1
|
Jackson TJ. Editorial Commentary: Endoscopic Repair of Abductor Tendon Tears Results in Variable Patient Reported Outcomes and Generally Good to Excellent Results. Arthroscopy 2024; 40:2307-2308. [PMID: 38431028 DOI: 10.1016/j.arthro.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
Abductor tendon pathology is fairly common, with up to a 25% incidence in patients having total hip arthroplasty and 30% having hip arthroscopy. A systematic review of endoscopic abductor tendon repair demonstrated that as few as 41% of patients with endoscopic repair of abductor tendon tears achieve a patient acceptable satisfactory state, but a major limitation of systematic reviews is extreme heterogeneity between included studies. Surgical techniques and skills differ, as do tear severity and confounding pathology such as labral tears. Another limitation is a focus on patient-reported outcome measures (PROMs). PROMs are important (we prefer happy patients with poor healing to unhappy patients with healed repairs), but PROMs are also "subjective," and different cohorts of patients in different studies from different locations may have different perceptions or goals with regard to pain and function. As surgeons, we are able to observe gait, strength, and, with advanced imaging when indicated or for research purposes, healing. These, combined with PROMs, influence overall assessment of outcome. Experience and review of the literature show that endoscopic surgical repair of abductor tendon tears generally shows good or excellent results. If a patient has significant pain improvement and objectively improved gait, a calculation of an outcome threshold based on a subjective survey may not tell the full story.
Collapse
|
2
|
Akhtar M, Razick D, Aamer S, Baig O, Dhaliwal A, Kamran K, Asad S, Shelton T. Forty-One to 75% of Patients Achieve a Patient Acceptable Symptomatic State After Endoscopic Repair of Hip Abductor Tendon Tears: A Systematic Review. Arthroscopy 2024; 40:2292-2306. [PMID: 38185183 DOI: 10.1016/j.arthro.2024.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/01/2023] [Accepted: 01/01/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE To systematically review clinical and functional outcomes of endoscopic repairs of hip abductor tendon tears. METHODS A search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed in the PubMed, Embase, and Cochrane databases using variations of the terms "endoscopy," "gluteus medius," "hip abductor," "outcome," "success," and "failure." Data for patient demographics, tear severity and location, patient-reported outcomes (PROs), clinical benefit, and rates of retears and revision surgery were collected and tabulated. Forest plots depicting preoperative versus postoperative PROs were generated. Quality assessment was performed using the modified Coleman Methodology Score. RESULTS In total, 13 studies, 3 Level III and 10 Level IV, were included in this review, with a total of 272 patients whose ages ranged from 46.0 to 66.9 years and follow-up times from 16.4 to 46.7 months. Most tears were isolated to the gluteus medius, with the number of partial- versus full-thickness tears being similar. Trendelenburg gait, reported by 4 studies, persisted in 0% to 13.6% of patients after repair. Of 9 studies reporting both preoperative and postoperative PROs at latest follow-up, 8 reported significant improvements in all PROs (P < .05). In 5 studies, rates of achieving minimal clinically important difference and patient-acceptable symptomatic state ranged from 50.0% to 93.3% and 40.7% to 75.0%, respectively. Surgical complication rates were 0% in 11 studies and 4.3% and 18.2% in 2 studies. Retear rates were 0% in 10 studies and ranged from 6.7% to 33.3% in 3 studies. Rates of revision due to retear, reported by 12 studies, were 0% in 8 studies and ranged from 2.2% to 13.0% in 4studies. CONCLUSIONS Endoscopic repairs of both partial- and full-thickness hip abductor tendon tears have good-to-excellent PROs and low complication, retear, and revision rates. However, rates of minimal clinically important difference and patient-acceptable symptomatic state achievement rates are highly variable and less than favorable. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Muzammil Akhtar
- California Northstate University College of Medicine, Elk Grove, California, U.S.A..
| | - Daniel Razick
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Sonia Aamer
- Southern California Orthopedic Institute, Bakersfield California, U.S.A
| | - Osamah Baig
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, U.S.A
| | - Anand Dhaliwal
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Khizur Kamran
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Shaheryar Asad
- California Northstate University College of Medicine, Elk Grove, California, U.S.A
| | - Trevor Shelton
- Utah Valley Orthopedics and Sports Medicine, Intermountain Health, Utah, U.S.A
| |
Collapse
|
3
|
Rice MW, Browning RB, Fenn TW, Hevesi M, Nho SJ. Defining the Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) at 2 years following open gluteus medius and/or minimus repair. J Hip Preserv Surg 2024; 11:92-97. [PMID: 39070207 PMCID: PMC11272634 DOI: 10.1093/jhps/hnad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/04/2023] [Accepted: 06/14/2023] [Indexed: 07/30/2024] Open
Abstract
To define Minimally Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) threshold scores after open gluteus medius and/or minimus repair. Primary open gluteus medius and/or minimus repair patients from November 2013 to March 2020 were identified. Patient reported outcomes (PROs) were assessed preoperatively, 1- and 2-year follow-up, including the Hip Outcome Score Activities of Daily Living (HOS-ADL), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12) and Visual Analog Scale (VAS) Pain. Thresholds for achieving a MCID and PASS postoperatively were calculated using the distribution method and receiver operator curve analysis; 25 patients (24 females, 1 male, age: 69 ± 6.8 years, body mass index: 26.9 ± 5.0 kg/m2) were included in final analyses. MCID threshold scores for HOS-ADL, mHHS, iHOT-12 and VAS Pain were calculated as 11.1, 6.2, 15.3 and 14.0, respectively. PASS threshold scores for each of the PROs were as follows: HOS-ADL (71.9), mHHS (60.0), iHOT-12 (49.2) and VAS Pain (36.8). MCID thresholds for HOS-ADL, mHHS, iHOT-12 and VAS Pain were achieved by 58.3%, 83.3%, 66.7% and 57.1% of patients, respectively. PASS thresholds for HOS-ADL, mHHS, iHOT-12 and VAS Pain were achieved by 52.4%, 44.8%, 65% and 59.1% of patients, respectively. Open gluteus medius and/or minimus repair results in a high rate of achievement of clinically significant outcomes at a minimum of 2 years postoperatively. MCID threshold values for HOS-ADL, mHHS, iHOT-12 and VAS Pain were 11.1, 6.2, 15.3 and 14.0, respectively. PASS threshold values for HOS-ADL, mHHS, iHOT-12 and VAS Pain were 71.9, 60.0, 49.2 and 36.8, respectively. The majority of patients achieved clinically significant outcomes with 81.3% and 77.3% achieving MCID and PASS for at least one PRO, respectively.
Collapse
Affiliation(s)
- Morgan W Rice
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, United States
| | - Robert B Browning
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, United States
| | - Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, United States
| | - Mario Hevesi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, United States
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, 1611 W. Harrison St., Chicago, IL 60612, United States
| |
Collapse
|
4
|
Morgan A, Moore M, Derry K, Bi A, Brown J, Youm T, Kaplan D. Surgical Treatment and Outcomes for Gluteal Tendon Tears. Curr Rev Musculoskelet Med 2024; 17:157-170. [PMID: 38619805 DOI: 10.1007/s12178-024-09896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE OF REVIEW Gluteus medius and minimus tears, or hip abductor tendon tears, are increasingly identified as a source of lateral hip pain. Once underappreciated and undertreated, they are now recognized as a cause of greater trochanteric pain syndrome and a pathology amenable to both nonoperative and operative modalities. This review summarizes relevant anatomy, clinical presentation, and treatment options for gluteus medius tears, focusing on surgical options. RECENT FINDINGS When surgical intervention is indicated, repair, reconstruction, or tendon transfer may be considered. Open and endoscopic repair techniques demonstrate similar outcomes with improvements in patient-reported outcomes and low complication and retear rates for both partial and full thickness tears. Variations in fixation construct and graft augmentations have been described, though clinical evidence remains limited to support specific techniques. Gluteus maximus transfer via open approach is a salvage option for the severely atrophied, retracted, or revision gluteus tendon; however, persistent limitations in abduction strength and gait abnormalities are common. Emerging evidence continues to evolve our understanding of surgical decision-making for gluteus tendon tears. The current literature supports either open or endoscopic repair techniques and open tendon transfer as a salvAage option. Further study is needed to determine the optimal fixation construct, the role of graft augmentation, and patient-related factors that influence postoperative outcomes.
Collapse
Affiliation(s)
- Allison Morgan
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Michael Moore
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Kendall Derry
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Andrew Bi
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Jahnya Brown
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Thomas Youm
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Daniel Kaplan
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA.
| |
Collapse
|
5
|
Song BM, Inclan PM, Kuhn AW, Stronach BM, Pascual-Garrido C. Gluteus Maximus Transfer for Irreparable Hip Abductor Deficiency: A Systematic Review and Meta-Analysis. J Arthroplasty 2024; 39:1117-1124.e1. [PMID: 37879422 DOI: 10.1016/j.arth.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Gluteus maximus tendon transfer has recently been described as a treatment option for irreparable abductor tendon tears. The purpose of this study was to systematically review outcomes following gluteus maximus tendon transfer for hip abductor deficiency. METHODS The published literature was queried for outcomes following gluteus maximus transfer in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcomes of interest included preoperative and postoperative functional scores, resolution of pain and gait abnormalities, postoperative rehabilitation protocols, surgical complications, reoperation rates, and postoperative magnetic resonance imaging. In total, 10 studies with a total of 125 patients (76% women) with a mean age of 67 years (range, 30 to 87) were identified for inclusion. RESULTS Modified Harris Hip Score (+30.1 ± 6.6 [95% confidence interval: +15.5 to +46.5]) and Visual Analog Scale for pain (-4.1 ± 1.1 [95% confidence interval: -7.1 to -1.0]) were improved following gluteus maximus transfer, compared to preoperative levels. No significant improvement was noted in abduction strength and 33% of patients demonstrated a residual Trendelenburg gait postoperatively. The overall complication rate was 5.6% (7 of 125), with a reoperation rate of 1.6% (2 of 125). CONCLUSIONS Gluteus maximus tendon transfer for abductor insufficiency has demonstrated reliable outcomes at 3 years, with improvement in hip function and pain. However, patients demonstrate modest improvements in abduction strength, and a significant subset will continue to demonstrate a Trendelenburg gait postoperatively.
Collapse
Affiliation(s)
- Bryant M Song
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Paul M Inclan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew W Kuhn
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
6
|
Allahabadi S, Chapman RS, Fenn TW, Browning RB, Nho SJ. The Gluteus-Score-7 Predicts the Likelihood of Both Clinical Success and Failure Following Surgical Repair of the Hip Gluteus Medius and/or Minimus. Arthroscopy 2024; 40:343-351.e4. [PMID: 37207918 DOI: 10.1016/j.arthro.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/20/2023] [Accepted: 03/19/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE To identify patient preoperative history, examination, and imaging characteristics that increase the risk of postoperative failure of gluteus medius/minimus repair, and to develop a decision-making aid predictive of clinical outcomes for patients undergoing gluteus medius/minimus repair. METHODS Patients from 2012 to 2020 at a single institution undergoing gluteus medius/minimus repair with minimum 2-year follow-up were identified. MRIs were graded according to the "three-grade" classification system: grade 1: partial-thickness tear, grade 2: full-thickness tears with <2 cm of retraction, grade 3: full-thickness tears with ≥2 cm retraction. Failure was defined as undergoing revision within 2 years postoperatively or not achieving both a cohort-calculated minimal clinically important difference (MCID) and responding "no" to patient acceptable symptom state (PASS). Inversely, success was defined as reaching both an MCID and responding "yes" to PASS. Predictors of failure were verified on logistic regression and a predictive scoring model, the Gluteus-Score-7, was generated to guide treatment-decision making. RESULTS In total, 30 of 142 patients (21.1%) were clinical failures at mean ± SD follow-up of 27.0 ± 5.2 months. Preoperative smoking (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.0-8.4; P = .041), lower back pain (OR, 2.8; 95% CI, 1.1-7.3; P = .038), presence of a limp or Trendelenburg gait (OR, 3.8; 95% CI, 1.5-10.2; P = .006), history of psychiatric diagnosis (OR, 3.7; 95% CI, 1.3-10.8; P = .014), and increased MRI classification grades (P ≤ .042) were independent predictors of failure. The Gluteus-Score-7 was generated with each history/examination predictor assigned 1 point and MRI classes assigned corresponding 1-3 points (min 1, max 7 score). A score of ≥4/7 points was associated with risk of failure and a score ≤2/7 points was associated with clinical success. CONCLUSIONS Independent risk factors for revision or not achieving either MCID or PASS after gluteus medius and/or minimus tendon repair include smoking, preoperative lower back pain, psychiatric history, Trendelenburg gait, and full-thickness tears, especially tears with ≥2 cm retraction. The Gluteus-Score-7 tool incorporating these factors can identify patients at risk of both surgical treatment failure and success, which may be useful for clinical decision-making. LEVEL OF EVIDENCE Level IV, prognostic case series.
Collapse
Affiliation(s)
- Sachin Allahabadi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Reagan S Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Robert B Browning
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
7
|
Inclan PM, Schwabe MT, Song BM, Kuhn AW, Layon DR, Clohisy JC, Pascual-Garrido C. Gluteus Maximus Transfer for Hip Abductor Deficiency. Arthrosc Tech 2023; 12:e671-e676. [PMID: 37323779 PMCID: PMC10265475 DOI: 10.1016/j.eats.2023.01.002] [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: 10/17/2022] [Accepted: 01/18/2023] [Indexed: 06/17/2023] Open
Abstract
Hip abductor deficiency resulting from gluteus medius and minimus pathology is increasingly recognized as a generator of lateral-sided hip pain. In the setting of a failed gluteus medius repair or in patients with irreparable tears, transfer of the anterior portion of the gluteus maximus muscle can be performed to treat gluteal abductor deficiency. The classic description of the gluteus maximus transfer technique relies solely on bone tunnel fixation. This article describes a reproducible technique that incorporates the addition of a distal row to the tendon transfer, which may improve fixation by both compressing the tendon transfer to the greater trochanter and providing improved biomechanical strength to the transfer.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Cecilia Pascual-Garrido
- Address correspondence to Cecilia Pascual-Garrido, MD, Ph.D., Adult Reconstruction–Adolescent and Young Adult Hip Service, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S Euclid Ave, MSC 8233-0004-5505, St Louis, MO 63110, U.S.A.
| |
Collapse
|
8
|
Yee C, Wong M, Cohen D, Kay J, Simunovic N, Duong A, Marín-Pena O, Laskovski JR, Ayeni OR. Labral Tears and Chondral Lesions Are Common Comorbidities Identified During Endoscopic Repair of Gluteal Tendon Tears for Greater Trochanteric Pain Syndrome: A Systematic Review. Arthroscopy 2023; 39:856-864.e1. [PMID: 35817376 DOI: 10.1016/j.arthro.2022.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The primary purpose of this study was to systematically review the literature on intraoperative findings during endoscopic treatment for greater trochanteric pain syndrome (GTPS). Secondary outcomes were preoperative imaging findings and postoperative functional outcome measures. METHODS Medline, PubMED, and Embase databases were searched from inception (1946, 1966, and 1974, respectively), to July 15, 2021, for records reporting intraoperative findings during endoscopic surgery for GTPS. Studies of Level I-IV evidence were eligible. All studies were assessed for quality using the Methodological Index for Non-Randomized Studies (MINORS) score. RESULTS Sixteen studies met the inclusion criteria. Most patients underwent endoscopic greater trochanteric bursectomy with repair of the gluteal tendons. Intraoperative conditions reported were gluteal tendon tears usually involving the gluteus medius tendon, labral tears, and chondral lesions. Three studies reported an average of 9% of patients who subsequently underwent conversion to total hip arthroplasty. Pain was assessed using the visual analog scale, and functional outcome measures were measured using the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score Sport-Specific subscale, Hip Outcome Score Activities of Daily Living subscale, and iHOT-12. Pain and functional outcomes demonstrated significant improvement in nearly all the studies where they were reported. CONCLUSIONS Patients who underwent endoscopic management of GTPS commonly underwent repair of gluteal tendon tears, and in many cases had concomitant labral tears and chondral lesions identified intraoperatively. There were low rates of adverse events, repair failure, and revision surgery. Patient-reported functional outcomes were improved at follow-up at least 1 year postoperatively. LEVEL OF EVIDENCE IV, systematic review of level IV or better investigations.
Collapse
Affiliation(s)
- Caitlin Yee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Wong
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Hip Surgery Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Nicole Simunovic
- Hip Surgery Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Andrew Duong
- Hip Surgery Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Oliver Marín-Pena
- Hip Surgery Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jovan R Laskovski
- Crystal Clinic Orthopedic Center, St. Thomas Hospital, Akron, Ohio, U.S.A
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
9
|
Recreational activity after open hip abductor repair. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04734-5. [PMID: 36547750 PMCID: PMC10374787 DOI: 10.1007/s00402-022-04734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hip abductor tear (HAT) is an increasingly diagnosed cause of refractory lateral hip pain and dysfunction, affecting 10-25% of the general population. PURPOSE (1) to determine the rate of return to activity and to assess the physical and recreational activity of patients undergoing open hip abductor repair (oHATr) and (2) to describe the modification or initiation of new sports disciplines. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 28 patients (29 hips) who underwent an oHATr were prospectively analyzed at a midterm follow-up of 3.5 (range 2-5) years. The sports and recreational activity levels, as well as type of sports practiced before and after surgery, and The Veterans RAND 12 Item Health Survey (VR-12) were assessed via questionnaire. RESULTS At the final follow-up, all patients were active in sports after surgery. The duration and frequency of sports activities showed a slight decrease (48-42 min per week and 3.2-2.9 sessions per week, respectively) (p = 0.412 and 0.135, respectively). The VR-12 had a score of 45 (13.12-63.18) points for the physical component and 41 (32-53.8) points for the mental component. 100% of the patients would undergo the surgery again. 95% of patients were satisfied with the overall results of the surgical outcome, with 98% satisfied with their hip pain relief and ability to undertake daily and work activities. Moreover, 94% were satisfied with their ability to return to recreational activities. The failure rate in our cohort was approximately 14%. CONCLUSION All patients who underwent an oHATr were able to return at least to one type of sport. This cohort was highly satisfied with their sports involvement and recreational activity achievement. In addition, 88% of patients reported that oHATr improved sports activity. There was a shift from higher to lower impact sports. Furthermore, just 3 hips present a retear after surgery.
Collapse
|
10
|
Thaunat M, Pacoret V, Saad M, Saint-Etienne A, Morvan A. Endoscopic treatment of gluteus medius tendon tear. Orthop Traumatol Surg Res 2022; 108:103393. [PMID: 36075568 DOI: 10.1016/j.otsr.2022.103393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 02/03/2023]
Abstract
Tears in the gluteus medius and minimus tendons are a common cause of greater trochanter pain syndrome (GTPS). Given the non-specific clinical signs and imaging findings, they are often misdiagnosed, with delayed treatment. The lesions can show several aspects: trochanteric bursitis, simple tendinopathy, partial or full-thickness tear, tendon retraction, or fatty degeneration. Non-surgical treatment associates physical rehabilitation and activity modification, oral analgesics, anti-inflammatories and peri-trochanteric injections (corticosteroids, PRP). In the event of symptoms recalcitrant to medical treatment, surgery may be indicated. A 5-stage classification according to intraoperative observations and elements provided by MRI is used to guide technique: isolated bursectomy with microperforation, single or double row tendon repair, or palliative surgery such as muscle transfer (gluteus maximus with or without fascia lata). The development of conservative hip surgery now makes it possible to perform all of these surgical techniques endoscopically, with significant improvement in functional scores and pain in the short and medium term and a lower rate of complications than with an open technique. However, tendon retraction and fatty degeneration have been reported to be factors of poor prognosis for functional results and tendon healing and palliative tendon transfer gives mixed results for recovery of tendon strength. It is therefore preferable not to wait for the onset of Trendelenburg gait to propose endoscopic repair of the gluteus medius tendon in case of pain with a tear visible on MRI and failure of more than 6 months' medical treatment. Based on expert opinion, this article provides an update on the diagnosis of gluteus medius lesions, treatment, and in particular the place of endoscopy, indications and current results. LEVEL OF EVIDENCE: V.
Collapse
Affiliation(s)
- Mathieu Thaunat
- Ramsay Santé, hôpital Privé Jean Mermoz, centre orthopédique Santy, 24, avenue Paul Santy, 69008 Lyon, France.
| | - Victor Pacoret
- Ramsay Santé, hôpital Privé Jean Mermoz, centre orthopédique Santy, 24, avenue Paul Santy, 69008 Lyon, France
| | - Maxime Saad
- Ramsay Santé, hôpital Privé Jean Mermoz, centre orthopédique Santy, 24, avenue Paul Santy, 69008 Lyon, France
| | - Adrien Saint-Etienne
- Ramsay Santé, hôpital Privé Jean Mermoz, centre orthopédique Santy, 24, avenue Paul Santy, 69008 Lyon, France
| | - Antoine Morvan
- Clinique du sport Bordeaux-Mérignac, 4, rue Georges Nègrevergne, 33700 Mérignac, France
| |
Collapse
|
11
|
Gómez Bermúdez SJ, Quiroz Álvarez JE, Avendaño Arango V, Moore Velásquez JL. Avulsión traumática aguda del músculo glúteo medio en una paciente sin antecedente de dolor de cadera: presentación de un caso. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.5.1552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introducción: Se presenta el caso clínico de una mujer con avulsión aguda completa del glúteo medio en su inserción distal en el trocánter mayor, con cuadro de evolución menor de 24 horas desde la aparición del dolor peritrocantérico, en ausencia de un claro desencadenante o desgaste crónico degenerativo documentado. En la evaluación por urgencias ante la sospecha diagnóstica, se hace radiografía anteroposterior (AP) de pelvis y lateral de la cadera afectada, con posterior confirmación de hallazgospor resonancia magnética nuclear (RMN). El tratamiento se realiza mediante una técnica quirúrgica reconstructiva dentro de la primera semana de la lesión, con excelentes resultados clínicos y funcionales.
Conclusión: La avulsión traumática aguda del músculo glúteo medio es una patología con una baja incidencia, lo que hace que la evidencia disponible para guiar su manejo sea escasa. Se presenta este caso clínico con la intención de exponer el abordaje clínico y diagnóstico de esta entidad y mostraruna opción de manejo con resultados satisfactorios.
Collapse
|
12
|
Merrill CA, Fleisig GS, Arceo C, Jebeles NA, Emblom BA. Endoscopic Gluteus Medius Repair. Arthrosc Tech 2022; 11:e1787-e1791. [PMID: 36311331 PMCID: PMC9596725 DOI: 10.1016/j.eats.2022.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/18/2022] [Indexed: 02/03/2023] Open
Abstract
Endoscopic gluteus medius repair is indicated after failed conservative management for debilitating peritrochanteric hip pain. In our experience, most of these surgeries are performed on women, 45 to 75 years old. Often for undersurface high-grade partial-thickness tears and some small full-thickness tears, a single-row repair technique is performed. For larger, full-thickness tears, a double-row repair is often performed. For minimal, superficial, partial-thickness tears with a longitudinal component of tearing through the gluteus medius tendon, a side-to-side repair is performed. Short-term follow-up shows significant improvements in hip outcome score for activities of daily living and in numeric rating scale.
Collapse
Affiliation(s)
| | - Glenn S. Fleisig
- Address correspondence to Glenn S. Fleisig, Ph.D., American Sports Medicine Institute, 833 St. Vincent's Drive, Suite 205, Birmingham, AL 35205, USA.
| | | | | | | |
Collapse
|
13
|
Della Rocca F, Di Francia V, Giuffrida A, Rosolani M, D'Ambrosi R, D'Addona A. Satisfactory results after endoscopic gluteus medius repair combined with selective gluteus maximus reflected tendon release for the treatment of a full-thickness tear of gluteus medius. Knee Surg Sports Traumatol Arthrosc 2022; 31:2038-2045. [PMID: 36066574 PMCID: PMC10090025 DOI: 10.1007/s00167-022-07140-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The current study aimed to report the mid-term follow-up results of endoscopic gluteus medius repair combined with a systematic release of the gluteus maximus reflected tendon. METHODS Twenty-two patients with a symptomatic full-thickness tear of the gluteus medius tendon, as diagnosed by clinical examination and imaging (MRI), and who had a failure of conservative treatment for at least 6 months, were retrospectively enrolled for this study. An endoscopic repair of gluteus medius was performed for all patients in combination with gluteus maximus reflected tendon release according to the Polesello technique. The Visual Analogue Scale (VAS) for pain, Modified Harris Hip Score (mHHS), Lower Extremity Functional Scale (LEFS), Hip Outcome Score-Activity Daily Life (HOS-ADL), and Hip Outcome Score-Sport Specific Subscale (HOS-SSS) were administered to each patient before surgery for 6 months, 1 year, and every following year after surgery. RESULTS All analysed hip scores (mHHS, LEFS, HOS-ADL, and HOS-SSS) showed statistically significant improvements between the pre-operative and post-operative values at 6 months, 1 year, and the latest follow-up appointments after surgery (p < 0.001). The mean pre-operative pain was 8.6 ± 1.0 on the VAS. After surgical treatment, the pain was significantly reduced (p < 0.001) on the VAS at 6 months (5.4 ± 1.5), 1 year (4.4 ± 1.8) and the latest follow-up control visit (3.6 ± 2.2). No patient-reported major complications (re-rupture, deep infection or neurovascular injury). Eleven (50%) patients indicated the results as excellent, 7 (32%) as good, 2 (9%) as fair, and 2 (9%) as poor. CONCLUSION The use of abductor tendon repair in combination with a systematic release of the reflected tendon of the gluteus maximus according to the Polesello technique seems to be a safe and effective endoscopic way of treating a full-thickness tear of the gluteus medius. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Federico Della Rocca
- Humanitas Research Hospital-IRCCS, Via Alessandro Manzoni 36, Rozzano, MI, Italy
| | - Vincenzo Di Francia
- Humanitas Research Hospital-IRCCS, Via Alessandro Manzoni 36, Rozzano, MI, Italy
| | - Alberto Giuffrida
- Humanitas Research Hospital-IRCCS, Via Alessandro Manzoni 36, Rozzano, MI, Italy
| | - Marco Rosolani
- Humanitas Research Hospital-IRCCS, Via Alessandro Manzoni 36, Rozzano, MI, Italy
| | - Riccardo D'Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, Milan, Italy.
| | - Alessio D'Addona
- Humanitas Research Hospital-IRCCS, Via Alessandro Manzoni 36, Rozzano, MI, Italy
| |
Collapse
|
14
|
Rice MW, Sivasundaram L, Hevesi M, Browning RB, Alter TD, Paul K, Nho SJ. Defining the Minimal Clinically Important Difference and Patient Acceptable Symptom State After Endoscopic Gluteus Medius or Minimus Repair With or Without Labral Treatment and Routine Capsular Closure at Minimum 5-Year Follow-up. Am J Sports Med 2022; 50:2629-2636. [PMID: 35913620 DOI: 10.1177/03635465221105469] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a paucity of information in the literature on midterm outcomes of endoscopic gluteus medius and/or minimus repair with concomitant labral treatment using only modern surgical techniques. PURPOSE To define the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) at a minimum of 5 years postoperatively for patients undergoing endoscopic hip abductor repair with routine capsular closure. STUDY DESIGN Case series; Level of evidence, 4. METHODS Consecutive patients who underwent primary endoscopic repair of gluteus medius and/or minimus tears between January 2012 and December 2015 by the senior author were eligible for inclusion. Patient-reported outcome scores were assessed preoperatively and at 5 years postoperatively: Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sport Specific (HOS-SS), modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The MCID was uniquely calculated using the distribution method, and the PASS was determined via the anchor-based method utilizing receiver operating characteristic curves and Youden index. RESULTS A total of 46 patients were included in the study. The majority were female (87.0%), with a mean ± standard deviation age of 59.1 ± 8.9 years and body mass index of 27.3 ± 6.9. Significant postoperative improvements (P < .001) in each of the 5 patient-reported outcomes were observed at 5 years postoperatively. The MCID threshold values were calculated as follows: HOS-ADL, 11.5; HOS-SS, 15.1; mHHS, 13.3; iHOT-12, 11.8; and VAS, 15.8. The PASS thresholds were calculated as follows: HOS-ADL, 75.7; HOS-SS, 79.7; mHHS, 81.2; and iHOT-12, 60.8. A majority of patients achieved a clinically significant outcome, with 96.2% of patients reaching a threshold score for the MCID or PASS for at least 1 patient-reported outcome. CONCLUSION Endoscopic hip abductor repair with concomitant arthroscopic labral treatment has a high rate of achievement of clinically significant outcomes and survivorship at a minimum 5-year follow-up. We defined the MCID for the HOS-ADL, HOS-SS, mHHS, iHOT-12, and VAS outcome scores to be 11.5, 15.1, 13.3, 11.8, and 15.8, respectively. The PASS threshold scores for the HOS-ADL, HOS-SS, mHHS and iHOT-12 scores of 75.7, 79.7, 81.2, and 60.8, respectively. Future researchers and clinicians can use the MCID and PASS values established in this study to better evaluate mid-term outcomes of patients undergoing hip abductor repair.
Collapse
Affiliation(s)
- Morgan W Rice
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Lakshmanan Sivasundaram
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Mario Hevesi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Robert B Browning
- Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Katlynn Paul
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
15
|
Looney AM, Bodendorfer BM, Donaldson ST, Browning RB, Chahla JA, Nho SJ. Influence of Fatty Infiltration on Hip Abductor Repair Outcomes: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:2568-2580. [PMID: 34495797 DOI: 10.1177/03635465211027911] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increasing evidence supports surgical intervention for hip abductor tears; however, the influence of fatty infiltration (FI) on outcomes after repair remains uncertain and has been addressed only in small case series. PURPOSE To clarify the relationship between FI and surgical outcomes for hip abductor tears. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic review and meta-analysis was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. FI severity was assessed by Goutallier-Fuchs (G-F) grade. The relationship between FI and improvement in Harris Hip Score (HHS)/modified Harris Hip Score (mHHS) and visual analog scale (VAS) score for pain was examined with mixed-effects metaregression. Outcomes with open and endoscopic techniques were also compared. RESULTS A total of 4 studies (206 repairs in 201 patients) were eligible. High-grade FI was associated with significantly less improvement in HHS/mHHS than both no FI (6.761 less; 95% CI, 3.983-11.570; P = .002) and low-grade FI (7.776 less; 95% CI, 2.460-11.062; P < .001) but did not significantly influence VAS score (P > .05). Controlling for FI severity, we found no significant difference in HHS/mHHS improvement between open versus endoscopic repair (P > .05 at each level), but open repair resulted in significantly greater improvement in VAS score for every G-F grade (all P < .005). CONCLUSION Surgical intervention for symptomatic hip abductor tendon tears improved outcomes as reflected by change in HHS/mHHS; however, the presence of high-grade FI resulted in less improvement. FI severity did not influence VAS scores for pain. Although no differences were found between open and endoscopic repairs in terms of FI-adjusted improvement in HHS/mHHS, open repairs resulted in significantly greater pain relief at each FI level.
Collapse
Affiliation(s)
- Austin M Looney
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC, USA.,The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Blake M Bodendorfer
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC, USA.,Midwest Orthopaedics, Rush, Chicago, Illinois, USA
| | | | - Robert B Browning
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Shane J Nho
- Midwest Orthopaedics, Rush, Chicago, Illinois, USA
| |
Collapse
|
16
|
Clinical results after open gluteus medius repair in single-row technique. J Exp Orthop 2022; 9:55. [PMID: 35689698 PMCID: PMC9188632 DOI: 10.1186/s40634-022-00483-x] [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: 03/11/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The aim of this retrospective study is to present the clinical results of open repair of gluteus medius and gluteus minimus tendon tears using the single-row suture anchor technique. Methods This retrospective study included 43 participants after open repair of the abductor tendon of the hip joint using a single-row suture anchor technique. Clinical outcome parameters were assessed by VAS (0–10), gait safety (1 = absolutely safe gait without assistive devices - 10 = gait not possible), SHV (0–100%), mHHS, WOMAC, and gluteal muscle strength status from single-leg stance and against gravity. Results Thirty-two female and 11 male subjects with an average age of 65.2 years were included in this study. Overall, a significant decrease in pain (VAS 3.2) and improvement in joint function is observed after a period of 22.3 months. The mHHS reached 61.9 points, WOMAC 28.2, SHV 69.8% and gait stability measured by the VAS reached 3.4. 58.1% of the participants reported not having Trendelenburg, while 4% could not control the single leg stance. Conclusions The present study shows that single row repair for open glutueus medius refixation indicates limited clinical results. Although there was an improvement in clinical outcome. The majority of subjects continued to report limiting symptoms.
Collapse
|
17
|
Maldonado DR, Glein RM, Lee MS, Annin S, Owens JS, Jimenez AE, Saks BR, Sabetian PW, Lall AC, Domb BG. Patients With Concomitant Painful External Snapping Hip and Femoroacetabular Impingement Syndromes Reported Complete Snapping Resolution With Release of the Gluteus Maximus and Iliotibial Band, and Comparable Minimum 2-Year Outcomes to a Propensity-Matched Control Group. Arthroscopy 2022; 38:1890-1899. [PMID: 34920010 DOI: 10.1016/j.arthro.2021.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To report minimum 2-year patient-reported outcome measures (PROMs) following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and painful external snapping hip (ESH) treatment and ESH resolution, and to compare these PROMs to a benchmark FAIS propensity-matched control group without ESH. METHODS Data were prospectively collected and retrospectively reviewed between November 2009 and April 2018. Patients were eligible if they were preoperatively diagnosed with FAIS and painful ESH and received primary hip arthroscopy to address these pathologies. ESH was treated with gluteus maximus and iliotibial band releases. Inclusion criteria were baseline and minimum two-year follow-up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. Exclusion criteria were Tönnis grade >1 and previous hip conditions. A secondary subanalysis was performed to benchmark these outcomes to a FAIS propensity-matched control group without ESH, according to age, sex, body mass index (BMI), Tönnis grade, and preoperative lateral center-edge and α-angles using a 1:3 ratio. The minimal clinically important difference (MCID) and the maximum outcome improvement (MOI) rates were reported. RESULTS Twenty-two hips (21 patients) were included. The mean age, BMI, and follow-up were 31.3 years ± 14.0, 26 kg/m2 ± 5.0, and 31.4 months ± 4.4, respectively, with 68.2% being female. ESH was resolved in 100% of patients. Significant improvement for all PROMs at a minimum two-year (P < .001) was reported. The minimum two-year PROMs and the rate of achieving the MCID and MOI threshold were comparable to the control group. CONCLUSION Following primary hip arthroscopy for FAIS and painful ESH, patients demonstrated significant improvement in all PROMs, and the rate of resolution of ESH was 100% at minimum two-year follow-up: with gluteus maximus and iliotibial band releases. Functional outcomes and rates of MCID and MOI achievement were comparable to a FAIS propensity-matched benchmark control group without ESH. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Rachel M Glein
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Michael S Lee
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Jade S Owens
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Andrew E Jimenez
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Benjamin R Saks
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Payam W Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A.; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A..
| |
Collapse
|
18
|
Open Hip Abductor Repair Hitting the Sack-Abductor Tendon Repair Significantly Improves Sleep Quality. J Clin Med 2021; 10:jcm10215164. [PMID: 34768684 PMCID: PMC8584347 DOI: 10.3390/jcm10215164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To (1) describe the prevalence of abnormal sleep quality in patients with hip abductor tears (HAT), to (2) determine whether sleep quality improves after open HAT repair, and to (3) to report clinical short-term outcomes in patients undergoing open HAT repair. METHODS The data of 28 patients (29 hips) who underwant open HAT repair were prospectively analyzed at midterm follow-up. The Pittsburgh Sleep Quality Index (PSQI), modified Harris Hip Score (mHHS), the University of California, Los Angeles activity scale (UCLA), and Visual Analog Scale (VAS) for pain were determined via questionnaire. Paired t-tests were applied to compare preoperative and post-operative Patient-reported Outcome Measures (PROMs). Logistic regression was performed to determine the association between PSQI improvement achievement and demographic variables (laterality, sex, age, body-mass-index (BMI), and preoperative mHHS). The minimal clinically important difference (MCID) was calculated for the mHHS. RESULTS A total of 28 patients were included. Four patients (14.3%) suffered post-operative complications after open HAT repair. The predominance of patients was female (77.4%), with a mean age of 60 ± 13 years. The average follow-up was 30.35 ± 16.62 months. Preoperatively, 27 (96.4%) patients experienced poor sleep quality (PSQI > 5); at follow-up, 7 (25%) patients experienced poor sleep quality. Univariate logistical regression analysis demonstrated no significant association between preoperative demographic data and achieving postoperative PSQI < 5. The MCID of mHHS was calculated to be 12.5. Overall, 90% of patients achieved MCID for mHHS. CONCLUSION Preoperative sleep quality was impaired in 96.4% of HAT patients (PSQI > 5). However, these patients showed an improvement in sleep disturbances after open HAT repair in the early postoperative period. Ninety percent of patients showed significant improvements in mHHS and achieved the corresponding MCID. LEVEL OF EVIDENCE Case series; Level IV.
Collapse
|
19
|
Kay J, Memon M, Lindner D, Randelli F, Ayeni OR. Arthroscopic management of greater trochanter pain syndrome and abductor tears has demonstrated promising results in terms of improvement in pain scores and functional outcomes: a scoping review. Knee Surg Sports Traumatol Arthrosc 2021; 29:2401-2407. [PMID: 33044606 DOI: 10.1007/s00167-020-06322-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Greater trochanteric pain syndrome (GTPS) refers to the constellation of signs and symptoms related to pain in the trochanteric region and has recently replaced the previously ubiquitous term of 'greater trochanteric bursitis'. GTPS is common, particularly in women 50-79 years of age, and the understanding and management of GTPS have expanded considerably in recent years to include management with arthroscopic and endoscopic techniques in recalcitrant cases. The purpose of this scoping literature review was to summarize the current evidence on arthroscopic management of GTPS including sources of evidence, key concepts, and gaps in the literature. METHODS A thorough electronic database search included studies published from 2009 to June 14, 2020. A total of 52 peer-reviewed articles were identified within the literature on arthroscopic or endoscopic management of GTPS. RESULTS Of the 52 identified papers, 12 were technique descriptions, 10 papers were review articles, and 30 papers were original clinical papers. Of the 30 clinical papers, 24 (80%) were of level IV evidence, 5 (17%) were of level III evidence, and 1 (3%) was level II evidence. Among the 30 clinical studies, 988 patients were included with 761 (77%) female. Indications for surgical management included a failed trial of conservative management in all 30 studies, typically after a period of 3-6 months. Surgical management consisted of arthroscopic/endoscopic abductor tendon repair in 16 (53%) studies, arthroscopic/endoscopic bursectomy and iliotibial band release in 12 (40%) studies, and arthroscopic/endoscopic gluteal tendon contracture release in 2 (7%) studies. CONCLUSION Overall, results following arthroscopic management of GTPS and abductor tears have been promising, including significantly improved pain scores and functional outcomes at final post-operative assessment. These studies support continued use and investigation of arthroscopic management strategies of GTPS and pave the way to conduct larger prospective studies to confirm these results in the future. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. HSC 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. HSC 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Dror Lindner
- Department of Orthopaedic Surgery, Yitzhak Shamir Medical Center, Zriffin, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Filippo Randelli
- Hip Department (CAD), Gaetano Pini, CTO Orthopedic Institute, University of Milan, Milan, Italy
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St. W. HSC 4E15, Hamilton, ON, L8N 3Z5, Canada.
| |
Collapse
|
20
|
Uso MB, Bothorel H, Poultsides L, Christofilopoulos P. Short-term outcomes following mini-open repair of chronic gluteus medius tendon tears using a double-row technique. J Hip Preserv Surg 2021; 8:202-208. [PMID: 35145719 PMCID: PMC8825688 DOI: 10.1093/jhps/hnab060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/09/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022] Open
Abstract
Gluteal tendon tears represent a common but underreported cause of lateral hip pain and dysfunction. In case of conservative management failure, a surgical procedure must be performed to relieve patient symptoms. Current operative treatments, either open or endoscopic, have been however associated with different drawbacks which led to the introduction of the mini-open technique. The aim of this study was to evaluate and report the short-term outcomes of patients operated through the aforementioned surgical technique for gluteus medius (GM) chronic tears. We retrospectively analysed the records of 14 consecutive patients operated at the La Tour hospital by mini-open repair using a double-row technique for full-thickness GM chronic tears. Intra- and post-operative complications were recorded. The pre- and post-operative pain on visual analogue scale (pVAS), modified Harris Hip score (mHHS), abduction strength and gait dysfunction were assessed for all patients. Pre- and post-operative values were compared to evaluate whether improvements were statistically significant and clinically relevant. The study cohort comprised 13 women (93%) and 1 man (3%) aged 62.4 ± 18.0 at index surgery. No intra- or post-operative complications were noted. Compared to pre-operative values, patients reported a significant improvement in mHHS (59.1 ± 7.1 vs 92.7 ± 4.6) and pVAS (7.4 ± 1.0 vs 1.3 ± 1.3) at last follow-up. Patients exhibited a perfect improvement in muscle strength (3.6 ± 0.5 vs 5.0 ± 0.0), and the proportion of patients with a positive Trendelenburg sign decreased from 71% to 0%. Mini-open repair of chronic GM tendon tears using a double-row technique demonstrated excellent clinical and functional outcomes at short follow-up. Level of Evidence: IV.
Collapse
Affiliation(s)
- Marc Barrera Uso
- Orthopedic Department, La Tour Hospital, Avenue J.-D. Maillard 3, Meyrin, Geneva CH-1217, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, Avenue J.-D. Maillard 3, Meyrin, Geneva CH-1217, Switzerland
| | - Lazaros Poultsides
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Agiou Pavlou 76, Pavlos Melas, Thessaloniki GR-56429, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan center, 10th km Thessaloniki-Thermi Rd, Thessaloniki GR-57001, Greece
| | | |
Collapse
|
21
|
Annin S, Lall AC, Meghpara MB, Maldonado DR, Shapira J, Rosinsky PJ, Ankem HK, Domb BG. Intraoperative Classification System Yields Favorable Outcomes for Patients Treated Surgically for Greater Trochanteric Pain Syndrome. Arthroscopy 2021; 37:2123-2136. [PMID: 33581305 DOI: 10.1016/j.arthro.2021.01.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To use a prospectively collected database to internally validate a previously published intraoperative classification system by determining its utility in improving patient-reported outcome scores (PROS). METHODS Open or endoscopic procedures performed at a single center between February 2008 and March 2018 with minimum 2-year follow-up were reviewed. Patients were prospectively classified intraoperatively as one of five greater trochanteric pain syndrome (GTPS) types according to the Lall GTPS classification system and underwent one of the six following surgical procedures: trochanteric bursectomy (TB, type I); TB with trochanteric micropuncture (type II); endoscopic suture staple repair (type IIIA); endoscopic single row transtendinous repair (type IIIB); open or endoscopic double row repair (type IV); and gluteus maximus/tensor fasciae latae transfers (type V). The following PROS were analyzed to assess the efficacy of treatment and validity of the classification scheme: modified Harris Hip Score (mHHS), Nonarthritic Hip Score, The International Hip Outcome Tool, Hip Outcome Score-Sport-Specific Subscale, and visual analog scale for pain. RESULTS In total, 324 patients (287 female, 37 male) underwent surgical management per GTPS classification type: 109 type I; 26 type II; 20 type IIIA; 118 type IIIB; 44 type IV; and 7 type V. The mean age and follow-up time were 51.9 ± 12.5 years and 44.5 ± 20.5 months, respectively. All patients PROS improved from baseline to minimum 2-year follow-up (P < .05). High rates of the minimal clinically important difference for mHHS (70.0-100.0) and Nonarthritic Hip Score (73.1-92.7) and patient acceptable symptomatic state for mHHS (70.0-94.5) and International Hip Outcome Tool (58.1-86.7) were achieved per GTPS type. Patient satisfaction was 7.9/10. CONCLUSIONS This validation study supports that the classification system and treatment algorithm for surgical treatment of various GTPS types leads to favorable patient-reported outcomes. These findings provide surgeons with a validated classification system and treatment algorithm to manage peritrochantric pathology diagnosed intraoperatively. LEVEL OF EVIDENCE III, prognostic study.
Collapse
Affiliation(s)
- Shawn Annin
- American Hip Institute Research Foundation, Chicago
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago; American Hip Institute, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | | | | | | | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago; American Hip Institute, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A..
| |
Collapse
|
22
|
Lubowitz JH, Brand JC, Rossi MJ. Hip Gluteus Medius and Minimus Endoscopic Treatment Results in Patient Satisfaction. Arthroscopy 2020; 36:2775-2776. [PMID: 33172572 DOI: 10.1016/j.arthro.2020.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 02/02/2023]
Abstract
Greater trochanteric pain syndrome includes a spectrum of hip pathology, including trochanteric bursitis, gluteus medius or minimus tendinosis, partial abductor tear, full-thickness tear, and full-thickness tear plus retraction (with or without fatty atrophy). Physical diagnosis includes palpation for tenderness at the greater trochanter and evaluation for strength loss, including observation of gait. Women are significantly more likely to have a tear of the hip abductors than men. Endoscopic treatment results in patient satisfaction, improved strength and gait, and few complications. Fatty degeneration of the abductor muscles or associated scoliosis has a negative effect on the outcome of gluteus medius repair.
Collapse
|