A Prospective 2-Year Clinical Evaluation of Augmented Hip Abductor Tendon Repair

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).

Modelling gluteus medius tendon degeneration and repair in a large animal model

“…This is likely due to the fact that gluteus medius tendon tears predominantly occur in tendinopathic tendons and surgical repair is often delayed following tear occurrence [9,24]. While new materials and biologics may enhance such repairs [25], development of these strategies are hampered by the lack of a representative, pre-clinical model which can mimic the loads and stresses following surgical repair.…”

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

“…The goal of biological or synthetic tissue augmentation is to decrease retear rates and increase patient satisfaction. Ebert et al 7 reported on a consecutive series of 146 patients who underwent open gluteal tendon repair using synthetic augmentation with the Ligament Augmentation and Reconstruction System. They reported significantly improved clinical and functional outcomes, high levels of patient satisfaction, and a relatively low failure rate up to 24 months after surgery.…”

“…Gluteus medius and minimus tendon tears have been recognized as a major cause of recalcitrant greater trochanteric pain syndrome. 6,7 Some authors noted the similarity of gluteus medius and minimus tendon insertions on the greater trochanter with those of the rotator cuff, leading to term hip abductor tendon tears as “rotator cuff tears of the hip.” 3,15…”

“…Gluteus medius and minimus tendon tears have been recognized as a major cause of recalcitrant greater trochanteric pain syndrome. 6,7 Some authors noted the similarity of gluteus medius and minimus tendon insertions on the greater trochanter with those of the rotator cuff, leading to term hip abductor tendon tears as ''rotator cuff tears of the hip.'' 3,15 Surgery is indicated when there are 4 associated conditions similar to rotator cuff tears: (1) duration of symptoms .6 months; (2) magnetic resonance imaging (MRI) showing a tendon tear; (3) failure of nonoperative management including physical therapy, activity modification, and injections; and (4) absence of significant retraction or fatty degeneration of the gluteus medius and minimus muscles.…”

Superior Gluteal Reconstruction Results in Promising Outcomes for Massive Abductor Tendon Tears

“…Moreover, the patients demonstrated significant improvement in pain, gait, strength, and subjective outcomes at a minimum of 2-year follow-up. 23 In patients undergoing abductor tendon suture-anchor repair augmented with a transosseous synthetic scaffold (LARS; Corin Group, Cirencester Cloucestershire, UK), Ebert et al 20,24 reported significant improvement in all mean patient PROs and clinical scores, including hip abductor strength and gait performance in 142 patients.…”