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Bourgeault-Gagnon Y, Lin D, Salmon LJ, Gooden BR, Lyons MC, Martina K, Tai JY, O'Sullivan MD. Gluteal Tendinopathy Is Associated With Lower Patient-Reported Outcome Measures in Total Hip Arthroplasty With a Posterior Approach: A Prospective Cohort Study of 1,538 Patients. J Arthroplasty 2024; 39:1796-1803. [PMID: 38331357 DOI: 10.1016/j.arth.2024.01.060] [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: 09/13/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Gluteal tendinopathy (GT) is found in 20 to 25% of patients undergoing total hip arthroplasty (THA). Despite this, there is a scarcity of literature assessing the association between GT and THA outcomes. The aim of this study was to evaluate whether intraoperative diagnosis of GT negatively affected postoperative outcomes. METHODS Consecutive patients undergoing primary THA for osteoarthritis via a posterior approach over 5 years were recruited in a prospective study. Gluteal tendinopathy was assessed and graded at the time of surgery, but not repaired. A total of 1,538 (93%) completed the patient-reported outcome measures (PROMs) at 1 year after surgery and were included in the analysis. The PROMs included the Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR), and EuroQol 5-Dimension, and were collected preoperatively and one year after THA. RESULTS The gluteal tendons were graded as 4 distinct grades: normal (n = 1,023, 66%), tendinopathy but no tear (n = 337, 22%), partial thickness tear (n = 131, 9%), and full thickness tear (n = 47, 3%). The occurrence of GT was associated with age, body mass index, and sex. There was no significant difference in baseline OHS or HOOS JR scores according to GT grade. As GT grade increased, lower median 1-year OHS (P = .001) and HOOS JR (P = .016) were observed. This association was confirmed by linear regression analysis with 1-year OHS (B = 0.5, 95% CI = -0.9 to -0.1, P = .011) when controlled for age and sex. CONCLUSIONS Gluteal tendinopathy was commonly observed and was associated with inferior 1-year PROMs in patients undergoing THA via posterior approach. Increasing degree of tendinopathy was a negative prognostic factor for outcomes and patient satisfaction. LEVEL OF EVIDENCE Level 2 (High quality prospective cohort study).
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Affiliation(s)
- Yoan Bourgeault-Gagnon
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia
| | - David Lin
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia
| | - Lucy J Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia; University of Notre Dame, Medical School, Sydney, New South Wales, Australia
| | - Benjamin R Gooden
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia
| | - Matthew C Lyons
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia
| | - Ka Martina
- Department of Orthopaedics, Mater Hospital, Wollstonecraft, New South Wales, Australia
| | - Jeffrey Y Tai
- University of New South Wales, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
| | - Michael D O'Sullivan
- North Sydney Orthopaedic and Sports Medicine Centre, Wollstonecraft, New South Wales, Australia
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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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Requicha F, Edwards SM, Rickman MS, Comley AS. Outcomes analysis of anterior and lateral approach for open repair of hip abductor tendons. Hip Int 2023; 33:812-818. [PMID: 35658688 DOI: 10.1177/11207000221103440] [Citation(s) in RCA: 1] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gluteal tendons tears are increasingly being recognised as a cause of recalcitrant trochanteric pain, but there is a paucity of robust studies analysing the type of tears, results and predictors of outcome. METHODS Patients with gluteal tendon tears resistant to conservative treatment who underwent isolated open repair (IR) or total hip arthroplasty and concomitant repair (THA+repair) with a minimum 1-year follow-up were retrospectively assessed separately. Type of tear, surgical approach, and fixation methods were registered. Complications and postoperative outcomes were analysed: visual analogue scale (VAS) of pain, VAS satisfaction, and activity level. Univariate regressions and multivariable models were developed. RESULTS 90 cases were included: 62 cases underwent IR and 28 cases THA+repair, with an average follow-up of 3.9 years and 2.6 years, respectively. 13 complications were found (n = 5 IR, n = 8 THA+repair), including 9 re-operations (n = 4 IR, n = 5 THA+repair). Mean VAS pain score was 3.02 (SD 2.74) for the IR and 2.32 (SD 2.43) for THA+repair group. Mean VAS satisfaction was 7.09 (SD 3.07) and 7.68 (SD 2.71) for the IR and THA+repair group, respectively. In the IR group 61.4% returned to all pre-injury activities, whereas in the THA+repair group 79% did. Full-thickness tears had higher VAS pain scores (p = 0.0175), and there was trend (p > 0.05) towards higher complications, re-tears and lower VAS satisfaction in this type of tears in both groups. No statistically significant differences were found in outcomes when comparing THA+repair through direct anterior (DAA) with lateral approach (LA). CONCLUSIONS Isolated gluteal tendon repair or THA+repairs seem to be safe procedures with high levels of satisfaction at short- to mid-term follow-up. The presence of a full-thickness tear is a predictor of inferior outcomes.
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Affiliation(s)
| | - Suzanne M Edwards
- Data, Design and Statistical Service, Adelaide Health Technology Assessment (AHTA), School of Public Health, The University of Adelaide, SA, Australia
| | - Mark S Rickman
- Wakefield Orthopaedic Clinic, Adelaide, SA, Australia
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, SA, Australia
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Ebert JR, Jain M, Janes GC. Good clinical outcomes, a high level of patient satisfaction and an acceptable re-operation rate are observed 7-10 years after augmented hip abductor tendon repair. Knee Surg Sports Traumatol Arthrosc 2023; 31:2131-2139. [PMID: 36939865 PMCID: PMC10183414 DOI: 10.1007/s00167-023-07382-3] [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: 10/24/2022] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To investigate the clinical outcome, level of patient satisfaction, re-injury and re-operation rates of patients 7-10 years after augmented hip abductor tendon repair. METHODS Between October 2012 and May 2015, 146 patients were referred to the senior author with symptomatic hip abductor tendon tears, of which 110 (101 female, 92%) were included in the current study and underwent hip abductor tendon repair augmented with LARS. Patients had a mean age of 63.2 years (range 43-82), body mass index of 27.8 (range 20.0-40.2) and duration of symptoms of 3.6 years (range 6 months-18 years). Patient-reported outcome measures (PROMs) were evaluated pre-operatively and at 3, 6, 12 and 24 months, as well as 7-10 years post-operatively, including the Oxford Hip Score (OHS), 12-item Short Form Health Survey (SF-12), a Visual Analogue Pain Scale (VAS) evaluating the frequency (VAS-F) and severity (VAS-S) of hip pain, and patient satisfaction. Adverse events, surgical failures, revisions and subsequent treatments on the ipsilateral hip were reported. RESULTS A significant improvement (p < 0.05) was observed for all PROMs and, while a mean deterioration was observed for all PROMs from 24 months to final review (7-10 years), these were not significant (n.s.). In the 90 patients retained and assessed at final review, 93% were satisfied with their hip pain relief and 89% with their ability to participate in recreational activities. Overall, 9 (of 110, 8.2%) surgical failures were observed over the 7-10-year follow-up period. CONCLUSIONS Good clinical scores, a high level of patient satisfaction and an acceptable re-injury rate were observed at 7-10 years after augmented hip abductor tendon repair, demonstrating satisfactory repair longevity. LEVEL OF EVIDENCE IV.
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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, Perth, WA, 6009, Australia. .,HFRC Rehabilitation Clinic, Perth, WA, Australia. .,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia.
| | - Mikhil Jain
- Leicester General Hospital, Leicester, England
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Centre, Perth, WA, Australia
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Yee C, Wong M, Cohen D, Kay J, Simunovic N, Duong A, Marín-Pena O, Laskovski JR, Ayeni OR. Labral Tears and Chondral Lesions Are Common Comorbidities Identified During Endoscopic Repair of Gluteal Tendon Tears for Greater Trochanteric Pain Syndrome: A Systematic Review. Arthroscopy 2023; 39:856-864.e1. [PMID: 35817376 DOI: 10.1016/j.arthro.2022.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE The primary purpose of this study was to systematically review the literature on intraoperative findings during endoscopic treatment for greater trochanteric pain syndrome (GTPS). Secondary outcomes were preoperative imaging findings and postoperative functional outcome measures. METHODS Medline, PubMED, and Embase databases were searched from inception (1946, 1966, and 1974, respectively), to July 15, 2021, for records reporting intraoperative findings during endoscopic surgery for GTPS. Studies of Level I-IV evidence were eligible. All studies were assessed for quality using the Methodological Index for Non-Randomized Studies (MINORS) score. RESULTS Sixteen studies met the inclusion criteria. Most patients underwent endoscopic greater trochanteric bursectomy with repair of the gluteal tendons. Intraoperative conditions reported were gluteal tendon tears usually involving the gluteus medius tendon, labral tears, and chondral lesions. Three studies reported an average of 9% of patients who subsequently underwent conversion to total hip arthroplasty. Pain was assessed using the visual analog scale, and functional outcome measures were measured using the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score Sport-Specific subscale, Hip Outcome Score Activities of Daily Living subscale, and iHOT-12. Pain and functional outcomes demonstrated significant improvement in nearly all the studies where they were reported. CONCLUSIONS Patients who underwent endoscopic management of GTPS commonly underwent repair of gluteal tendon tears, and in many cases had concomitant labral tears and chondral lesions identified intraoperatively. There were low rates of adverse events, repair failure, and revision surgery. Patient-reported functional outcomes were improved at follow-up at least 1 year postoperatively. LEVEL OF EVIDENCE IV, systematic review of level IV or better investigations.
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Affiliation(s)
- Caitlin Yee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michael Wong
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Hip Surgery Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Nicole Simunovic
- Hip Surgery Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Andrew Duong
- Hip Surgery Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Oliver Marín-Pena
- Hip Surgery Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Jovan R Laskovski
- Crystal Clinic Orthopedic Center, St. Thomas Hospital, Akron, Ohio, U.S.A
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
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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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Maslaris A, Vail TP, Zhang AL, Patel R, Bini SA. Impact of fatty degeneration on the functional outcomes of 38 patients undergoing surgical repair of gluteal tendon tears. Arch Orthop Trauma Surg 2022; 142:2173-2183. [PMID: 33651145 PMCID: PMC9381454 DOI: 10.1007/s00402-021-03787-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gluteal tendon tears (GTT) can cause pain and weakness of the hip. We analyze the impact of gluteal muscle fatty degeneration, atrophy and tear morphology on clinical outcomes of surgical repair. METHODS All sequential patients receiving surgical repair of GTTs via anchor sutures between 1/2015 and 11/2018 were retrospectively identified. MRIs were reviewed by a radiologist for tendon retraction, muscle atrophy and tear size. The Goutallier-Fuchs Classification (GFC) was used to quantify fatty degeneration as < 2° or ≥ 2°. Demographic and clinical variables were abstracted from the electronic records. The surveys HHS Section 1 and HOOS Jr. were obtained at last follow-up. The Pearson correlation and one-way ANOVA tests served for statistical analysis of clinical variance. RESULTS 38 patients were identified, 29 (76.3%) were female. The average age was 67. Of the 11 (28.9%) patients with a prior hip arthroplasty 87.5% of primary THAs had a direct lateral approach. 29 (76.3%) patients were treated open and 9 (23.7%) arthroscopically. At an average follow-up of 20.9 months, patients reported a significant improvement in pain (97%), analgesic use (85.7%), limp (52.6%) and abduction strength (54.2%) (all: P ≤ 0.01). GFC ≥ 2° were associated with significantly worse outcomes in terms of limp (0.19/3 vs. 1.2/3, P = 0.05), HHS-S1 (58.19 vs. 71.68, P = 0.04) and complication rates (37.5% vs. 0%, P = 0.02). There was a strong correlation between tear retraction (P = 0.005), tear size (P = 0.009) and muscle atrophy (P = 0.001) with GFC ≥ 2° but not with clinical outcomes. GFC ≥ 2° was strongly related to lateral THA exposures (P < 0.001). Surgical approach had no impact on clinical outcomes. CONCLUSION While fatty degeneration can negatively impact functional outcomes, pain relief is reliably achieved. Tear morphology and muscle atrophy did not correlate with outcomes in this patient cohort. Patients should be counseled to expect a residual limp after surgery if they have GFC ≥ 2° on MRI.
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Affiliation(s)
- Alexander Maslaris
- Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
- Department of Orthopaedics, Friedrich-Schiller University of Jena, Campus Eisenberg, 07607 Eisenberg, Germany
- Department of Orthopaedics and Trauma Surgery, Alfried-Krupp Hospital, Campus Rüttenscheid, 45131 Essen, Germany
| | - Thomas P. Vail
- Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
| | - Alan L. Zhang
- Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
| | - Rina Patel
- Department of Radiology of Biomedical Imaging, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
| | - Stefano A. Bini
- Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA 94143 USA
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Clinical results after open gluteus medius repair in single-row technique. J Exp Orthop 2022; 9:55. [PMID: 35689698 PMCID: PMC9188632 DOI: 10.1186/s40634-022-00483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose The aim of this retrospective study is to present the clinical results of open repair of gluteus medius and gluteus minimus tendon tears using the single-row suture anchor technique. Methods This retrospective study included 43 participants after open repair of the abductor tendon of the hip joint using a single-row suture anchor technique. Clinical outcome parameters were assessed by VAS (0–10), gait safety (1 = absolutely safe gait without assistive devices - 10 = gait not possible), SHV (0–100%), mHHS, WOMAC, and gluteal muscle strength status from single-leg stance and against gravity. Results Thirty-two female and 11 male subjects with an average age of 65.2 years were included in this study. Overall, a significant decrease in pain (VAS 3.2) and improvement in joint function is observed after a period of 22.3 months. The mHHS reached 61.9 points, WOMAC 28.2, SHV 69.8% and gait stability measured by the VAS reached 3.4. 58.1% of the participants reported not having Trendelenburg, while 4% could not control the single leg stance. Conclusions The present study shows that single row repair for open glutueus medius refixation indicates limited clinical results. Although there was an improvement in clinical outcome. The majority of subjects continued to report limiting symptoms.
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Modelling gluteus medius tendon degeneration and repair in a large animal model. Arch Orthop Trauma Surg 2022; 142:1-12. [PMID: 32813126 DOI: 10.1007/s00402-020-03573-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gluteus medius tendon tears often occur in the context of chronic tendinopathy and remain a difficult clinical problem. Surgical repair is challenging as it is often delayed and performed in degenerative tendons. No animal model currently exists to mimic the delayed repair of tendinopathic gluteus medius tears. The aims of this study were to develop a chronic model of gluteus medius tendinopathy and tear and then compare this model to an acute gluteus medius tear and repair. MATERIALS AND METHODS Six gluteus medius muscles were dissected and examined in mature sheep to confirm anatomical similarity to the human counterpart. Ten separate adult sheep underwent tendon detachment, followed by relook and histological sampling at 6 and 16 weeks to assess the extent of tendon degeneration. Six adult sheep underwent tendon repair at 6 weeks and were later assessed for healing of the tendon and compared to a further four adult sheep who underwent an acute tendon detachment and repair procedure. RESULTS The sheep gluteus medius muscle consisted of three compartments, the anterior, middle and posterior. All compartments inserted via the common tendon on the superolateral aspect of the greater trochanter. At both 6 and 16 weeks, there was significant tendinopathic changes on histology compared to controls as assessed by modified Movin's score (p = 0.018, p = 0.047) but no difference between the 6- and 16-week groups (p = 0.25). There were significant differences between delayed and acute repair in both histological appearance (p = 0.025) and biomechanical properties (p = 0.019), with acute repair superior in both. CONCLUSIONS Tendon detachment for 6 weeks is sufficient to produce histological changes similar to chronic tendinopathy and repair of this degenerative tendon results in significantly poorer healing when compared to an acute repair model. Animal models for gluteus medius tears should use a delayed repair model to improve clinical validity.
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Christofilopoulos P, Kenanidis E, Bartolone P, Poultsides L, Tsiridis E, Kyriakopoulos G. Gluteus maximus tendon transfer for chronic abductor insufficiency: the Geneva technique. Hip Int 2021; 31:751-758. [PMID: 32397754 DOI: 10.1177/1120700020924330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The treatment options of chronic abductor insufficiency in the setting of muscle degeneration, are limited and technically demanding. We present the outcomes of a salvage technique for unreconstructable, chronic abductor tears performed by a single surgeon. METHODS We retrospectively evaluated 38 patients who were surgically managed for chronic abductor insufficiency. Patients without hip implants and patients following primary or revision total hip arthroplasty (THA) were involved. All patients had a Trendelenburg gait, impaired muscle strength of abduction (⩽M4) and fatty degeneration of muscles (Goutallier ⩾3). They underwent transfer of a flap of the anterior third of gluteus maximus to the greater trochanter that was sutured under the slightly mobilised vastus lateralis. The level of pain, functional scores, muscle strength and Trendelenburg gait were re-evaluated at 12 postoperative months. RESULTS The mean age of patients was 70.2 years. 10 patients received the tendon transfer on a native hip, 6 following primary THA and 22 after revision THA. The mean pain level (3.2 vs. 7, p < 0.001) and Harris Hip Score (80.2 vs. 41.6, p < 0.001) and the median abductor strength (4 vs. 3, p < 0.001) was significantly improved compared to the preoperative scores. 26 patients demonstrated negative and 12 positive Trendelenburg sign at 12 postoperative months. No serious complications were reported. CONCLUSIONS This salvage technique improved the strength of abduction and functional results and reduced the level of pain in 80% of patients with chronic abductor tears. The short-term outcomes of the procedure were favourable; however, further evaluation is needed.
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Affiliation(s)
| | - Eustathios Kenanidis
- Orthopaedic Department, Hospital de la Tour, Geneva, Switzerland.,Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Centre of Orthopaedics and Regenerative Medicine (C.O.RE.) - Centre of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University,Thessaloniki, Greece
| | | | - Lazaros Poultsides
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Centre of Orthopaedics and Regenerative Medicine (C.O.RE.) - Centre of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University,Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece.,Centre of Orthopaedics and Regenerative Medicine (C.O.RE.) - Centre of Interdisciplinary Research and Innovation (C.I.R.I.) - Aristotle University,Thessaloniki, Greece
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Barrera M, 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
- 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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13
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Ladurner A, Fitzpatrick J, O'Donnell JM. Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation. Orthop J Sports Med 2021; 9:23259671211016850. [PMID: 34377713 PMCID: PMC8330465 DOI: 10.1177/23259671211016850] [Citation(s) in RCA: 3] [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: 12/29/2020] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Gluteal tendinopathy is the most common lower limb tendinopathy. It presents with varying severity but may cause debilitating lateral hip pain. Purpose: To review the therapeutic options for different stages of gluteal tendinopathy, to highlight gaps within the existing evidence, and to provide guidelines for a stage-adjusted therapy for gluteal tendinopathy. Study Design: Systematic review; Level of evidence, 4. Methods: We screened Scopus, Embase, Web of Science, PubMed, PubMed Central, Ovid MEDLINE, CINAHL, UpToDate, and Google Scholar databases and databases for grey literature. Patient selection, diagnostic criteria, type and effect of a therapeutic intervention, details regarding aftercare, outcome assessments, complications of the treatment, follow-up, and conclusion of the authors were recorded. An assessment of study methodological quality (type of study, level of evidence) was also performed. Statistical analysis was descriptive. Data from multiple studies were combined if they were obtained from a single patient population. Weighted mean and range calculations were performed. Results: A total of 27 studies (6 randomized controlled trials) with 1103 patients (1106 hips) were included. The mean age was 53.7 years (range, 17-88 years), and the mean body mass index was 28.3. The ratio of female to male patients was 7:1. Radiological confirmation of the diagnosis was most commonly obtained using magnetic resonance imaging. Reported treatment methods were physical therapy/exercise; injections (corticosteroids, platelet-rich plasma, autologous tenocytes) with or without needle tenotomy/tendon fenestration; shockwave therapy; therapeutic ultrasound; and surgical procedures such as bursectomy, iliotibial band release, and endoscopic or open tendon repair (with or without tendon augmentation). Conclusion: There was good evidence for using platelet-rich plasma in grades 1 and 2 tendinopathy. Shockwave therapy, exercise, and corticosteroids showed good outcomes, but the effect of corticosteroids was short term. Bursectomy with or without iliotibial band release was a valuable treatment option in grades 1 and 2 tendinopathy. Insufficient evidence was available to provide guidelines for the treatment of partial-thickness tears. There was low-level evidence to support surgical repair for grades 3 (partial-thickness tears) and 4 (full-thickness tears) tendinopathy. Fatty degeneration, atrophy, and retraction can impair surgical repair, while their effect on patient outcomes remains controversial.
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Affiliation(s)
- Andreas Ladurner
- Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Jane Fitzpatrick
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - John M O'Donnell
- Hip Arthroscopy Australia, Richmond, Australia.,Swinburne University of Technology, Hawthorn, Australia
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14
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Weber AE, Bell JA, Bolia IK. Hip Abductor and Peritrochanteric Space Conditions. Clin Sports Med 2021; 40:311-322. [PMID: 33673889 DOI: 10.1016/j.csm.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The hip trochanteric bursa, tendinous insertions of the gluteal muscles, and the origin vastus lateralis make up the main structures of the peritrochanteric space. Greater trochanteric pain syndrome (GTPS) refers to pain generated by one or multiple disorders of the peritrochanteric space, such as trochanteric bursitis, gluteus medius and minimus tendinopathy or tear, and disorders of the proximal iliotibial band. Patients with GTPS might present with associated intra-articular hip pathology, which requires further investigation and appropriate management. Successful midterm outcomes have been reported in patients undergoing surgical treatment of GTPS using an open or endoscopic approach.
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Affiliation(s)
- Alexander E Weber
- USC Epstein Family for Sports Medicine at Keck Medicine of USC, 1520 San Pablo Street, #2000, Los Angeles, CA 90033, USA.
| | - Jennifer A Bell
- USC Epstein Family for Sports Medicine at Keck Medicine of USC, 1520 San Pablo Street, #2000, Los Angeles, CA 90033, USA
| | - Ioanna K Bolia
- USC Epstein Family for Sports Medicine at Keck Medicine of USC, 1520 San Pablo Street, #2000, Los Angeles, CA 90033, USA
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Sizeland TJB, Fearon AM, Perriman DM, Gilbert S, Lynch JT, Smith PN, Spratford W. People after gluteal tendon repair have gait characteristics which are similar to those of a healthy cohort. Clin Biomech (Bristol, Avon) 2020; 80:105176. [PMID: 33007675 DOI: 10.1016/j.clinbiomech.2020.105176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gluteal-tendon repair is reported to be effective for relieving pain and improving function in patients with gluteal-tendon tears. However, post-operative three-dimensional gait analysis has never been conducted in gluteal-tendon repair patients. Thus, our primary aim was to investigate how biomechanical gait parameters differ between age- and sex-matched participants with and without gluteal-tendon repair. METHODS Vicon motion analysis technology was used to measure gait characteristics of 25 gluteal-tendon repair participants and 29 matched healthy comparison group participants. A generalised linear multivariate model was used to compare external hip-adduction moment, range of movement in hip adduction and internal rotation, pelvic obliquity, trunk lean, stride length and velocity of both cohorts throughout stance. FINDINGS There were no differences between the groups in external hip adduction moment, pelvic obliquity and range of movement in hip adduction and internal rotation. Gluteal-tendon repair participants had a shorter stride length (P = 0.031) and reduced walking velocity (P = 0.015). Ipsilateral trunk lean was reduced in gluteal-tendon repair participants at the first-peak external hip-adduction moment (P = 0.016), mid-stance minimum external hip-adduction moment (P = 0.029) and second-peak external hip-adduction moment (P = 0.006). INTERPRETATION There were no differences between the gluteal-tendon repair and comparison groups for external hip-adduction moment and pelvic obliquity. This suggests that gluteal-tendon repair may restore hip control in stance. Slower walking speed, reduced stride length and decreased ipsilateral trunk lean may reflect persistence of pre-operatively developed gait adaptations. Future studies of gait biomechanics before and after gluteal-tendon repair would be needed to substantiate this theory.
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Affiliation(s)
| | - Angela M Fearon
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
| | - Diana M Perriman
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Sally Gilbert
- Australian National University Medical School, Canberra, Australia.
| | - Joseph T Lynch
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Paul N Smith
- Australian National University Medical School, Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - Wayne Spratford
- University of Canberra Health Research Institute, University of Canberra, Canberra, Australia.
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16
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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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17
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Abstract
Hip abductor tendon tear is a difficult problem to manage. The hip abductor mechanism is made up of the gluteus medius and minimus muscles, both of which contribute to stabilising the pelvis through the gait cycle. Tears of these tendons are likely due to iatrogenic injury during arthroplasty and chronic degenerative tendinopathy. Ultrasound and magnetic resonance imaging have provided limited clues regarding the pattern of disease and further work is required to clarify both the macro and microscopic pattern of disease. While surgery has been attempted over the last 2 decades, the outcomes are variable and the lack of high-quality studies have limited the uptake of surgical repair. Hip abductor tendon tears share many features with rotator cuff tears, hence, innovations in surgical techniques, materials and biologics may apply to both pathologies.
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Affiliation(s)
- Mark F Zhu
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
| | | | | | - Simon W Young
- The University of Auckland, Auckland, New Zealand.,North Shore Hospital, Auckland, New Zealand
| | - Jacob T Munro
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
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18
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Maslaris A, Vail TP, Zhang AL, Patel R, Jäger M, Bini SA. Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients. J Arthroplasty 2020; 35:S352-S358. [PMID: 32279942 DOI: 10.1016/j.arth.2020.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/01/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Little is known about the relative efficacy of open (OGR) vs endoscopic (EGR) gluteal tendon repair of gluteal tendon tears in minimizing pain and restoring function. Our aim is to compare these 2 surgical techniques and quantify their impact on clinical outcomes. METHODS All patients undergoing gluteal tendon tear repair at our institution between 2015 and 2018 were retrospectively reviewed. Pain scores, limp, hip abduction strength, and the use of analgesics were recorded preoperatively and at last follow-up. The Hip disability and Osteoarthritis Outcome Score Junior and Harris Hip Score Section1 were obtained at last follow-up. Fatty degeneration was quantified using the Goutallier-Fuchs Classification (GFC). Statistical analysis was conducted using one-way analysis of variance and t-tests. RESULTS Forty-five patients (mean age 66, 87% females) met inclusion criteria. Average follow-up was 20.3 months. None of the 10 patients (22%) undergoing EGR had prior surgery. Of 35 patients (78%) undergoing OGR, 12 (27%) had prior hip replacement (75% via lateral approach). The OGRs had more patients with GFC ≥2 (50% vs 11%, P = .02) and used more anchors (P = .03). Both groups showed statistical improvement (P ≤ .01) for all outcomes measured. GFC >2 was independently associated with a worst limp and Harris Hip Score Section 1 score (P = .05). EGR had a statistically higher opioid use reduction (P < .05) than OGR. Other comparisons between EGR and OGR did not reach statistical significance. CONCLUSION In this series, open vs endoscopic operative approach did not impact clinical outcomes. More complex tears were treated open and with more anchors. Fatty degeneration adversely impacted outcomes. Although further evaluation of the efficacy of EGR in complex tears is indicated, both approaches can be used successfully.
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Affiliation(s)
- Alexander Maslaris
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California; Department of Orthopaedics, Friedrich-Schiller University of Jena, Campus Eisenberg, Eisenberg, Germany
| | - Thomas P Vail
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Rina Patel
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Marcus Jäger
- Department of Orthopaedics, University of Duisburg-Essen, Essen, Germany
| | - Stefano A Bini
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
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19
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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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20
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Ebert JR, Smith A, Breidahl W, Fallon M, Janes GC. Association of Preoperative Gluteal Muscle Fatty Infiltration With Patient Outcomes in Women After Hip Abductor Tendon Repair Augmented With LARS. Am J Sports Med 2019; 47:3148-3157. [PMID: 31513430 DOI: 10.1177/0363546519873672] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip abductor tendon repair has demonstrated encouraging outcomes. The influence of fatty infiltration (FI) on outcome has not been explored. PURPOSE To investigate the association between preoperative hip abductor FI and clinical outcome after hip abductor tendon repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 84 women underwent hip abductor tendon repair. The mean age was 64.6 years (range, 43-84 years); body mass index, 27.7 (range, 20.0-40.2); and duration of symptoms, 3.4 years (range, 6 months-20 years). The 6-minute walk test, isometric hip abduction strength assessment, and patient-reported outcome measures, including the Harris Hip Score and Oxford Hip Score, were completed presurgery and 2 years after surgery. Patient satisfaction and perceived improvement were assessed 2 years after surgery. All patients underwent preoperative magnetic resonance imaging on the affected hip, and the Goutallier system was used to grade the degree of FI in the anterior, middle, and posterior thirds of the gluteus medius and minimus on a 0-4 ordinal scale. A single FI score for the gluteus medius and minimus was calculated, as was a combined FI score. RESULTS All clinical scores significantly improved over time (P < .001). Preoperatively, FI was more severe in the gluteus minimus, with the most severe FI (grades 2-4) demonstrated in the middle (n = 56, 66.7%) and anterior (n = 17, 20.2%) portions of the gluteus minimus and the middle (n = 27, 32.1%) and anterior (n = 12, 14.3%) portions of the gluteus medius. Older age was associated with greater FI (combined FI score: r = 0.529, P < .001), although duration of symptoms (r = 0.035, P = .753) and body mass index (r = 0.089, P = .464) were not. Greater FI was associated with less improvement in hip strength of the unaffected leg (coefficient, -1.6, 95% CI: -2.8 to -0.4), although no other significant associations were observed between FI and pre- or postoperative clinical scores. CONCLUSION Preoperative FI was not associated with pertinent parameters of patient outcome after hip abductor tendon repair, including pain, symptoms, functional capacity, perceived improvement, and satisfaction. Based on these outcomes, surgical repair may be considered in the presence of more severe FI.
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, Australia.,HFRC Rehabilitation Clinic, Nedlands, Australia
| | - Anne Smith
- The School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | | | | | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Australia
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21
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Ebert JR, Fearon AM, Smith A, Janes GC. Responsiveness of the Victorian Institute for Sport Assessment for Gluteal Tendinopathy (VISA-G), modified Harris hip and Oxford hip scores in patients undergoing hip abductor tendon repair. Musculoskelet Sci Pract 2019; 43:1-5. [PMID: 31129382 DOI: 10.1016/j.msksp.2019.05.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND A lack of consensus exists on which patient-reported outcome measures (PROMs) best evaluate change following hip abductor tendon (HAT) repair. OBJECTIVES To compare the responsiveness of the Victorian Institute for Sport Assessment for Gluteal Tendinopathy (VISA-G), Oxford Hip (OHS) and modified Harris Hip (mHHS) scores in patients undergoing HAT repair. STUDY DESIGN Prospective case series. METHODS 56 patients underwent HAT repair and were evaluated pre-surgery and 3, 6 and 12 months post-operatively using the VISA-G, OHS, mHHS and a Global Rating of Change (GRC) scale. Internal and external responsiveness, the minimal clinically important change (MIC) and the presence of ceiling effects were evaluated. The extent to which VISA-G change was associated with mHHS and OHS change was investigated, as was the extent to which PROM changes were discriminatory for GRC improvement. RESULTS All PROMs demonstrated large standardized effect sizes (>1), with the VISA-G demonstrating responsiveness similar to the mHHS and OHS. At 12 months, the GRC correlated similarly with VISA-G (0.42, 95% CI: 0.17-0.61), mHHS (0.44, 95% CI: 0.17-0.61) and OHS (0.53, 95% CI: 0.31-0.70) changes. Using a GRC anchor of ≥4, an MIC of 29/100, 29/91 (32/100) and 16/48 (33/100) was observed for the VISA-G, mHHS and OHS, respectively. At 12 months ceiling effects existed for the mHHS (18/56, 32.1%) and OHS (13/56, 23.2%), but not VISA-G (1/56, 1.8%). CONCLUSION The VISA-G demonstrated acceptable responsiveness and was more resistant to ceiling effects, though demonstrated similar change scores and correlations with perceived improvement to the mHHS and OHS. CLINICAL TRIAL REGISTRATION This research trial is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12616001655437).
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Affiliation(s)
- Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Perth, Western Australia, 6009, Australia; HFRC Rehabilitation Clinic, 117 Stirling Highway, Nedlands, Western Australia, 6009, Australia.
| | - Angela M Fearon
- UCRISE, Faculty of Health, University of Canberra, ACT, 2617, Australia
| | - Anne Smith
- The School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Bentley, Perth, Western Australia, 6102, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth, Western Australia, 6005, Australia
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22
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Ebert JR, Bucher TA, Mullan CJ, Janes GC. Clinical and functional outcomes after augmented hip abductor tendon repair. Hip Int 2018; 28:74-83. [PMID: 28967055 PMCID: PMC6159837 DOI: 10.5301/hipint.5000525] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/21/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome. Surgical studies are often reported in small cohorts and with limited information on functional improvement. This study reports the clinical and functional outcomes after HAT repair. METHODS 112 patients with symptomatic HAT tears, diagnosed via magnetic resonance imaging, underwent open bursectomy, V-Y lengthening of the iliotibial band, debridement of the diseased tendon, decortication of the trochanteric foot-plate and reattachment of the tendon with suture anchors, augmented with a LARS ligament through a trans-osseous tunnel. Patients were evaluated pre-surgery and at 3, 6 and 12 months post-surgery using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, hip range of motion, 6-minute walk and 30-second single leg stance tests. Maximal isometric hip abduction strength (HAS) was assessed and limb symmetry indices (LSIs) were calculated between the operated and non-operated limbs. Patient satisfaction and perceived global rating of change (GRC) was evaluated. Analysis of variance evaluated improvement over time. RESULTS There was a significant improvement (p<0.05) in all clinical and functional measures. HAS significantly improved over time (p<0.002) and all LSIs were >85% at 12 months. At 12 months, a mean GRC score of 3.5 (range -1 to 5) was reported, while 96% of patients were satisfied with their surgical outcome. There was a 2.7% (n = 3) failure rate at 12 months. CONCLUSIONS HAT reconstruction, augmented with a synthetic ligament, demonstrated significantly improved clinical and functional outcomes, high levels of patient satisfaction and a low failure rate to 12 months post-surgery.
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Affiliation(s)
- Jay R. Ebert
- School of Human Sciences, University of Western Australia, Perth - Australia
| | - Thomas A. Bucher
- Orthopaedic Department, Fremantle Hospital, Fremantle - Australia
| | - Conor J. Mullan
- Orthopaedic Department, Royal Victoria Hospital, Belfast - UK
| | - Gregory C. Janes
- Perth Orthopaedic and Sports Medicine Centre, West Perth - Australia
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23
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Huxtable RE, Ackland TR, Janes GC, Ebert JR. Clinical outcomes and frontal plane two-dimensional biomechanics during the 30-second single leg stance test in patients before and after hip abductor tendon reconstructive surgery. Clin Biomech (Bristol, Avon) 2017; 46:57-63. [PMID: 28514698 DOI: 10.1016/j.clinbiomech.2017.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip abductor tendon tears are a common cause of Greater Trochanteric Pain Syndrome. Conservative treatments are often ineffective and surgical reconstruction may be recommended. This study investigated the improvement in clinical outcomes and frontal plane two-dimensional biomechanics during a 30-second single leg stance test, in patients undergoing reconstruction. We hypothesized that clinical scores and pertinent biomechanical variables would significantly improve post-surgery, and these outcomes would be significantly correlated. METHODS Twenty-one patients with symptomatic tendon tears underwent reconstruction. Patients were evaluated pre-surgery, and at 6 and 12months post-surgery, using patient-reported outcome measures, assessment of hip abductor strength and six-minute walk capacity. Frontal plane, two-dimensional, biomechanical variables including pelvis-on-femur angle, pelvic drop, trunk lean and lateral pelvic shift, were evaluated throughout a 30-second single leg stance test. ANOVA evaluated outcomes over time, while Pearson's correlations investigated associations between clinical scores, pain, functional and biomechanical outcome variables. FINDINGS While clinical and functional measures significantly improved (P<0.05) over time, no significant group differences (P>0.05) were observed in biomechanical variables from pre- to post-surgery. While five patients displayed a positive Trendelenburg sign pre-surgery, only one was positive post-surgery. Clinical outcomes and biomechanical variables during the single leg stance test were not correlated. INTERPRETATION Despite improvements in clinical and functional measures over time, biomechanical changes during a weight bearing single leg stance test were not significantly different following tendon repair. Follow up beyond 12months may be required, whereby symptomatic relief may precede functional and biomechanical improvement.
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Affiliation(s)
- Rose E Huxtable
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
| | - Timothy R Ackland
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia
| | - Gregory C Janes
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram Street, West Perth 6005, Western Australia, Australia
| | - Jay R Ebert
- School of Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia; HFRC, Nedlands, 6009, Western Australia, Australia.
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24
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Drummond J, Fary C, Tran P. The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome. Arch Orthop Trauma Surg 2016; 136:1547-1554. [PMID: 27405492 DOI: 10.1007/s00402-016-2511-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Greater trochanteric pain syndrome (GTPS), previously referred as trochanteric bursitis, is a debilitating condition characterised by chronic lateral hip pain. The syndrome is thought to relate to gluteal tendinopathy, with most cases responding to non-operative treatment. A number of open and endoscopic surgical techniques targeting the iliotibial band, trochanteric bursa and gluteal tendons have, however, been described for severe recalcitrant cases. We report the outcomes of one such endoscopic approach here. MATERIALS AND METHODS We retrospectively reviewed 49 patients (57 operations) who had undergone endoscopic longitudinal vertical iliotibial band release and trochanteric bursectomy. Inclusion criteria included diagnosed GTPS with a minimum of six months of non-operative treatment. Exclusion criteria included concomitant intra- or extra-articular hip pathology and previous hip surgery including total hip arthroplasty. Outcomes were assessed using the Visual Analogue Scale, Oxford hip Score and International Hip Outcome Tool (iHOT-33). RESULTS The series included 42 females and 7 males with a mean age of 65.0 years (26.7-88.6). Mean follow-up time was 20.7 months (5.3-41.2). Eight patients had full thickness gluteal tendon tears, of which 7 were repaired. Adjuvant PRP was injected intraoperatively in 38 of 57 operations (67.2 %). At follow-up, overall mean Visual Analogue Scale values had decreased from 7.8 to 2.8 (p < 0.001), Oxford hip Scores had increased from 20.4 to 37.3 (p < 0.001) and iHOT-33 scores had increased from 23.8 to 70.2 (p < 0.001). Of the 57 operations performed, patients reported feeling very satisfied with the surgical outcome in 28 operations (49.1 %), satisfied in 17 operations (29.8 %) and less than satisfied in 12 operations (21.1 %). CONCLUSIONS While the majority of patients with GTPS will improve with non-operative management, endoscopic iliotibial band release, trochanteric bursectomy and gluteal tendon repair is a safe and effective treatment for severe recalcitrant cases.
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Affiliation(s)
- James Drummond
- Western Health, Melbourne, VIC, Australia. .,Department of Orthopaedic Surgery, Western Hospital, Level 1 South, 160 Gordon St, Footscray, VIC, 3011, Australia.
| | - Camdon Fary
- Western Health, Melbourne, VIC, Australia.,Department of Orthopaedic Surgery, Western Hospital, Level 1 South, 160 Gordon St, Footscray, VIC, 3011, Australia
| | - Phong Tran
- Western Health, Melbourne, VIC, Australia.,Department of Orthopaedic Surgery, Western Hospital, Level 1 South, 160 Gordon St, Footscray, VIC, 3011, Australia
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Nurkovic J, Jovasevic L, Konicanin A, Bajin Z, Ilic KP, Grbovic V, Skevin AJ, Dolicanin Z. Treatment of trochanteric bursitis: our experience. J Phys Ther Sci 2016; 28:2078-81. [PMID: 27512268 PMCID: PMC4968510 DOI: 10.1589/jpts.28.2078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/07/2016] [Indexed: 12/02/2022] Open
Abstract
[Purpose] Trochanteric bursitis is a disease for which there are no effective
standardized therapy protocols. Very often pain persists in spite of applying all
therapeutic treatments. The purpose of this study was to determine whether treatment of
trochanteric bursitis with a local injection of bicomponent corticosteroid and 2%
lidocaine would improve patients’ conditions and relieve pain symptoms in the trochanteric
area. [Subjects and Methods] A retrospective observational study was conducted of 2,217
patients in a 6 year follow-up period at the Special Hospital “Agens”, Mataruska Banja,
Serbia. [Results] Of 2,217 examined patients, 58 (2.6%) patients were found to suffer from
trochanteritis associated with low back pain, and 157 (7%) were found to suffer from
trochanteric pains without low back pains. Local corticosteroid therapy followed by
physical therapy was effective in 77 (49%) of these patients, and only corticosteroid
injection in 61 (39%) patients. A single injection was given to 47 (29.9%) of the
patients. Two injections were given to 9 (5.7%) patients, and from 3 to 5 injections were
given repeatedly every 4–6 weeks to 7 (4.5%) patients. [Conclusion] For most patients,
local injections of corticosteroids with lidocaine alone or followed by physical therapy
gave satisfactory results.
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Affiliation(s)
- Jasmin Nurkovic
- Department of Biomedical Sciences, State University of Novi Pazar, Serbia; Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Serbia; Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Ljubisa Jovasevic
- Department of Biomedical Sciences, State University of Novi Pazar, Serbia; Special Hospital "Agens", Serbia
| | - Admira Konicanin
- Department of Biomedical Sciences, State University of Novi Pazar, Serbia
| | - Zoran Bajin
- Department of Biomedical Sciences, State University of Novi Pazar, Serbia; Institute for Orthopaedic Surgery "Banjica", Serbia
| | - Katarina Parezanovic Ilic
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Serbia; Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Vesna Grbovic
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Serbia; Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Aleksandra Jurisic Skevin
- Center for Physical Medicine and Rehabilitation, Clinical Center Kragujevac, Serbia; Faculty of Medical Sciences, University of Kragujevac, Serbia
| | - Zana Dolicanin
- Department of Biomedical Sciences, State University of Novi Pazar, Serbia; General Hospital Novi Pazar, Serbia
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26
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Levy DM, Bogunovic L, Grzybowski JS, Kuhns BD, Bush-Joseph CA, Nho SJ. All-Endoscopic Single-Row Repair of Full-Thickness Gluteus Medius Tears. Arthrosc Tech 2016; 5:e1-6. [PMID: 27073767 PMCID: PMC4809738 DOI: 10.1016/j.eats.2015.08.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 08/28/2015] [Indexed: 02/03/2023] Open
Abstract
Abductor tendon tears typically develop insidiously in middle-aged women and can lead to debilitating lateral hip pain and a Trendelenburg limp. The gluteus medius tendon is most commonly torn and may show fatty degeneration over time, similar to the rotator cuff muscles of the shoulder. Endoscopic repair offers a therapeutic alternative to traditional open techniques. This article describes the workup, examination, and endoscopic repair of a full-thickness gluteus medius tear presenting as lateral hip pain and weakness. The surgical repair for this case used a single-row suture anchor technique. In addition, the indications and technique for a double-row repair will be discussed.
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Affiliation(s)
- David M. Levy
- Address correspondence to David M. Levy, M.D., Rush University Medical Center, 1611 W Harrison St, Ste 300, Chicago, IL 60612, U.S.A.
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