight, body mass index, and smoking status, were also collected. RESULTS A total of 21 patients were included in the study, with a mean follow-up of 19.7 months (range, 12.1-32.3 months). The mean improvements from preinjection to postinjection follow-up were 56.73 to 74.17 for mHHS, 68.93 to 84.14 for HOS-ADL, 45.54 to 66.72 for HOS-Sport, and 34.06 to 66.33 for iHOT-33. All mean outcome measure improvements were clinically and statistically significant (P < .001). Length of follow-up was positively correlated with improvements in HOS-ADL (P = .021) and HOS-Sport (P = .004) scores. No adverse events were observed during or after the procedure. CONCLUSION In this registry study with prospective follow-up, we found ultrasound-guided intratendinous PRP injections to be a safe and effective treatment option for chronic recalcitrant gluteus medius tendinopathy due to moderate to severe tendinosis and/or partial tendon tears. Well-powered randomized controlled studies are warranted to confirm our findings and further define the ideal candidates for this treatment.
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Affiliation(s)
- James J. Lee
- Hospital for Special Surgery, New York, New York, USA
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Results following repair of gluteus medius defects following total hip arthroplasty. Hip Int 2016; 21:293-8. [PMID: 21698577 DOI: 10.5301/hip.2011.8400] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2011] [Indexed: 02/04/2023]
Abstract
13 patients with tears in the gluteus medius tendon following total hip arthroplasty were studied. The diagnosis of a gluteal tear was made on the basis of clinical signs and a positive arthrogram of the hip in all cases. 11 patients underwent gluteus medius repair and two patients declined surgery. 10 patients attended a review clinic (eight gluteal repair patients and two conservatively managed patients) and three were reviewed by telephone and medical notes. The mean follow up was 61 months (range 12-116 months). The mean age at follow up was 71.42 years (69-79 years) and the male to female ratio was 5:8. The mean duration of symptoms prior to repair was 16 months. An anterolateral transgluteal approach had been used for primary surgery in nine cases and in four cases the original surgical approach was unknown. The mean Harris Hip score prior to repair was 77.4 (range 55-87), which improved to a mean post operative Harris hip score of 86.97 (range 79-96) following repair. The Oxford hip score prior to repair was 20 (range 16-25) which improved to a mean of 14.2 after repair (range 4-29). 9 out of 11 patients who had the repair were satisfied and would recommend the procedure. We believe an accurate and timely diagnosis together with repair can reduce the morbidity associated with this post-operative complication following THA.
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Lindner D, Shohat N, Botser I, Agar G, Domb BG. Clinical presentation and imaging results of patients with symptomatic gluteus medius tears. J Hip Preserv Surg 2015; 2:310-5. [PMID: 27011854 PMCID: PMC4765298 DOI: 10.1093/jhps/hnv035] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 03/10/2015] [Accepted: 04/26/2015] [Indexed: 11/25/2022] Open
Abstract
Greater trochanteric pain syndrome (GTPS) is a common complaint. Recently, it has become well recognized that tendinopathy and tears of the gluteus medius (GM) are a cause of recalcitrant GTPS. Nevertheless, the clinical syndrome associated with GM tears is not fully characterized. We characterize the clinical history, findings on physical examination, imaging and intraoperative findings associated with symptomatic GM tears. Forty-five patients (47 hips) who underwent GM repair for the diagnosis of tear were evaluated. Pain was estimated on the visual analog scale (VAS) and hip-specific scores were administered to assess functional status. The imaging modalities were reviewed and intra operative findings were recorded. The average patient age was 54 years (17–76), 93% were females. Symptom onset was commonly insidious (75%) and the average time to diagnosis was 28 months (2–240). The most common pain location was the lateral hip (75%). The average pre-surgery VAS and modified Harris Hip Score were 6.65 (0–10) and 55.5 (12–90), respectively. All patients had pathological findings on magnetic resonance angiogram (MRA) ranging from tendinosis to complete tears of the GM tendon. There was a discrepancy between MRA interpretation by a radiologist and findings during surgery. Hip abductor tears are an under-recognized cause of hip pain and hip symptomatology. In this study, we further characterize the clinical presentation of this entity. The data we present here may facilitate early diagnosis, early orthopedic care and avoid unnecessary prolonged patient sufferings.
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Affiliation(s)
- Dror Lindner
- 1. Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel; 2. American Hip Institute, Chicago, IL, USA
| | - Noam Shohat
- 1. Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Itamar Botser
- 3. Department of Orthopedics, Stanford University, Stanford, CA, USA
| | - Gabriel Agar
- 1. Department of Orthopedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Benjamin G Domb
- 2. American Hip Institute, Chicago, IL, USA; 4. Loyola University Stritch School of Medicine, Chicago, IL, USA; 5. Hinsdale Orthopedics, Hinsdale, IL, USA
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Outcomes after primary open or endoscopic abductor tendon repair in the hip: a systematic review of the literature. Arthroscopy 2015; 31:530-40. [PMID: 25442666 DOI: 10.1016/j.arthro.2014.09.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/12/2014] [Accepted: 09/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to systematically appraise the evidence on primary open and endoscopic abductor tendon repair. METHODS A systematic review of the literature was performed to (1) identify the demographic undergoing abductor tendon repair, (2) summarize the overall outcomes after primary surgical abductor tendon repair, (3) identify the type of tear most commonly encountered intraoperatively, (4) summarize the repair methods used, and (5) identify the published complication and tendon retear rates. RESULTS A total of 8 articles were identified as eligible for inclusion. All studies were Level IV Evidence. Of the patients undergoing surgical repair, 90% were women. As assessed by a variety of outcome measures, most patients reported good to excellent functional outcomes and pain reduction after open or endoscopic repair. Intraoperatively, tears of the gluteus medius and partial-thickness tears were encountered most often. Tears involving both the gluteus medius and minimus occurred 29% of the time. Complication rates were low for both the open and endoscopic approaches. No tendon retears were documented after endoscopic repair, whereas the retear rate after open repair was 9%. CONCLUSIONS Patients undergoing surgical repair for partial- and full-thickness tears are mostly women. Intraoperatively, tears almost always include the gluteus medius, with concomitant tearing of the gluteus minimus in approximately one-third of cases. Both open and endoscopic techniques are viable surgical approaches to repairing abductor tendon tears in the hip that produce good to excellent functional results and reduce pain; however, endoscopic repair appears to result in fewer postoperative complications including tendon retear. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Davies JF, Davies DM. Surgical Technique for the Repair of Tears to the Gluteus Medius and Minimus Tendons of the Hip. JBJS Essent Surg Tech 2014; 4:e11. [PMID: 30775118 DOI: 10.2106/jbjs.st.m.00072] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction We describe the surgical treatment of tears to the abductor tendons of the hip, which are typically progressive and can lead to recalcitrant pain and progressive weakness, leading to considerable difficulties with walking. Step 1 Perform the Exposure and Identify the Tear Place the patient in the lateral decubitus position, expose the lateral peritrochanteric space, and then identify the extent of the tear. Step 2 Mobilize the Tendons Mobilize the typically scarred-in tendons from the surrounding tissue to allow the tendon to be brought back down to the trochanter. Step 3 Prepare the Tendon and Greater Trochanter Debride the tendon, and lightly burr the greater trochanter to maximize the healing of the tendon to the bone. Step 4 Locate the Insertional Site of the Tendons and Place the Suture Anchors or Drill Holes Into This Site Identify the area of the footprint for each of the tendons; all suture anchors should be placed in the footprint, and the transosseous drill holes should straddle the near and far edges of the footprint. Step 5 Reattach the Tendons After all of the sutures are placed, tie them down, starting with the pull sutures first, to bring the tendon back to bone; then secure the tendon down with the simple sutures. Step 6 Reinforce Larger Tears Reinforce larger tears to protect them and aid in their healing. Step 7 Postoperative Protocol The postoperative protocol period consists of partial weight-bearing for specific periods of time, followed by vigorous physical therapy for strengthening and gait retraining. Results Surgical repair can improve function and reliably decreases pain in patients with a hip abductor tear.IndicationsContraindicationsPitfalls & Challenges.
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Affiliation(s)
- Joseph F Davies
- Aurora Advanced Orthopedics, 13328 Hawthorne Court, Milwaukee, WI 53097. E-mail address:
| | - Dana M Davies
- 2231 East Pratt Street, Apartment 3, Baltimore, MD 21231
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Acute calcific tendinitis of the gluteus medius: an uncommon source for back, buttock, and thigh pain. Semin Arthritis Rheum 2013; 43:824-9. [PMID: 24393625 DOI: 10.1016/j.semarthrit.2013.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 11/29/2013] [Accepted: 12/06/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was conducted to describe the imaging features and clinical manifestations in acute calcific tendinitis (CaT) of the gluteus medius muscle (GMe). METHODS A retrospective analysis was conducted, aimed at six patients with acute calcific tendinitis of the gluteus medius muscle (CaT-GMe), who were seen between January 2011 and December 2012. Clinical presentations, radiologic data (radiography, CT, and MRI), and laboratory reports were all subject to review. RESULTS All patients presented with pain and decreased range of motion (ROM) at the hip. Two of the six patients experienced pain in the anterolateral thigh and groin, with antalgic gait (anterior group). The other four complained of low back, buttock, and posterolateral thigh pain, accompanied by difficulty in standing and antalgic gait (posterior group). Edema within the GMe or effusion surrounding the muscle was regularly identified on MRIs. Calcific deposits were conspicuous in the gluteus medius tendon attachments to the lateral (anterior group) and superoposterior (posterior group) facets of the greater trochanter on radiography, CT, or MRI. Complete resolution of symptoms was uniformly achieved in 5-10 days with conservative management. CONCLUSIONS Acute CaT-GMe should be considered in any patient suffering lateral hip pain (with either groin or low back pain) and ROM limitation. Images of the hip characteristically show edema of the gluteus medius and calcifications lateral or superior to the greater trochanter.
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Woyski D, Olinger A, Wright B. Smaller insertion area and inefficient mechanics of the gluteus medius in females. Surg Radiol Anat 2013; 35:713-9. [DOI: 10.1007/s00276-013-1096-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
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A biomechanical comparison of repair techniques for complete gluteus medius tears. Arthroscopy 2012; 28:1410-6. [PMID: 22703870 DOI: 10.1016/j.arthro.2012.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the biomechanical fixation stability conferred by 2 specific arthroscopic repair techniques for complete gluteus medius tendon tears. METHODS Twelve fresh-frozen human cadaveric hemi-pelves were tested. Six received double-row repair with massive cuff stitches (DR-MCS), whereas the remaining 6 underwent double-row repair with knotless lateral anchors (DR-KLA). Constructs were preloaded to 10 N, tested from 10 N to 125 N at 90 N/s for 150 cycles, and then loaded to failure at 1 mm/s. Markers were placed on the tissue for video tracking. RESULTS No significant differences in cyclic outcomes were observed. The DR-KLA construct showed a significantly higher normalized yield load than the DR-MCS construct. Post-yield extension for the DR-MCS construct was significantly higher than that for the DR-KLA construct. At yield load, the optically measured soft-tissue elongation of the DR-KLA construct was significantly higher than that of the DR-MCS construct. CONCLUSIONS This study strongly suggests that the biomechanical stability conferred by DR-MCS and DR-KLA constructs for gluteus medius tendon repair is similar. Because the failure load of the DR-KLA construct is strongly correlated to bone mineral density (BMD), clinical considerations of bone quality may be particularly important for gluteus medius repairs. CLINICAL RELEVANCE Maximum load was strongly correlated to BMD in the DR-KLA group. On the basis of this analysis, BMD should be considered during surgical planning.
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El-Husseiny M, Patel S, Rayan F, Haddad F. Gluteus medius tears: an under-diagnosed pathology. Br J Hosp Med (Lond) 2011; 72:12-6. [DOI: 10.12968/hmed.2011.72.1.12] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Domb BG, Nasser RM, Botser IB. Partial-thickness tears of the gluteus medius: rationale and technique for trans-tendinous endoscopic repair. Arthroscopy 2010; 26:1697-705. [PMID: 20951538 DOI: 10.1016/j.arthro.2010.06.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 05/26/2010] [Accepted: 06/01/2010] [Indexed: 02/02/2023]
Abstract
Tears in the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis, have recently emerged as an important cause of recalcitrant greater trochanter pain syndrome. Advances in endoscopic surgery of the hip have created opportunities to better evaluate and treat pathology in the peritrochanteric compartment. We reviewed the literature on trochanteric pain syndrome and gluteus medius tendon injuries. Existing techniques for endoscopic and open gluteus tendon repair and potential challenges in restoration of abductor function were analyzed. Partial-thickness undersurface tears of the gluteus medius were identified as a common pathologic entity. Although these tears are otherwise analogous to partial-thickness tears of the rotator cuff, the lack of arthroscopic access to the deep side of the gluteus medius tendon represents a unique technical challenge. To address the difficulty in visualizing and thus repairing undersurface tears of the gluteus medius, a novel endoscopic trans-tendinous repair technique was developed. The purposes of this article are to review the anatomy, pathology, and existing repair techniques of gluteus medius tendon tears and to describe the rationale and surgical steps for endoscopic trans-tendinous repair.
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Affiliation(s)
- Benjamin G Domb
- Loyola University Stritch School of Medicine, Chicago, Illinois, USA.
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MR imaging changes in the trochanteric area of asymptomatic individuals: A potential for misdiagnosis of pain in the trochanteric region. Eur J Radiol 2009; 72:480-2. [DOI: 10.1016/j.ejrad.2008.07.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 11/22/2022]
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Furia JP, Rompe JD, Maffulli N. Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med 2009; 37:1806-13. [PMID: 19439756 DOI: 10.1177/0363546509333014] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Greater trochanteric pain syndrome is often a manifestation of underlying gluteal tendinopathy. Extracorporeal shock wave therapy is effective in numerous types of tendinopathies. HYPOTHESIS Shock wave therapy is an effective treatment for chronic greater trochanteric pain syndrome. STUDY DESIGN Case control study; Level of evidence, 3. METHODS Thirty-three patients with chronic greater trochanteric pain syndrome received low-energy shock wave therapy (2000 shocks; 4 bars of pressure, equal to 0.18 mJ/mm(2); total energy flux density, 360 mJ/mm(2)). Thirty-three patients with chronic greater trochanteric pain syndrome were not treated with shock wave therapy but received additional forms of nonoperative therapy (control). All shock wave therapy procedures were performed without anesthesia. Evaluation was by change in visual analog score, Harris hip score, and Roles and Maudsley score. RESULTS Mean pretreatment visual analog scores for the control and shock wave therapy groups were 8.5 and 8.5, respectively. One, 3, and 12 months after treatment, the mean visual analog score for the control and shock wave therapy groups were 7.6 and 5.1 (P < .001), 7 and 3.7 (P < .001), and 6.3 and 2.7 (P < .001), respectively. One, 3, and 12 months after treatment, mean Harris hip scores for the control and shock wave therapy groups were 54.4 and 69.8 (P < .001), 56.9 and 74.8 (P < .001), and 57.6 and 79.9 (P < .001), respectively. At final follow-up, the number of excellent, good, fair, and poor results for the shock wave therapy and control groups were 10 and 0 (P < .001), 16 and 12 (P < .001), 4 and 13 (P < .001), and 3 and 8 (P < .001), respectively. Chi-square analysis showed the percentage of patients with excellent (1) or good (2) Roles and Maudsley scores (ie, successful results) 12 months after treatment was statistically greater in the shock wave therapy than in the control group (P < .001). CONCLUSION Shock wave therapy is an effective treatment for greater trochanteric pain syndrome.
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Affiliation(s)
- John P Furia
- SUN Orthopedics and Sports Medicine, 900 Buffalo Road, Lewisburg, PA 17837, USA.
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Lequesne M, Djian P, Mathieu P, Vuillemin-Bodaghi V. Étude prospective des tendinobursites trochantériennes rebelles. Images IRM des ruptures tendineuses glutéales opérées. Résultats cliniques et IRM des sutures. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.rhum.2007.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lequesne M, Djian P, Vuillemin V, Mathieu P. Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair. Joint Bone Spine 2008; 75:458-64. [PMID: 18450496 DOI: 10.1016/j.jbspin.2007.12.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES (1) To compare MRI and surgical findings in patients with refractory greater trochanter pain syndrome and (2) to assess surgical outcomes. METHODS All consecutive patients seen between 2002 and 2006 by a single clinician were selected for surgical treatment according to the following criteria: (1) tendinopathy confirmed by physical tests; (2) painful disability persisting for at least 6 months despite treatment; (3) on MRI: area of high signal intensity on T2-weighted images, in the area of gluteus medius and/or minimus tendon; and (4) absence of marked muscle atrophy or fatty degeneration. Two musculoskeletal radiologists interpreted images by consensus. A single surgeon operated on all patients. RESULTS Eight patients met the criteria for surgery. All were women, aged 71.1 (SD: 9.4). Mean symptoms duration before surgery: 14.3 months (11.8). Surgery confirmed the presence of a tear of the lateral part of the gluteus medius tendon in all eight patients, with an associated tear of its main tendon in one patient, all tears revealed on MRI. An associated tear of the gluteus minimus tendon was present at surgery in five patients, of which three were not seen on MRI (false negative). Bursitis was confirmed in all eight patients. Steady complete remission of spontaneous and provoked (physical examination) pain was observed in seven patients and partial remission in one (mean follow-up: 22.4 months (SD: 16.3)). Six MRIs performed after 20+/-12 months showed good reinsertion of the sutured tendon. CONCLUSION The eight MR images of tear of the lateral part of the gluteus medius tendon were all confirmed at surgery. Three of five associated tendon tears (gluteus minimus only) were not seen on MRI. Surgical treatment was very effective in all patients but one.
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Affiliation(s)
- Michel Lequesne
- Rheumatology Department, Leopold-Bellan Hospital, 31-33 rue Guilleminot, 75014 Paris, France.
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Anatomy and dimensions of the gluteus medius tendon insertion. Arthroscopy 2008; 24:130-6. [PMID: 18237695 DOI: 10.1016/j.arthro.2007.11.015] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 11/03/2007] [Accepted: 11/25/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the area, dimensions, and orientation of the gluteus medius footprint to provide an improved understanding of its insertional anatomy. METHODS Eight fresh-frozen cadaveric hips were dissected, leaving only the most distal gluteus medius tendon attached to the greater trochanter. The tendon insertion footprint and proximal femur were digitized and mapped by use of 3-dimensional computer navigation software. The area, location, and dimensions of the tendon insertion were determined. RESULTS The gluteus medius tendon has 2 distinct insertion sites on the greater trochanter, the lateral facet and the superoposterior facet. The mean areas of insertion onto the lateral and superoposterior facets were 438.0 mm2 (SD, 57.7 mm2) and 196.5 mm2 (SD, 48.4 mm2), respectively. The lateral facet footprint had a mean longitudinal dimension of 34.8 mm (SD, 4.3 mm), was angled at a mean of 36.8 degrees (SD, 6.7 degrees ) relative to the long axis of the femur, and had a mean minimum width of 11.2 mm (SD, 1.8 mm). The superoposterior facet's shape approximated that of a circle, with a mean diameter of 17 mm (SD, 2.0 mm). CONCLUSIONS The gluteus medius tendon has 2 distinct and consistent insertion sites onto the greater trochanter. This information will provide surgeons with a better understanding of the footprint anatomy when evaluating gluteus medius tendon tears. CLINICAL RELEVANCE Gluteus medius tendon tears can be a source of significant pain and morbidity. This study describes the anatomic morphology of this tendon insertion, which should aid in its repair when necessary.
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Chebil M, Mezghani M, Kooli M, Zlitni M. Du diagnostic au traitement de la rupture de la coiffe de hanche : à propos d'un cas. ACTA ACUST UNITED AC 2007; 50:48-54. [PMID: 17098317 DOI: 10.1016/j.annrmp.2006.07.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 07/28/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To report a case of spontaneous gluteus medius tear repaired surgically in a 42-year-old woman patient without any other antecedent other than diabetes. PATIENT AND METHODS-RESULTS: Trochanteric pain evolving for 7 months led to scintigraphy objectifying a hyperfixation of the trochanter and ultrasonography showing an inflammatory gluteus medius tendon. These examinations were supplemented by magnetic resonance imaging and tomodensitometry visualising the tendon rupture but no marked fat degeneration of the muscle despite atrophy of this one. Surgical exploration confirmed the presence of a major rupture of the gluteus medius tendon, which was reinserted through an osseous trench. Rehabilitation involved protecting the tendon, by an installation of the member in abduction and passive mobilization from the third postoperative day, with a move to partial support on day 45. The result after 16 months was excellent, the patient returning to work 8 months after the surgery without any residual pain. CONCLUSION The spontaneous rupture of the gluteus medius, often ignored, can occur in young subjects and induce limited function, often well corrected by reinsertion surgery.
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Affiliation(s)
- M Chebil
- Service de rééducation fonctionnelle, complexe sanitaire Djebel-Oust-Zaghouan, Tunisie.
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