Association of Preoperative Gluteal Muscle Fatty Infiltration With Patient Outcomes in Women After Hip Abductor Tendon Repair Augmented With LARS

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.

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

“…The overall mean age (sample size adjusted) was 53.7 years (range, 17-88 years), and the mean body mass index (14 studies ** ) was 28.3 (range, 19.4-40.2). One study excluded male participants 22 ; for the remaining studies, the female-to-male sex ratio was calculated as 7:1. Information on laterality was provided in 7 studies, 9 , 10 , 29 , 33 , 38 , 50 , 53 with 54.3% of left hips treated.…”

“…Pain was most commonly assessed using a visual analog scale (VAS; 16 studies ¶¶ ) or numeric rating scale (NRS; 2 studies 10 , 42 , 51 ). Common patient-reported outcome measures (PROMs) were the modified Harris Hip Score (mHHS; 9 studies ## ), Harris Hip Score (HHS; 8 studies 14 , 18 , 21 , 22 , 31 , 38 , 41 , 50 ), Oxford Hip Score (6 studies 8 , 9 , 17 , 21 , 22 , 31 ), 12-Item Short Form Health Survey (SF-12; 5 studies 4 , 21 , 22 , 31 , 50 ), Hip Outcome Score (HOS; 4 studies 29 , 37 , 40 , 50 ), global rating of change scale (4 studies 21 , 22 , 31 , 42 ), 36-Item Short Form Health Survey (SF-36; 3 studies 8 , 9 , 17 ), and Patient Acceptable Symptom State (3 studies 4 , 25 , 26 ). Rarely used measures for the determination of outcomes were the Lower Extremity Functional Scale, 10 , 18 Nonarthritic Hip Score, 29 , 53 and Merle D’Aubigné–Postel score 17 , ...…”

“…Patient satisfaction was reported in 12 studies a and was commonly determined using a Likert scale. Common functional outcome assessments were resisted hip abduction in 7 studies, 14 , 21 , 22 , 29 , 31 , 40 , 42 a 30-second single-leg stance test (3 studies 14 , 21 , 31 ), a 6-minute walk test (2 studies 21 , 22 ), or an evaluation of range of motion or gait abnormalities (Trendelenburg sign, limping; 6 studies 18 , 23 , 29 , 38 , 40 , 41 ). The follow-up period ranged from 1.5 weeks to 100 months.…”

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.…”

Development of a Predictive Algorithm for Symptomatic Hip Abductor Tears in Patients Undergoing Primary Hip Arthroscopy

“…Other authors have since replicated these results and shown improvement with surgical repair in various types of hip abductor pathology. 12,17,36,38,45 To the best of our knowledge, no previous studies have evaluated risk factors for the presence of hip abductor tears in patients undergoing hip arthroscopy.…”