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Jackson T, Wright D, Long C, Truong V, Adamson G, McGarry MH, Lee TQ. The Gluteus Medius Experiences Significant Excursion With Hip Flexion. Arthrosc Sports Med Rehabil 2023; 5:100745. [PMID: 37645402 PMCID: PMC10461148 DOI: 10.1016/j.asmr.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/11/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To evaluate the effect of hip flexion and rotation on excursion of the gluteus medius (Gmed) and minimus (Gmin) myotendinous unit. Methods Seven hips from 4 cadaveric specimens (males, 68.5 ± 18.3 years old) were dissected to isolate the Gmed posterior and lateral insertions and the Gmin proximal and distal insertions. Sutures were placed from tendon insertions through origins created in the iliac fossa to simulate the myotendinous unit. A load of 10N was applied. Myotendinous excursion was measured at 10° hip extension and 0°, 45°, and 90° of hip flexion in neutral rotation, and from maximum internal and external rotation in 90° flexion. The amount of abduction and rotation was also measured at each flexion position with 20N applied to each tendon. Repeated-measures analysis of variance with Tukey post hoc was used for statistics. Results Gmed-lateral excursion ranged from 2.4 ± 0.4 mm in 10° of hip extension to 23.0 ± 1.5 mm in 90° of flexion (P < .001), and Gmed-posterior excursion ranged from 0.92 ± 0.5 mm in 10° of extension to 38.1 ± 1.1 mm in 90° of flexion (P < .001). Gmin excursion shortened with hip flexion from 4.2 ± 0.3 mm in 10° of extension to -0.2 ± 1.5 mm in 90° of flexion (Gmin-prox: P = .525, Gmin-distal: P < .001). At 90° flexion from maximum internal to maximum external rotation, Gmin-distal and proximal demonstrated a 92.6% and 51.3% increase in excursion, respectively (P < .001). Gmed-lateral and Gmed-posterior demonstrated 49.4% and 23.1% increase in excursion with external rotation, respectively (P < .001). Conclusions The Gmed myotendinous unit undergoes significant excursion with hip flexion, whereas both Gmed and Gmin had significant excursion with femoral external rotation in 90° flexion. Clinical Relevance It is important to understand whether active or passive hip flexion or rotation in the early postoperative period causes excessive strain to an abductor tendon repair. We found that consideration should be given to limit flexion after Gmed repair and external rotation after Gmed or Gmin repairs.
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Affiliation(s)
- Timothy Jackson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - David Wright
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Charles Long
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Victor Truong
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Gregory Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Michelle H. McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Thay Q. Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
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Zhu MF, Smith B, Krishna S, Musson DS, Riordan PR, McGlashan SR, Cornish J, Munro JT. The pathological features of hip abductor tendon tears - a cadaveric study. BMC Musculoskelet Disord 2020; 21:778. [PMID: 33243210 PMCID: PMC7690166 DOI: 10.1186/s12891-020-03784-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/10/2020] [Indexed: 01/06/2023] Open
Abstract
Background The hip abductors are crucial in maintaining pelvic stability. Tears in these tendons are common and often debilitating. There is uncertainty regarding both the histological and macroscopic features of hip abductor tears. This study aims to clarify both the macroscopic and microscopic features of the tendon and enthesis in hip abductor tendon tears. Methods Thirty-six cadavers with an average age of 81 were dissected, and the hip abductor mechanisms removed en-bloc. The presence, location and size of the tears were recorded and analysed. The samples were processed into histological blocks and viewed using both transmitted and polarised light. Tendon histology was graded using the modified Movin’s score in three sections (deep, middle and superficial layers) and the enthesis graded separately using 5-point criteria. Analysis of variance was used to confirm histological features associated with tears. Results Tears were found in 24 of 36 samples (67%). The most common finding was an isolated tear in the gluteus minimus (46%), followed by concurrent gluteus medius and gluteus minimus tears (33%). Histology revealed significantly more degeneration in both the tendon (p = 0.0005) and enthesis (p = 0.0011) when tears were present. Furthermore, these changes were concentrated in the deeper layers of the tendon (p = 0.0002) and enthesis (p = 0.003). Conclusion This study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. Degenerative changes occur in both the tendon and enthesis, with the deeper layers predominantly affected. These findings are important for guiding surgical repair techniques and to aid the development of novel materials and biologics. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03784-3.
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Affiliation(s)
- Mark F Zhu
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand. .,Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand.
| | - Brittany Smith
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Sanjeev Krishna
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - David S Musson
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Peter R Riordan
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, New Zealand
| | - Sue R McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, New Zealand
| | - Jillian Cornish
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Jacob T Munro
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand
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A Technique for Endoscopic in Situ Repair of Undersurface Hip Abductor Tears. Arthrosc Tech 2020; 9:e1831-e1836. [PMID: 33294348 PMCID: PMC7695751 DOI: 10.1016/j.eats.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023] Open
Abstract
Endoscopic repair of hip abductor tendons has been shown to have equivalent outcomes and lower complication rates compared with open repair. First reported in 2007, endoscopic repair has become more frequent, with multiple techniques previously described. Frequently, hip abductor tears involve a partial-thickness undersurface component that has been previously addressed endoscopically by making a longitudinal split in the tendon to access the diseased tissue. However, we present a technique for addressing these undersurface tears in situ, accessing the undersurface of the tear by coming under the distal anterior edge of the gluteus medius tendon.
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Longstaffe R, Dickerson P, Thigpen CA, Shanley E, Kissenberth MJ, Folk J, Pill SG. Both open and endoscopic gluteal tendon repairs lead to functional improvement with similar failure rates: a systematic review. J ISAKOS 2020; 6:28-34. [PMID: 33833043 DOI: 10.1136/jisakos-2020-000474] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/12/2020] [Accepted: 07/29/2020] [Indexed: 11/03/2022]
Abstract
IMPORTANCE Operative treatment of gluteal tendon tears is becomingly increasingly more common with varying surgical techniques and rehabilitation protocols. OBJECTIVE To perform a systematic review of gluteal tendon repair as it relates to tear characteristics, rehabilitation protocols, patient-reported outcomes, satisfaction, resolution of gait deviation and complication rates. EVIDENCE REVIEW A comprehensive literature search of PubMed and Embase/MEDLINE was used to identify all literature pertaining to gluteal tendon repair. A total of 389 articles were identified. FINDINGS A total of 22 studies (611 hips) were included in this review. The majority of tears were noted to be partial thickness (77.9% vs 22.1%). Both arthroscopic and open repair demonstrated improvements in functional outcomes. Within studies documenting gait deviation, 54% were noted to have gait deviation preoperatively, of which approximately 70% had resolution following repair. On average, abduction strength increased almost one whole grade (0.84) following repair. Overall complication rate was found to be 5.2% (20 of 388 hips). Endoscopic repair demonstrated a decreased complication rate compared with open (0.7% vs 7.8%). Retear rate was found to be 3.8%, with open repair having a slightly increased rate compared with endoscopic repair (3.4% vs 4.1%). CONCLUSIONS AND RELEVANCE The majority of tears tend to be partial thickness with involvement of gluteus medius in almost all cases and concomitant involvement of gluteus minimus in close to half of cases. Both endoscopic and open gluteal tendon repairs resulted in improvements in outcomes and functional improvement. Retear rates were similar between the two repair techniques, while endoscopic repair demonstrated a lower complication rate. LEVEL OF EVIDENCE Level IV, systematic review.
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Affiliation(s)
- Robert Longstaffe
- University of Manitoba Department of Surgery, Section Orthopaedics, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Patrick Dickerson
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
| | - Charles A Thigpen
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA.,ATI Physical Therapy, Greenville, South Carolina, USA
| | - Ellen Shanley
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA.,ATI Physical Therapy, Greenville, South Carolina, USA
| | - Michael J Kissenberth
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
| | - Jason Folk
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
| | - Stephan G Pill
- Prisma Health Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina, USA
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Abstract
Abductor tendon lesions and insertional tendinopathy are the most common causes of lateral thigh pain. Gluteal tendon pathology is more prevalent in women and frequency increases with age. Chronic atraumatic tears result in altered lower limb biomechanics. The chief complaint is lateral thigh pain. Clinical examination should include evaluation of muscle strength, lumbar spine, hip and fascia lata pathology. The hip lag sign and 30-second single leg stance tests are useful in diagnosing abductor insufficiency. Magnetic resonance imaging (MRI) is the gold-standard investigation to identify abductor tendon tears and evaluate the extent of muscle fatty infiltration that has predictive value on the outcome of abductor repair. Abductor tendinosis treatment is mainly conservative, including non-steroidal anti-inflammatory medications, activity modification, local corticosteroid injections, plasma-rich protein, physical and radial shockwave therapy. The limited number of available high-quality studies on treatment outcomes and limited evidence between tendinosis and partial ruptures make it difficult to provide definite conclusions regarding the best management of gluteal tendinopathy. Surgical management is indicated in complete and partial gluteal tendon tears that are unresponsive to conservative treatment. There are various open and arthroscopic surgical procedures for direct repair of abductor tendon tears. There is limited evidence concerning surgical management outcomes. Prerequisites for effective tendon suturing are neurologic integrity and limited muscle fatty infiltration. Chronic irreparable tears with limited muscle atrophy and limited fatty infiltration can be augmented with grafts. Gluteus maximus or/vastus lateralis muscle transfers are salvage reconstruction procedures for the management of chronic end-stage abductor tears with significant tendon insufficiency or gluteal atrophy.
Cite this article: EFORT Open Rev 2020;5:464-476. DOI: 10.1302/2058-5241.5.190094
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Affiliation(s)
- Eustathios Kenanidis
- Hôpital de la Tour, Geneva, Switzerland.,Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Centre of Orthopaedics and Regenerative Medicine (CORE) - Centre of Interdisciplinary Research and Innovation (CIRI) - Aristotle University Thessaloniki, Greece
| | - George Kyriakopoulos
- Hôpital de la Tour, Geneva, Switzerland.,Gennimatas General Hospital, Cholargos, Athens, Greece
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Nazal MR, Abraham PF, Conaway WK, Quinlan NJ, Gillinov SM, Gibbs JS, Upadhyaya S, Alpaugh K, Martin SD. Endoscopic Repair of Full-Thickness Gluteus Medius and Minimus Tears-Prospective Study With a Minimum 2-Year Follow-Up. Arthroscopy 2020; 36:2160-2169. [PMID: 32387651 DOI: 10.1016/j.arthro.2020.04.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the short-term outcomes of endoscopic repair of full-thickness gluteus medius and minimus tendon tears with a minimum of 2-year follow-up and add to the paucity of literature on abductor tendon tears. METHODS All patients who underwent endoscopic abductor tendon repair between December 2013 and August 2017 were prospectively evaluated. The inclusion criteria for this study were primary full-thickness gluteal tendon tears and at least 2-years of follow-up. Clinical outcome data consisted of visual analog scale (VAS) pain score, hip abduction strength, Trendelenburg sign, complications, and patient-reported outcome measures (PROMs): modified Harris Hip Score, Hip Outcome Score, Non-arthritic Hip Scale, International Hip Outcome Tool-33, and Lower Extremity Functional Scale. RESULTS A total of 15 hips, all full-thickness tears, met inclusion criteria with an average follow-up of 31.2 months, with no patients being excluded. On physical examination, there was a significant improvement in VAS pain score from 5.36 to 2.43 (P = .0243), hip abduction strength with 8 (53.3%) hips improving by at least 1 point (P = .02056), and resolution of Trendelenburg sign in all 15 hips at 2-years (P = .0019). The mean difference for all 6 PROMs was statistically significant, even after Bonferroni adjustment, with the majority of patient improvement exceeding the minimal clinically important difference (MCID) thresholds: modified Harris Hip Score: 86.67%, Hip Outcome Score-ADL: 86.67%, Hip Outcome Score-SSS: 66.67%, Non-arthritic Hip Scale: 93.33%, and International Hip Outcome Tool-33: 80%. Greater Goutallier grade was associated with a greater VAS pain score. There were no complications, including no retears. CONCLUSIONS In this study of 15 hips with full-thickness gluteal tendon tears managed endoscopically, we found excellent outcomes that exceeded the MCID thresholds in the majority of patients at an average of 31.2 months follow-up, while offering the potential advantages of less tissue violation, ambulatory day surgery, and fewer complications compared with open repair. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Mark R Nazal
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A..
| | - Paul F Abraham
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A
| | - William K Conaway
- Orthopedic Surgery Residency Program, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
| | - Noah J Quinlan
- Orthopaedic Surgery Residency, University of Utah, Salt Lake City, Utah, U.S.A
| | - Stephen M Gillinov
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A
| | - Jada S Gibbs
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A
| | - Shivam Upadhyaya
- Harvard Combined Orthopedic Residency Program, Boston, Massachusetts, U.S.A
| | - Kyle Alpaugh
- Orthopaedic Surgery Residency, University of Massachusetts, Worcester, Massachusetts, U.S.A
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, U.S.A
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7
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Parker EA, Meyer AM, Laskovski JR, Westermann RW. Endoscopic Gluteus Medius Repair With an ITB-Sparing Versus ITB-Splitting Approach: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120922196. [PMID: 32548182 PMCID: PMC7249574 DOI: 10.1177/2325967120922196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background: During hip endoscopy, the iliotibial band (ITB) can be split or preserved to
access the peritrochanteric workspace. To our knowledge, no comparative
studies have been performed to analyze patient-reported outcomes (PROs) and
surgical failure rates (gluteus medius retear and/or revision surgery rates)
for ITB-sparing versus ITB-splitting approaches in endoscopic gluteus medius
repairs. Purpose: To perform a systematic review and meta-analysis of the literature to
evaluate PROs and failure rates of patients undergoing ITB-sparing versus
ITB-splitting repairs of the gluteus medius. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by following PRISMA (Preferred Reporting
Items for Systematic Meta-Analyses) guidelines and using the PubMed,
Cochrane CENTRAL, and Embase databases. The quality of evidence was
evaluated using the modified Coleman Methodology Score. Level 1-4 studies
were evaluated for endoscopic abductor repair techniques on all types of
gluteus medius tears. Given the small number of studies and varying
population sizes, all quantitative data were adjusted for study population
size. Results: A total of 13 studies met our inclusion criteria, while more granular data,
including ITB approach, were available for 8 studies. Because of the paucity
of literature on the subject, all included studies were of lower quality per
the modified Coleman Methodology Score. The visual analog scale for pain,
the modified Harris Hip Score (mHHS), and the surgical failure rates were
compared between approaches. Patients who underwent ITB splitting had a
significantly greater change in mHHS (45.5 ± 4.6 vs 27.3 ± 6.5;
P < .001) and lower surgical failure rates (3.67 ±
2.33 vs 4.75 ± 2.54; P = .04). There was no significant
difference in change in visual analog scale for splitting versus sparing
(4.26 ± 0.41 vs 4.39 ± 0.14; P = .96). The results may have
been biased by between-group differences, such as patients who undergo ITB
sparing being significantly younger. Conclusion: Endoscopic gluteus medius repair is a reliable procedure to improve pain and
function in appropriately selected patients. This study highlighted the lack
of high-quality literature available regarding ITB approach. However, the
evidence to date has suggested that ITB approach may influence hip-specific
PROs. Splitting the ITB during abductor repair may be associated with a
greater improvement in mHHS and lower surgical failure rates. Further
prospective comparative studies are warranted to evaluate the effect of ITB
approach.
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Affiliation(s)
- Emily A Parker
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | - Alex M Meyer
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | | | - Robert W Westermann
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
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8
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Hapa O, Işın Y, Toklong M, Hüsemoğlu B, Edizer M, Havitçioğlu H. Bare area on the trochanter and its correlations to gluteal tendon insertion dimensions. J Hip Preserv Surg 2020; 7:38-42. [PMID: 32382427 PMCID: PMC7195920 DOI: 10.1093/jhps/hnaa001] [Citation(s) in RCA: 2] [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: 04/30/2019] [Revised: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 01/08/2023] Open
Abstract
Gluteus medius and minimus tears have recently been reported to be very common and the main etiology of lateral sided hip pain. The purpose of this study was to determine whether there is any correlation between the dimensions of the tendon insertions and bare areas (BA) and various bony landmarks. Twenty-seven hemipelvises from adult male hips were included. The bony landmarks [anterior tip (Ta), posterior tip of trochanter, vastus tubercle (VT) and center of BA] were marked. The longitudinal lengths and widths (maximum) of posterosuperior (PS), lateral facets (LF), minimus insertion (Min) and BA and the distance between posterior (Tp) and Ta and between anterior/posterior tips and the VT or center of BA were measured using a digital caliper. A correlation analysis was performed between variables. There was a correlation between LFlength and Minlength (r = 0.4, P = 0.01) and between Ta-BA and PS + LF (r = 0.5, P = 0.003) or Minlength (r = 0.4, P = 0.016). LFwidth was negatively correlated with BAwidth (r = -0.4, P = 0.002). Tp-BA was negatively correlated with BAwidth (r = -0.4, P = 0.01). LFwidth was correlated with Tp-BA, and this nearly reached statistical significance (r = 0.3, P = 0.05). BA can be used intraoperatively as landmarks to estimate the width of the LF and also to determine the length of the longitudinal insertion of the gluteus medius and minimus tendons.
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Affiliation(s)
| | | | | | | | - Mete Edizer
- Department of Anatomy, Dokuz Eylül University, 35340, İzmir, Turkey
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9
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Ebert JR, Brogan K, Janes GC. A Prospective 2-Year Clinical Evaluation of Augmented Hip Abductor Tendon Repair. Orthop J Sports Med 2020; 8:2325967119897881. [PMID: 32030347 PMCID: PMC6977235 DOI: 10.1177/2325967119897881] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/03/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome. Studies reporting surgical outcomes are often on small cohorts and with limited information on functional improvement. Purpose: To report the 2-year clinical and functional outcomes in a series of patients undergoing HAT repair augmented with a ligament augmentation and reconstruction system (LARS) ligament. Study Design: Case series; Level of evidence, 4. Methods: Between October 2012 and December 2016, a total of 142 patients with symptomatic HAT tears underwent open bursectomy, V-Y lengthening, and reattachment of the tendon with suture anchors augmented with a LARS ligament. This included 132 women (93%) with a mean age of 64.3 years (range, 43-84 years), a mean body mass index of 28.2 kg/m2 (range, 20.0-41.3 kg/m2), and an average duration of symptoms of 4.0 years (range, 6 months-20 years). Following surgery, patients underwent a graduated rehabilitation program consisting of hydrotherapy and land-based exercises. Patient-reported outcome measures (PROMs) were evaluated preoperatively and at 3, 6, 12, and 24 months postoperatively with the Harris Hip Score, Oxford Hip Score, 12-item Short Form Health Survey, and visual analog scale (VAS) for pain. Hip range of motion, hip abduction strength, 30-s single-leg stance (SLS), and 6-minute walk test (6MWT) capacity were evaluated. Patient satisfaction and perceived global rating of change were evaluated postsurgery. Analysis of variance was employed to evaluate clinical improvement over time. Results: A significant improvement (P < .05) was demonstrated up to 24 months in all PROMs and clinical scores, including hip range of motion in all planes, hip abductor strength limb symmetry indices (mean ± SD; presurgery, 90.1% ± 42.5%; 24 months, 102.6% ± 15.0%), and the 6MWT (presurgery, 421.8 ± 91.9 m; 24 months, 509.7 ± 105.1 m). Furthermore, several variables, including pain (VAS and pain scores during the 6MWT and 30-s SLS) and patient-perceived improvement (global rating of change), continued to improve from 12 to 24 months. At 24 months, 95.7% of patients were satisfied with their surgical outcome (excluding 3 patients who underwent reoperation within the 24-month period). There was a 5.6% (n = 8) failure rate over the study period. Conclusion: HAT repair augmented with a synthetic ligament demonstrated significantly improved clinical and functional outcomes, high levels of patient satisfaction, and a relatively low failure rate up to 24 months postsurgery. Registration: ACTRN12616001655437 (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Australia.,HFRC Rehabilitation Clinic, Nedlands, Australia
| | - Kit Brogan
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia
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10
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Suppauksorn S, Nwachukwu BU, Beck EC, Okoroha KR, Nho SJ. Superior Gluteal Reconstruction for Severe Hip Abductor Deficiency. Arthrosc Tech 2019; 8:e1255-e1261. [PMID: 32042581 PMCID: PMC7000343 DOI: 10.1016/j.eats.2019.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/25/2019] [Indexed: 02/03/2023] Open
Abstract
Abductor tendon tears are one of the common causes of recalcitrant laterally based hip pain and dysfunction. In most cases, abductor tendon tears are associated with chronic nontraumatic tearing of the gluteus medius tendon. Restoring abductor function of the hip by primary repair of the gluteus medius tendon has been reported to have good and excellent outcomes. However, primary repair might not be as effective for chronic detachment of the gluteus medius tendon with a wide separation from the femoral footprint or severe tendon loss. The lack of tendinous foot for repair and the intrinsically degenerative condition of the tendon may create high tension at the repair site thereby predisposing to surgical failure. We believe that the use of soft-tissue allograft from the Achilles tendon or human dermal allograft may help strengthen the surgical site. We describe a superior gluteal reconstruction technique that is suitable for cases with abductor tendon tear with severe tendon loss.
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Affiliation(s)
- Sunikom Suppauksorn
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U. Nwachukwu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C. Beck
- Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Kelechi R. Okoroha
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J. Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
- Address correspondence to Shane J. Nho, M.D., M.S., Department of Orthopaedics, Rush University Medical Center, 1611 West Harrison St., Suite 300, Chicago, IL 60612, U.S.A.
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11
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