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Hecht CJ, Lavu MS, Kaelber DC, Homma Y, Kamath AF. Association between abductor tears and hip pathology: A nationwide large cohort study. J Orthop 2024; 53:140-146. [PMID: 38601894 PMCID: PMC11002529 DOI: 10.1016/j.jor.2024.03.036] [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: 03/13/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Although gluteal tears have been observed in a substantial percentage of total hip arthroplasty (THA) patients and hip osteoarthritis (OA) has been shown to alter the function of the gluteal muscles, the association between gluteal tears and hip OA has not been characterized. Therefore, we evaluated (1) the overlap between hip OA and gluteal tears, (2) the relative risks of gluteal tears in patients who have hip OA, and (3) gluteal tear-free survival after diagnosis or treatment for hip osteoarthritis. Methods This retrospective study sourced data from TriNetX, a research network that aggregates data from over 92 million patients. Relative risks for gluteal tears were calculated for known risk factors for gluteal tears, age ≥45 years, female sex, and obesity, as well as for hip OA, hip injections, and THA. A subgroup analysis was performed utilizing a Cox proportional hazard model for patients who were diagnosed with hip OA, received a hip injection, or underwent THA in 2015 to assess gluteal tear-free survival over a 9-year timeframe. Results There was a large degree of overlap between patients with hip OA and gluteal tears, as 17.9% of patients with hip OA and 27.5% of patients with a gluteal tear also had the other pathology. Hip OA was associated with a markedly increased risk of a gluteal tear compared to healthy controls (Relative risk: 26.75, 95% CI: 26.64-26.86). Upon controlling for the established risk factors of gluteal tears, patients with hip OA had a markedly more likely to subsequently be diagnosed with an abductor tear (Hazard ratio: 12.46, 95% CI: 11.75-13.22). Conclusion Overall, these findings suggest a strong association between hip OA and the development of gluteal tears, in which further investigation is merited to determine the biomechanical pathophysiology underlying this potential relationship to inform prevention and treatment strategies.
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Affiliation(s)
- Christian J. Hecht
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Monish S. Lavu
- Department of Orthopaedics, Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - David C. Kaelber
- Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, 44106, USA
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, 44109, USA
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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Kaiser D, Hoch A, Sutter R, Zingg PO. Gluteus maximus tendon transfer as a salvage option for painful chronic hip abductor insufficiency: clinical and MRI results with a minimum follow-up of 24 months. Hip Int 2024; 34:240-247. [PMID: 37670460 PMCID: PMC10935620 DOI: 10.1177/11207000231197760] [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] [Accepted: 07/09/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Chronic hip abductor insufficiency is a rare debilitating condition. In cases refractory to conservative treatment and not amenable to direct repair an augmentation becomes necessary. The preferred salvage method at our institution is augmentation with the anterior third of the gluteus maximus tendon. The aim of this study is to describe the results of 8 patients, treated for painful chronic hip abductor insufficiency with gluteus maximus muscle transfer, after a minimal follow-up of 24 months including a full clinical and MRI evaluation of the hip abductors pre- and postoperatively. METHODS We retrospectively reviewed a consecutive series of 8 patients who were surgically managed for painful chronic hip abductor insufficiency. All patients had a Trendelenburg sign, impaired muscle strength (M ⩽ 3) as well as a complete avulsion of the hip abductors with marked fatty degeneration (⩾3). Pain levels, muscle strength, functional scores as well as a postoperative MRI was obtained after a minimal follow-up of 24 months. RESULTS The mean age of the patients was 69 years, mean follow-up was 35 (26-54) months. Pain was significantly reduced postoperatively to VAS 2.5 from VAS 5 (p = 0.046). Trendelenburg sign remained positive in all patients and hip abductor strength did not improve significantly from 2.4 to 3.1 (p = 0.19). Complete healing of the transferred tendon was confirmed by MRI in all patients at last follow-up. CONCLUSIONS In the setting of painful chronic hip abductor insufficiency refractory to conservative treatment with advanced muscle degeneration without the possibility of a direct reconstruction the gluteus maximus tendon transfer significantly decreased pain. The effect on hip abductor strength and patient-reported functional outcome scores is limited. Despite the modest results it remains our preferred salvage treatment option for lack of better alternatives. Larger studies are necessary to confirm these findings.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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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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Harper KD, Park KJ, Rodriguez-Perez MA, Lambert BS, Gilcrease-Garcia B, Sullivan TC, Incavo SJ. Clinical Outcomes for Open Hip Abductor Repair Using Tenodesis and Bone Trough Repair Techniques. J Arthroplasty 2022; 37:S444-S448. [PMID: 35227534 DOI: 10.1016/j.arth.2022.01.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/11/2022] [Accepted: 01/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip abductor complex tears remain an injury without a clear consensus on management. Surgical treatment has been recommended after unsuccessful nonoperative management. This study evaluates both tenodesis and bone trough techniques, with treatment choices guided by previously described tear classification. METHODS This is a retrospective cohort study of 45 hips in 44 patients who underwent surgical treatment for symptomatic, chronic hip abductor tear unresponsive to nonoperative treatment. Demographics and preoperative and postoperative values (including visual analog scale pain scores, gait assessment, and muscle strength) were evaluated. Type I tears were treated using tendon tenodesis. Type II tears were treated through a bone trough repair. RESULTS Forty-five hips (44 patients) were operated on with a minimum of 6-month follow-up. There were 27 type I and 18 type II tears. Eighty-seven percent of patients were female. Twenty-eight percent of type II patients (5/18) had a preexisting arthroplasty in place. Significant improvements in pain (P < .001), gait (P < .001), and muscle strength (P < .001) were achieved in both the tear types. Type I repairs showed superior results to type II repairs. However, both showed significant improvements. Postoperative magnetic resonance imaging at 6 months showed healed tenodesis in 81% (17/21) of type I tears and 50% (5/10) of type II tears. CONCLUSION Our study shows improvement in pain and function after surgical repair of hip abductor tendon injuries in both simple and complex tears. This improvement is seen even during ongoing surgical site healing. Magnetic resonance imaging findings may remain abnormal for more than 1 year after surgery and do not clearly denote repair failure.
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Affiliation(s)
- Katharine D Harper
- Washington DC VA Medical Center, Department of Orthopedic Surgery Center, Washington, DC
| | - Kwan J Park
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX
| | | | - Bradley S Lambert
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX
| | - Brian Gilcrease-Garcia
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX
| | - Thomas C Sullivan
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX
| | - Stephen J Incavo
- Houston Methodist Hospital, Houston Methodist Orthopedics & Sports Medicine, Houston, TX
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Tsutsumi M, Nimura A, Akita K. Clinical anatomy of the musculoskeletal system in the hip region. Anat Sci Int 2021; 97:157-164. [PMID: 34686966 PMCID: PMC8817995 DOI: 10.1007/s12565-021-00638-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/15/2021] [Indexed: 01/09/2023]
Abstract
Although the hip joint is regarded as inherently stable, hip pain and injuries caused by traumatic/non-traumatic hip instability are relatively common in active individuals. A comprehensive understanding of hip anatomy may provide better insight into the relationships between hip stability and clinical problems. In this review, we present our recent findings on the hip morphological characteristics, especially focusing on the intramuscular tendon of the gluteus medius tendon and its insertion sites, hip capsular attachment on the anterosuperior region of the acetabular margin, and composition of the iliofemoral ligament. We further discussed the hip stabilization mechanism based on these findings. The characteristics of the gluteus medius tendon suggest that even a single muscle has multiple functional subunits within the muscle. In addition, the characteristics of the hip capsular attachment suggest that the width of the capsular attachment is wider than previously reported, and its wide area shows adaptive morphology to mechanical stress, such as bony impression and distribution of the fibrocartilage. The composition of the iliofemoral ligament and its relation to periarticular structures suggest that some ligaments should be defined based on the pericapsular structures, such as the joint capsule, tendon, and aponeurosis, and also have the ability to dynamically coordinate joint stability. These anatomical perspectives provide a better understanding of the hip stabilization mechanism, and a biomechanical study or an in vivo imaging study, considering these perspectives, is expected in the future.
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Affiliation(s)
- Masahiro Tsutsumi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan.
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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White LM, Oar DA, Naraghi AM, Griffin A, Safir OA. Gluteus minimus tendon: MR imaging features and patterns of tendon tearing. Skeletal Radiol 2021; 50:2013-2021. [PMID: 33779785 DOI: 10.1007/s00256-021-03745-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To highlight the spectrum of pathology and patterns of gluteus minimus tendon tearing observed on MR imaging of the hip. METHODS AND MATERIALS Retrospective review of consecutive hip MRI exams with findings of gluteus minimus tendon (GMin) pathology. A total of 194 exams in 178 patients (148 female, mean age 61) were reviewed. MRI exams are assessed for GMin: tendinopathy, partial, or complete tendon tears. GMin muscular fatty atrophy, enthesopathic cortical irregularities of the greater trochanter (GT), and peri-trochanteric edema or bursal fluid collections were assessed in all cases. In all cases of complete GMin tendon tearing, position and relationship of GMin tendon were assessed relative to its normal insertion site and adjacent soft tissues. RESULTS Clinical indications for MR imaging included hip pain (n = 151), and weakness or altered gait (n = 13). Insertional GMin tendinopathy was seen in 72, partial tearing in 81, and complete tendon tearing in 40 cases. Complete tendon tearing without proximal retraction was observed in 38/40 cases with soft tissue continuity visualized between distal tendon fibers and the proximal vastus lateralis muscle. Peri-trochanteric bursal fluid (n = 61), osseous irregularities of the GT (n = 118), and fatty atrophy GMin (n = 102) were statistically associated with partial or complete GMin tendon tearing (p < 0.001). CONCLUSIONS The spectrum of GMin tendon pathology observed on MR imaging ranges from tendinopathy to complete tears. The majority of complete distal GMin tendon tears from the greater trochanter show continuity of distal tendon fibers with the proximal vastus lateralis, distally tethering and limiting proximal tendon retraction.
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Affiliation(s)
- Lawrence M White
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada. .,Joint Department of Medical Imaging, Mount Sinai Hospital, 600 University Ave, Rm 562-A, Toronto, Ontario, M5G 1X5, Canada.
| | - David A Oar
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital, 600 University Ave, Rm 562-A, Toronto, Ontario, M5G 1X5, Canada
| | - Ali M Naraghi
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital, 600 University Ave, Rm 562-A, Toronto, Ontario, M5G 1X5, Canada
| | - Anthony Griffin
- Department of Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Oleg A Safir
- Department of Orthopedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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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.
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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
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