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Endoscopic Repair of Full-Thickness Abductor Tendon Tears: Surgical Technique and Outcome at Minimum of 1-Year Follow-up

Published:October 21, 2013DOI:https://doi.org/10.1016/j.arthro.2013.08.024

      Purpose

      The purpose of this study was to assess the surgical outcomes of endoscopically repaired full-thickness abductor tendon tears using validated outcome measures.

      Methods

      After institutional review board approval was obtained, clinical outcome data were retrospectively collected from patients who underwent endoscopic gluteus medius and/or minimus repair by a single surgeon between August 2009 and September 2011. With a minimum follow-up of 1 year, patients were evaluated using the modified Harris Hip Score and the validated Hip Outcome Score (HOS). The HOS questionnaire included 2 subsections: HOS–Activities of Daily Living and HOS-Sports. Physical examination data were gathered during routine clinic visits, 1 year postoperatively. Statistical analysis was descriptive. The change in strength testing postoperatively was assessed with the Wilcoxon signed rank test, with significance set at P ≤ .05.

      Results

      Twelve patients were identified, 1 of whom was excluded; 10 of 11 patients (91%) completed the study requirements. The mean patient age was 65.9 years (range, 60 to 74 years), 70% were women, and the mean follow-up period was 23 months (range, 13 to 38 months). The mean postoperative scores were 84.7 (SD, 14.5) for the modified Harris Hip Score and 89.1 (SD, 11.3) for the HOS–Activities of Daily Living, with 90% patient satisfaction. All patients had clinically and statistically improved abductor tendon strength (P = .004). Patients with good to excellent outcomes were younger (P < .001). There were no complications identified.

      Conclusions

      In our small series, endoscopic abductor tendon repair was an effective surgical intervention after failed conservative management at short-term follow-up. Patients had reliably good to excellent outcomes with improved strength during hip abduction, were at low risk of complications, and were satisfied with the outcome. In addition, younger patients achieved better outcomes.

      Level of Evidence

      Level IV, therapeutic case series.
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      References

        • Segal N.A.
        • Felson D.T.
        • Torner J.C.
        • et al.
        Greater trochanteric pain syndrome: Epidemiology and associated factors.
        Arch Phys Med Rehabil. 2007; 88: 988-992
        • Tibor L.M.
        • Sekiya J.K.
        Differential diagnosis of pain around the hip joint.
        Arthroscopy. 2008; 24: 1407-1421
        • Lachiewicz P.F.
        Abductor tendon tears of the hip: Evaluation and management.
        J Am Acad Orthop Surg. 2011; 19: 385-391
        • Bird P.A.
        • Oakley S.P.
        • Shnier R.
        • Kirkham B.W.
        Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome.
        Arthritis Rheum. 2001; 44: 2138-2145
        • LaBan M.M.
        • Weir S.K.
        • Taylor R.S.
        “Bald trochanter” spontaneous rupture of the conjoined tendons of the gluteus medius and minimus presenting as trochanteric bursitis.
        Am J Phys Med Rehabil. 2004; 83: 806-809
        • Cvitanic O.
        • Henzie G.
        • Skezas N.
        • Lyons J.
        • Minter J.
        MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus).
        AJR Am J Roentgenol. 2004; 182: 137-143
        • Flack N.
        • Nicholson H.D.
        • Woodley S.J.
        A review of the anatomy of the hip abductor muscles, gluteus medius, gluteus minimus, and tensor fascia lata.
        Clin Anat. 2012; 25: 697-708
        • Kingzett-Taylor A.
        • Tirman P.F.J.
        • Feller J.
        • et al.
        Tendinosis and tears of the gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings.
        AJR Am J Roentgenol. 1999; 173: 1123-1126
        • Roberston W.J.
        • Gardner M.J.
        • Barker J.U.
        • Boraiah S.
        • Lorich D.J.
        • Kelly B.T.
        Anatomy and dimensions of the gluteus medius tendon insertion.
        Arthroscopy. 2008; 24: 130-136
        • Kagan A.
        Rotator cuff tears of the hip.
        Clin Orthop Relat Res. 1999; 368: 135-140
      1. Shindle MK, Voos JE, Heyworth BE, et al. Hip arthroscopy in the athletic patient: Current techniques and spectrum of disease. J Bone Joint Surg Am 2007;89(suppl 3):29-43.

      2. Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical treatment for peritrochanteric space disorders in the hip. Arthroscopy 2007;23:1246.e1-1246.e5. Available online at www.arthroscopyjournal.org.

        • Williams B.S.
        • Cohen S.P.
        Greater trochanteric pain syndrome: A review of anatomy diagnosis and treatment.
        Anesth Analg. 2009; 108: 1662-1670
        • Walsh M.J.
        • Walton J.R.
        • Walsh N.A.
        Surgical repair of gluteal tendons: A report of 72 cases.
        J Arthroplasty. 2011; 26: 1514-1519
        • Voos J.E.
        • Shindle M.K.
        • Pruett A.
        • Asnis P.D.
        • Kelly B.T.
        Endoscopic repair of gluteus medius tendon tears of the hip.
        Am J Sports Med. 2009; 47: 743-747
        • Domb B.G.
        • Nasser R.M.
        • Botser I.B.
        Partial thickness tears of the gluteus medius: Rationale and technique for transtendinous endoscopic repair.
        Arthroscopy. 2010; 26: 1697-1705
        • Martin R.L.
        • Kelly B.T.
        • Philippon M.J.
        Evidence of validity for the hip outcome score.
        Arthroscopy. 2006; 22: 1304-1311
        • Byrd J.W.
        • Jones K.S.
        Prospective analysis of hip arthroscopy with 2-year follow-up.
        Arthroscopy. 2000; 16: 578-587
        • Gaudelli C.
        • Mohtadi N.
        Pulmonary embolism after hip arthroscopy.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1224-1225
        • Bunker T.D.
        • Esler C.A.N.
        • Leach W.J.
        Rotator-cuff tear of the hip.
        J Bone Joint Surg Br. 1997; 79: 618-620
        • Davies H.
        • Zhaeentan S.
        • Tavakkolizadeh A.
        • Janes G.
        Surgical repair of chronic tears of the hip abductor mechanism.
        Hip Int. 2009; 19: 372-376
        • McCormick F.
        • Nwachkwu B.U.
        • Alpaugh K.
        • Martin S.D.
        Predictors of hip arthroscopy outcomes for labral tears at a minimum 2-year follow-up: The influence of age and arthritis.
        Arthroscopy. 2012; 28: 1359-1364
        • Cormier G.
        • Berthelot J.M.
        • Maugars Y.
        • SRO (Societe de Rhumatologie de l'Ouest)
        Gluteus tendon rupture is underrecognized by French orthopedic surgeons: Results of a mail survey.
        Joint Bone Spine. 2006; 73: 411-413