Abductor Tendon Tears of the Hip

Pierce, Todd P.; Issa, Kimona; Kurowicki, Jennifer; Festa, Anthony; McInerney, Vincent K.; Scillia, Anthony J.

doi:10.2106/jbjs.rvw.17.00076

Cited by 17 publications

(19 citation statements)

References 42 publications

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“…The hip abductors comprise the GMed, GMin and tensor fasciae latae. 4 The GMed originates from the anterior superior iliac spine and the outer border of the iliac crest towards the posterior superior iliac spine. 5 A recent cadaveric study demonstrated three distinct GMed origins: gluteal fossa and aponeurosis, and the posteroinferior edge of the iliac crest.…”

Section: Anatomy and Function Of Gluteal Musclesmentioning

confidence: 99%

“…GTPS is more prevalent in women than men and demonstrates peak prevalence between the fourth and sixth decades of life. 4 The rate of gluteal tendinosis and ruptures increases with age. In an observational study of 185 patients over 50 years old with non-hip-related problems, the incidence of gluteal ruptures increased from 10% in the under the sixties to 50% in the over seventies groups.…”

Section: Epidemiologymentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) is the gold-standard examination in evaluating abductor muscles and tendon anatomy. 4 Metal artefact reduction sequences (MARS) and multiple acquisitions with variable-resonance image combinations MRI (MAVRIC) are advanced MRI protocols that enable improved assessments when prosthetic hips are present. The size and shape of muscles, tendinosis, partial or complete tendon defects and fatty infiltration of gluteal muscles can be assessed.…”

Section: Imagingmentioning

confidence: 99%

“… 3 Hip abductor tendinopathy can range from tendinosis to complete tendon rupture, frequently complicated by muscle fat atrophy. 4 This instructional review aims to present an outline of current literature evidence regarding the anatomy, diagnosis and treatment of hip abductor tendon lesions and specifically of GMed and GMin.…”

Section: Introductionmentioning

confidence: 99%

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Lesions of the abductors in the hip

et al. 2020

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Abductor tendon lesions and insertional tendinopathy are the most common causes of lateral thigh pain. Gluteal tendon pathology is more prevalent in women and frequency increases with age. Chronic atraumatic tears result in altered lower limb biomechanics. The chief complaint is lateral thigh pain. Clinical examination should include evaluation of muscle strength, lumbar spine, hip and fascia lata pathology. The hip lag sign and 30-second single leg stance tests are useful in diagnosing abductor insufficiency. Magnetic resonance imaging (MRI) is the gold-standard investigation to identify abductor tendon tears and evaluate the extent of muscle fatty infiltration that has predictive value on the outcome of abductor repair. Abductor tendinosis treatment is mainly conservative, including non-steroidal anti-inflammatory medications, activity modification, local corticosteroid injections, plasma-rich protein, physical and radial shockwave therapy. The limited number of available high-quality studies on treatment outcomes and limited evidence between tendinosis and partial ruptures make it difficult to provide definite conclusions regarding the best management of gluteal tendinopathy. Surgical management is indicated in complete and partial gluteal tendon tears that are unresponsive to conservative treatment. There are various open and arthroscopic surgical procedures for direct repair of abductor tendon tears. There is limited evidence concerning surgical management outcomes. Prerequisites for effective tendon suturing are neurologic integrity and limited muscle fatty infiltration. Chronic irreparable tears with limited muscle atrophy and limited fatty infiltration can be augmented with grafts. Gluteus maximus or/vastus lateralis muscle transfers are salvage reconstruction procedures for the management of chronic end-stage abductor tears with significant tendon insufficiency or gluteal atrophy. Cite this article: EFORT Open Rev 2020;5:464-476. DOI: 10.1302/2058-5241.5.190094

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Section: Anatomy and Function Of Gluteal Musclesmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lesions of the abductors in the hip

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“… 43 , 47 , 48 54 Gluteal tendinopathy typically affects women in their fourth to sixth decades of life and manifests as chronic lateral hip pain and tenderness. 45 , 47 The degenerative progression of tendinopathy is common. 3 , 13 The cellular mechanism of tendon degeneration has been described by Bhabra et al, 2 distinguishing 4 grades of tendinopathy ( Table 1 ).…”

mentioning

confidence: 99%

Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

Ladurner

Fitzpatrick

O’Donnell

2021

Orthopaedic Journal of Sports Medicine

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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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A roadmap to develop clinical guidelines for open surgery of acute and chronic tears of hip abductor tendons

Kenanidis

Christofilopoulos

2020

Knee Surg Sports Traumatol Arthrosc

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PurposeAbductor tendon tears are increasingly recognised as a common cause of lateral hip pain. Surgical treatment of these tears has been recommended, but the indications and types of open surgery have not been precisely elucidated yet. This manuscript aimed to critically review the literature concerning all open treatment options for this condition while identifying knowledge gaps and introducing a treatment algorithm. MethodsLiterature search was conducted, including PubMed, Cochrane library, ScienceDirect and Ovid MEDLINE from 2000 to May 2020. Inclusion criteria were set as: (i) clinical studies reporting outcomes following open surgical treatment of acute or chronic hip abductor tendon tears, (ii) studies reporting an open direct or augmented suturing or muscle transfer procedure, (iii) acute or chronic tears found in native or prosthetic hips. ResultsA total of 34 studies published between 2004 and 2020 were included. The vast majority of studies were uncontrolled case series of a single treatment method. A total of 970 patients (76% women) with an age range between 48 and 76 years were involved. Women between 60 and 75 years old were most commonly treated. Preoperative evaluation of patients and reporting of open surgical technique and outcomes are inconsistent. All studies reported variable improvement of pain, functional outcomes and gait of patients. Overall, complication rates ranged from 0 to 31.2%. ConclusionThe current literature on this topic is highly heterogeneous, and the overall level of the available evidence is low. A roadmap to develop practical guidelines for open surgery of acute and chronic tears of abductor tendons is provided. The anatomy and chronicity of the lesion, the extent of fatty infiltration and neurologic integrity of hip abductor muscles may influence both treatment choice and outcome. Further high‐quality studies with standardisation of preoperative evaluation of patients and reporting of outcomes will help delineate best treatments. Level of evidenceIV.

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Abductor Tendon Tears of the Hip

Cited by 17 publications

References 42 publications

Lesions of the abductors in the hip

Lesions of the abductors in the hip

Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

A roadmap to develop clinical guidelines for open surgery of acute and chronic tears of hip abductor tendons

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