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Nadeau NJ, Marder RS, Fasulo SM, Richards SM, Kraeutler MJ, Scillia AJ. Comparable Pain Levels and Functional Outcomes With and Without the Use of Dermal Allograft Augmentation in Endoscopic Gluteus Medius Repair. Arthroscopy 2024:S0749-8063(24)00622-4. [PMID: 39209076 DOI: 10.1016/j.arthro.2024.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To compare retrospectively the clinical outcomes of patients undergoing endoscopic gluteal tendon repair with and without the use of dermal allograft augmentation. METHODS A retrospective review of prospectively collected data, single-surgeon cohort study was performed on all patients undergoing endoscopic gluteus medius repair (GMR) and GMR with augmentation (GMR-A) between April 2017 and April 2022. Dermal allograft augmentation was used in cases where intraoperative gluteus tissue quality was poor. An electronic survey of patient-reported outcome measures (PROMs) was completed at a minimum of 1 year postoperatively. PROMs included a visual analog scale (VAS) for pain; the University of California, Los Angeles (UCLA) Activity Scale; the modified Harris Hip Score (mHHS); the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS); and the Single Assessment Numeric Evaluation (SANE). The proportion of patients achieving the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for each PROM were compared between groups. RESULTS Sixty-four patients were reached for follow-up (26 GMR, 38 GMR-A). No differences were found between the groups in terms of demographics. There was a significantly longer time to follow-up in the GMR group (39.4 ± 26.9 vs 24.2 ± 11.7 months, P = .003). There were no differences between the GMR and GMR-A groups in terms of postoperative PROMs including VAS (3.3 ± 2.6 vs 3.3 ± 2.8, P = .99), UCLA (5.8 ± 2.1 vs 5.1 ± 2.0, P = .17), mHHS (70.1 ± 18.1 vs 68.9 ± 17.8, P = .80), HOS-SSS (67.7 ± 28.9 vs 62.5 ± 30.2, P = .50), and SANE (71.7 ± 27.9 vs 71.3 ± 22.8, P = .95). A significantly greater proportion of patients in the GMR group achieved a PASS for UCLA (64% vs 34%, P = .02). One patient each in the GMR (3.8%) and GMR-A (2.6%) groups underwent revision gluteus medius repair with dermal allograft augmentation at the final follow-up. CONCLUSIONS Our study demonstrates comparable clinical outcomes with and without the use of dermal allograft augmentation in endoscopic gluteus medius repairs. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Nicolas J Nadeau
- Hackensack Meridian School of Medicine, Nutley, New Jersey, U.S.A
| | - Ryan S Marder
- St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Sydney M Fasulo
- St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Sean M Richards
- Hackensack Meridian School of Medicine, Nutley, New Jersey, U.S.A
| | - Matthew J Kraeutler
- Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery & Rehabilitation, Lubbock, Texas, U.S.A
| | - Anthony J Scillia
- St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A..
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2
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Browning RB, Fenn TW, Allahabadi S, Vogel MJ, Chapman RS, Beals C, Chan J, Nho SJ. Open and Endoscopic Gluteus Medius and/or Minimus Repair Achieves Clinical Success Regardless of Tear Grade: High-Grade Fatty Infiltration Portends Worse Outcomes. Arthroscopy 2024:S0749-8063(24)00398-0. [PMID: 38844013 DOI: 10.1016/j.arthro.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 05/04/2024] [Accepted: 05/12/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE To evaluate minimum 2-year gluteus medius and/or minimus repair clinical success rates stratified by the 3-grade magnetic resonance imaging (MRI)-based classification (MRI grade) and to evaluate clinical success rates by the surgical approach used at each MRI grade and by the Goutallier-Fuchs (GF) classification. METHODS A retrospective review identified patients who underwent primary endoscopic or open gluteus medius and/or minimus repair from 2012 to 2021 performed by a single surgeon. Preoperative MRI scans were classified using the MRI grade and GF classification. Patient-reported outcomes were collected preoperatively and at minimum 2-year follow-up. Cohort-specific minimal clinically important difference and patient acceptable symptom state achievement was recorded. Rates of clinical success, defined as achievement of the 2-year minimal clinically important difference or patient acceptable symptom state with avoidance of revision surgery, were compared by MRI grade, by surgical approach at each MRI grade, and by GF classification. RESULTS A total of 112 patients (71 with MRI grade 1, 19 with grade 2, and 22 with grade 3) were included. MRI grade 1 patients underwent endoscopic repair (P < .001) more often than the other groups. The overall clinical success rate was 90%. Clinical success rates by MRI grade were 93% for grade 1, 95% for grade 2, and 77% for grade 3 (P = .087). Clinical success rates by the endoscopic and open surgical approaches used at each MRI grade were 93% versus 90% for grade 1 (P = .543), 91% versus 100% for grade 2 (P > .999), and 60% versus 92% for grade 3 (P = .135). GF grade 1 tears achieved a higher rate of clinical success than GF grade 4 tears (100% vs 71%, P = .030). CONCLUSIONS Primary repair of gluteus medius and/or minimus tears resulted in clinical success in most patients irrespective of MRI grade and irrespective of the surgical approach used at each MRI grade, yet GF grade 1 tears showed a significantly higher clinical success rate than GF grade 4 tears. LEVEL OF EVIDENCE Level IV, prognostic retrospective case series.
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Affiliation(s)
- Robert B Browning
- 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, U.S.A
| | - Thomas W Fenn
- 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, U.S.A..
| | - Sachin Allahabadi
- 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, U.S.A
| | - Michael J Vogel
- 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, U.S.A
| | - Reagan S Chapman
- 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, U.S.A
| | - Corey Beals
- 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, U.S.A
| | - Jimmy Chan
- 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, U.S.A
| | - 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, U.S.A
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3
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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.
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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.
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Kahana-Rojkind AH, McCarroll TR, Kuhns BD, Parsa A, Quesada-Jimenez R, Domb BG. Parachute Technique for Dermal Allograft Augmentation in Open Gluteal Abductor Repair. Arthrosc Tech 2024; 13:102958. [PMID: 38835452 PMCID: PMC11144959 DOI: 10.1016/j.eats.2024.102958] [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: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
Retracted full-thickness tears of the gluteus medius tendon are a well-recognized cause of disabling weakness and pain that significantly impact patients' quality of life. We present an efficient knotless parachute technique for dermal allograft augmentation in open gluteal abductor tendon repairs. Our technique reinforces the suture-tendon interface by incorporating a robust biological scaffold into a knotless double-row fixation. This approach capitalizes on the increased pressure and contact area achieved between the greater trochanter and the dermal allograft/gluteus medius tendon construct without the prominence of knotted sutures.
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Affiliation(s)
| | | | - Benjamin D. Kuhns
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, 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
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Dove JH, Lemme NJ, Modest JM, Talley-Bruns RC, Tabaddor RR, Fadale PD. A Review of Abductor Tendon Tears: The Hidden Lesion of the Hip. JBJS Rev 2022; 10:01874474-202212000-00005. [PMID: 36546777 DOI: 10.2106/jbjs.rvw.22.00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
» Greater trochanteric pain syndrome consists of a group of associated conditions involving the lateral hip that can be debilitating to patients, mostly women between ages 40 and 60 years. » Abductor tendon tears are becoming a more recognized cause of lateral hip pain in patients without hip osteoarthritis. » Diagnosis of this condition is critical to patient care because misdiagnosis often leads to unnecessary prolonged pain and even unnecessary procedures that address different pathologies. » Treatment strategies consists of nonoperative modalities such as nonsteroidal anti-inflammatory medications, corticosteroid injections, and physical therapy, but for refractory cases, surgical techniques including repair, augmentation, and reconstruction have been well-described in the literature providing patients with acceptable outcomes.
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Affiliation(s)
- James H Dove
- Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Ebert JR, Fearon AM, Smith PN, Janes GC. Recommendations in the rehabilitation of patients undergoing hip abductor tendon repair: a systematic literature search and evidence based rehabilitation protocol. Arch Orthop Trauma Surg 2022; 142:3165-3182. [PMID: 33983527 DOI: 10.1007/s00402-021-03952-7] [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: 11/17/2020] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is hip abductor tendon (HAT) tears. Traditionally, these patients have been managed non-operatively, often with temporary pain relief. More recently, there has been an increase in published work presenting the results of surgical intervention. A variety of open and endoscopic transtendinous, transosseous and/or bone anchored suture surgical techniques have been reported, with and without the use of tendon augmentation for repair reinforcement. While patient outcomes have demonstrated improvements in pain, symptoms and function, post-operative rehabilitation guidelines are often vague and underreported, providing no guidance to therapists. MATERIALS AND METHODS A systematic search of the literature was initially undertaken to identify published clinical studies on patients undergoing HAT repair, over a 3-year period up until May 2020. Following the application of strict inclusion and exclusion criteria, studies were identified and the detail relevant to rehabilitation was synthesized and presented. Published detail was combined with the authors clinical experience, with a detailed overview of rehabilitation proposed for this patient cohort. RESULTS A total of 17 studies were included, reporting varied detail on components of rehabilitation including post-operative weight bearing (WB) restrictions, the initiation of passive/active hip range of motion (ROM) and resistance exercises. A detailed rehabilitation guide is proposed. CONCLUSION In combining the current published literature on rehabilitation after HAT repair and our own clinical experience in the surgical management and post-operative rehabilitation of these patients, we present an evidence-based, structured rehabilitation protocol to better assist surgeons and therapists in treating these patients. This rehabilitation protocol has been implemented for several years through our institutions with encouraging published clinical outcomes.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. .,HFRC, 117 Stirling Highway, Nedlands, WA, 6009, Australia.
| | - Angela M Fearon
- ACT, UCRISE, Faculty of Health, University of Canberra, Woden, 2617, Australia
| | - Paul N Smith
- ACT, Trauma & Orthopaedic Research Unit Canberra Hospital, Woden, 2617, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, WA, 6005, Australia
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Browning RB, Clapp IM, Alter TD, Nwachukwu BU, Wolfson T, Suppauksorn S, Nho SJ. Superior Gluteal Reconstruction Results in Promising Outcomes for Massive Abductor Tendon Tears. Arthrosc Sports Med Rehabil 2021; 3:e1321-e1327. [PMID: 34712970 PMCID: PMC8527271 DOI: 10.1016/j.asmr.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 05/19/2021] [Indexed: 11/07/2022] Open
Abstract
Purpose To evaluate the 1-year outcomes of a small patient series following open gluteus medius/minimus repair with human dermal allograft incorporated into the repair construct using a double-row repair. Methods Data from consecutive patients undergoing a superior gluteal reconstruction for massive, irreparable abductor tendon tears with severe tendon loss and atrophy by a single fellowship trained surgeon from January 2018 to May 2019 were collected and analyzed. Baseline demographic data and magnetic resonance imaging were collected preoperatively. Clinical outcomes including Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris hip score (mHHS), international Hip Outcome Score-12 (iHOT-12), visual analog scale (VAS) pain, and VAS satisfaction were recorded at 1-year postoperatively. Results A total of 8 patients underwent open superior gluteal reconstruction for severe hip abductor deficiency. The mean age and body mass index were 62.6 ± 7.3 years and 29.6 ± 5.3 kg/m2, respectively. The majority of patients were female (N = 7, 87.5%). Three (37.5%) patients had undergone previous endoscopic gluteus medius repair and presented for revision surgery. All patients had full-thickness tears with gluteus medius and gluteus minimus involvement. Patients were evaluated at an average of 11.5 ± 1.7 months from the initial surgical intervention and reported a mean HOS-ADL of 82.9 ± 24.3, HOS-SS of 73.2 ± 37.3, mHHS of 83.6 ± 17.1, iHOT-12 of 63.9 ± 27.4, VAS Pain of 30.0 ± 23.1, and VAS Satisfaction of 87.1 ± 17.0. There was no evidence of retears in this patient cohort as defined by physical examination findings and/or corroborating magnetic resonance imaging. Conclusions Superior gluteal reconstruction for massive, irreparable abductor tendon tears with severe tendon loss and atrophy is a technique that demonstrates promising 1-year postoperative outcomes in both primary and revision patients. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Robert B Browning
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
| | - Ian M Clapp
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
| | - Thomas D Alter
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Theodore Wolfson
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
| | - Sunikom Suppauksorn
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
| | - Shane J Nho
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
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8
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Migliorini F, Kader N, Eschweiler J, Tingart M, Maffulli N. Platelet-rich plasma versus steroids injections for greater trochanter pain syndrome: a systematic review and meta-analysis. Br Med Bull 2021; 139:86-99. [PMID: 34405857 DOI: 10.1093/bmb/ldab018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Greater trochanter pain syndrome (GTPS) is characterized by a persistent and debilitating pain around the greater trochanter. GTPS can be caused by a combination of gluteus medius or minimus tendinopathy, snapping hip or trochanteric bursitis. SOURCE OF DATA Recent published literatures identified from PubMed, EMBASE, Google Scholar, Scopus. AREAS OF AGREEMENT Platelet rich plasma (PRP) and corticosteroids (CCS) injections are useful options to manage symptoms of GTPS. AREAS OF CONTROVERSY Whether PRP leads to superior outcomes compared to CCS injections is unclear. GROWING POINTS A systematic review and meta-analysis comparing PRP versus CCS in the management of GTPS was conducted. AREAS TIMELY FOR DEVELOPING RESEARCH PRP injections are more effective than CCS at approximately 2 years follow-up.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Nardeen Kader
- Department of Orthopedics, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Rd, Epsom KT18 7EG, UK
| | - Jörg Eschweiler
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Markus Tingart
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital of Aachen, 52074 Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, 01782 Stoke on Trent, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
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9
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Kocaoglu B, Paksoy AE, Cerciello S, Ollivier M, Seil R, Safran M. Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes. Am J Sports Med 2021; 49:1570-1577. [PMID: 33793365 DOI: 10.1177/0363546521999678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months). RESULTS Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant (P < .001 to P = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups (P = .042); however, there was no significant difference between the SR and DR groups (P = .32) in terms of retear rates. CONCLUSION Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.
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Affiliation(s)
- Baris Kocaoglu
- Department of Orthopedic Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Ahmet Emre Paksoy
- Department of Orthopedic Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Simone Cerciello
- Casa di Cura Villa Betania, Rome, Italy.,Marrelli Hospital, Crotone, Italy
| | - Matthieu Ollivier
- Institute for Locomotion, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Romain Seil
- Clinique d'Eich, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.,Luxembourg Institute of Health, Strassen, Luxembourg
| | - Marc Safran
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, California, USA
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