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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: 5] [Impact Index Per Article: 5.0] [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.
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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
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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.
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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
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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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Vogel MJ, Jan K, Alvero AB, Gilat R, Ebersole JW, Nho SJ. Gluteus Repair Yields Satisfactory Clinically Significant Outcome Achievement by 1 Year in Mostly Partial-Thickness Tears With Preoperative Hip Abduction Weakness Associated With Delayed Achievement. Arthroscopy 2024:S0749-8063(24)00231-7. [PMID: 38508287 DOI: 10.1016/j.arthro.2024.02.044] [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: 12/22/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To define the time to achievement of clinically significant outcomes (CSOs) after primary gluteus medius and/or minimus (GM) repair and to identify factors associated with delayed CSO achievement. METHODS Patients who underwent primary GM repair between January 2012 and June 2021 with complete preoperative, 6-month, 1-year, and 2-year Hip Outcome Score-Activities of Daily Living (HOS-ADL) were retrospectively identified. Cohort-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated. The time to achievement of MCID and PASS was analyzed using Kaplan-Meier survival analysis. Median time to MCID and PASS achievement was recorded. Multivariate stepwise Cox regressions were used to identify factors associated with delayed CSO achievement. RESULTS Fifty GM repairs were identified (age 59.4 ± 9.7 years, body mass index 27.9 ± 6.2, 94% female). Tears were grade 1 in 39 cases, grade 2 in 7 cases, and grade 3 in 4 cases. Endoscopic repair was performed in 35 cases, and open repair was performed in 15 cases. Labral debridement and repair were each performed in 15 cases. Median time to CSO achievement was 5.7 months for MCID and 11.0 months for PASS. The 2-year cumulative probability of MCID and PASS achievement was 92.7% and 66.7%, respectively. Preoperative hip abduction weakness on physical examination was associated with delayed achievement of MCID (hazard ratio 2.27, confidence interval 1.067-7.41, P = .039) and PASS (hazard ratio 3.89, confidence interval 1.341-11.283, P = .012). CONCLUSIONS This study demonstrated that in patients undergoing repair of primarily grade 1 GM tears, most achieved MCID by 6 months, and more than one half achieved PASS by 12 months. Preoperative hip abduction weakness on physical examination was associated with delayed CSO achievement. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Michael J Vogel
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery.
| | - Kyleen Jan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery
| | - Alexander B Alvero
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery
| | - Ron Gilat
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery; Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - John W Ebersole
- Department of Musculoskeletal Radiology, 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
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Larson JH, Brusalis CM, Allahabadi S, Fenn TW, Chapman RS, Browning RB, Kaplan DJ, Nho SJ. Outcomes of Isolated Endoscopic Gluteal Tendon Repair Compared With Concomitant Endoscopic Gluteal Tendon Repair and Arthroscopic Hip Labral Repair: A Propensity-Matched Analysis With Minimum 2-Year Follow-up. Orthop J Sports Med 2024; 12:23259671231215340. [PMID: 38379577 PMCID: PMC10878227 DOI: 10.1177/23259671231215340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 02/22/2024] Open
Abstract
Background Both gluteal and labral tears are common sources of hip pain, but no studies have evaluated how concomitant arthroscopic labral repair and correction of femoroacetabular impingement syndrome (FAIS) affect outcomes after endoscopic gluteus/minimus repair. Purpose (1) To compare patient-reported outcomes (PROs) and clinically significant outcomes achievements between patients who underwent endoscopic gluteus medius/minimus and arthroscopic hip labral repair with correction of FAIS versus endoscopic gluteus medius/minimus repair without labral repair and (2) to define threshold scores required to achieve the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Specific, modified Harris Hip Score (mHHS), 12-item international Hip Outcome Tool, and visual analog scale for pain in these patients. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent primary endoscopic gluteus medius/minimus repair between 2012 and 2020 were identified. Those who underwent concomitant arthroscopic labral repair and correction of FAIS with femoroplasty or acetabuloplasty as indicated were propensity matched in a 1 to 1 ratio by sex, age, and body mass index to patients who underwent gluteus medius/minimus repair without labral repair. Patients who completed the study PROs were assessed preoperatively and at 2 years postoperatively. Threshold scores required to achieve the MCID and PASS thresholds were calculated. Results A total of 32 patients who underwent simultaneous gluteal and labral repair (G+L) were matched to 32 patients who underwent gluteal repair without labral repair (G); 75% of patients in the G cohort underwent labral debridement, while 25% in this cohort received no labral treatment. A significant difference was observed between groups in preoperative mHHS scores (G+L, 54.4 ± 12.9 vs G, 46.3 ± 14; P = .048) but no differences in any other PRO scores (P≥ .207). The MCID/PASS thresholds were as follows: Hip Outcome Score-Activities of Daily Living (11.14/83.82), Hip Outcome Score-Sports Specific (16.07/59.72), mHHS (11.47/70.95), 12-item international Hip Outcome Tool (13.73/45.49), and visual analog scale for pain (14.30/22). There were no significant differences in MCID or PASS achievement rates between the 2 groups (P≥ .108). Conclusion Patients who underwent combined G+L demonstrated comparable PROs and clinically significant outcomes achievement rates to patients who underwent G, highlighting sustained successful outcomes for patients with gluteal tendon pathology and concomitant FAIS and labral tears.
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Affiliation(s)
- Jordan H. Larson
- 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, USA
| | - Christopher M. Brusalis
- 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, USA
| | - 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, USA
| | - 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, USA
| | - 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, USA
| | - 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, USA
| | - Daniel J. Kaplan
- 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, USA
| | - 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, USA
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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.
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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
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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.
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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.
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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.
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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
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Zügner R, Hjelmberg N, Rolfson O, Strömberg C, Saari T. Gluteus Maximus Transfer following Total Hip Arthroplasty Does Not Improve Abductor Moment: A Case-Control Gait Analysis Study of 15 Patients with Gluteus Medius Disruption. J Clin Med 2022; 11:jcm11113172. [PMID: 35683559 PMCID: PMC9181114 DOI: 10.3390/jcm11113172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 02/01/2023] Open
Abstract
Gluteus maximus flap transfer (GMT) is a surgical technique used to improve gait kinematics and kinetics, as well as to reduce and ameliorate the functional outcome in patients with hip abductor deficiency following total hip arthroplasty (THA). The purpose of this observational study was to evaluate the gait pre- and postoperatively and examine whether GMT increases the abduction moment. Materials and Methods: A gait analysis based on reflective markers and force plates was performed in 15 patients who underwent GMT and were examined using an optical tracking system before and at a minimum of 13 months after the operation. The median follow-up time was 24 (13−60) months. The primary outcome was hip abduction moment (Nm/kg) during gait. The control group consisted of 15 female subjects without any gait pathology. Results: The mean adduction moment was significantly higher compared with controls before the operation (p = 0.02), but this did not apply to the abduction moment (p = 0.60). At the group level, the abduction moment did not improve postoperatively (p = 0.30). Only six of fifteen patients slightly improved their hip abduction moment postoperatively. However, speed (0.74 to 0.80 m/s) and cadence (94 to 105 steps/min) were improved (p < 0.03). Discussion: The results of this study showed no improvement in the hip abduction moment after GMT surgery. In our experience, abduction deficiency following primary THA is still a difficult and unsolved problem.
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Affiliation(s)
- Roland Zügner
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Correspondence: ; Tel.: +46-703–101863
| | - Natalie Hjelmberg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Christer Strömberg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
| | - Tuuli Saari
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden; (N.H.); (O.R.); (C.S.); (T.S.)
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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Maldonado DR, Fox JD, Kyin C, Jimenez AE, Saks BR, Curley AJ, Lall AC, Domb BG. Maximal Outcome Improvement Willingness Thresholds Are Predictive of a Patient’s Willingness to Undergo the Same Surgery, in Retrospect, Given the Known Outcome of Their Primary Hip Arthroscopy. Arthrosc Sports Med Rehabil 2022; 4:e1007-e1013. [PMID: 35747669 PMCID: PMC9210379 DOI: 10.1016/j.asmr.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/11/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To determine the percent maximal outcome improvement willingness thresholds (MOWTs) for the Nonarthritic Hip Score (NAHS) and the visual analog scale (VAS) for pain that were associated with a patient’s willingness to undergo surgery, in retrospect, given the known outcome of their primary hip arthroscopy with concomitant endoscopy for gluteus medius (GM) tear repair. Methods An anchor question was provided to patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome with concomitant endoscopic GM tear repair between April 2008 to April 2020. Patients were included if they answered the anchor question and had baseline and postoperative minimum 1-year follow-up scores for the NAHS and VAS. Patients were excluded if they had a previous ipsilateral hip surgery, Tönnis grade >1, hip dysplasia, previous hip conditions, or a preoperative score that was already at the maximum value for the NAHS and VAS scores. Receiver operating characteristic (ROC) analysis was used to determine the MOWT. Significance was indicated by a P value <.05. Results A total of 107 patients (107 hips) were included, with 101 (94.4%) females and 6 (5.6%) males. The average age and body mass index was 56.20 ± 9.88 years and 28.80 ± 4.92 kg/m2, respectively. The average follow-up time was 54.89 ± 29.52 months. The ROC analysis determined that the MOWT for the mHHS and VAS were 54.7%, and 62.6%, respectively. The probability of a patient being willing to undergo surgery again if they met the MOWT was 85.8% and 85.6% for the NAHS and VAS, respectively. Conclusion The MOWTs that were predictive of willingness to undergo surgery again following primary hip arthroscopy with concomitant endoscopy for GM tear repair were 54.7% and 62.6% for the NAHS, and VAS, respectively. Clinical Relevance Outcome assessment has been a point of increasing emphasis in hip preservation surgery. Having a tool to measure whether patients would go through the process of surgery again knowing their current outcome status is important to understanding outcomes after surgery.
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Maldonado DR, Youssefzadeh KA, Wydra F, Sherman B, Gerhardt MB. High Prevalence of Lumbosacral Pathology in Patients with Greater Trochanteric Pain Syndrome. Arthroscopy 2022; 38:1189-1192. [PMID: 34601010 DOI: 10.1016/j.arthro.2021.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish prevalence of lumbar and lumbosacral pathologies in patients with hip abductor tendon disorders. METHODS A retrospective review of patients' charts was conducted over a 5-year period, January 2013 to October 2018, using the S76 and M76 International Classification of Diseases Tenth Revision (ICD-10) codes. Patients with symptomatic and radiologically confirmed hip abductor tendon disorders (partial and full-thickness tear of the gluteus medius tear with or without gluteus minimus tearing) were included in the study. No exclusion criteria were applied. Patient medical history was examined for concurrent diagnoses of lumbar and lumbosacral pathologies (radiculopathy, lumbar stenosis, degenerative disc disease, and neurogenic claudication). RESULTS One-hundred and three patients with hip abductor tendon disorders were identified. Forty-seven (45.6%) patients had low-grade partial abductor tears, while 56 (54.4%) of patients had a high-grade partial or complete abductor tear. Fifty (48.5%) patients carried a concomitant lumbosacral diagnosis, with 20 (19.4%) patients being diagnosed with lumbar stenosis and 45 (43.7%) being diagnosed with degenerative disc disease. CONCLUSION Patients with hip abductor tendon disorders were associated with a high prevalence of underlying lumbar and lumbosacral pathologies. Nevertheless, a causal relationship between these conditions cannot be established. LEVEL OF EVIDENCE Level IV. Retrospective Case Series.
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Affiliation(s)
- David R Maldonado
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
| | - Keon A Youssefzadeh
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A..
| | - Frank Wydra
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
| | | | - Michael B Gerhardt
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
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