Clinical and functional outcomes after augmented hip abductor tendon repair

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.

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

“…While published evidence grows and encouraging clinical outcomes have been reported in patients undergoing HAT repair for symptomatic HAT tears, these studies 14,22,37,47 generally have small patient cohorts with only a few reporting outcomes in more than 30 patients. These studies 3,10,36,[38][39][40]42 often lack meaningful patient clinical review and present varied satisfaction levels, some 9,40 with high surgical failure rates beyond 30%.…”

“…This consisted of hydrotherapy and land-based exercises. 14 The early focus of the rehabilitation program was on managing postoperative pain and swelling, improving mobility, and increasing weightbearing capacity. Specific structured exercises were prescribed as of 2 to 4 weeks postsurgery (to progress from those provided…”

“…14,16 Second, a 30-s single-leg stance (SLS) test 32 was employed on the operated limb, evaluating the presence and severity of pain following 10-, 20-, and 30-s SLS tests (on a VAS of 0-10). 14,16 Third, patients underwent a 6-minute walk test (6MWT) to assess the maximum distance that they could walk in a 6-minute period, 17 with a VAS pain scale (0-10) again employed to evaluate pain severity before and at 2, 4, and 6 minutes into the test. 14,16 Finally, maximal isometric hip abduction strength was assessed on the operated and unaffected limbs with a T5 Cable Tensiometer (Pacific Scientific Company) per the technique and procedure previously reported.…”

“…2,8,28 Despite first being reported in 1997 by Bunker et al, 4 a review 13 published in 2015 highlighted encouraging outcomes in patients embarking on HAT surgical repair via a range of surgical techniques, with numerous open, endoscopic, and augmented techniques reported since that time. 5,14,22,[24][25][26]31,33 Interestingly, only a few of these studies 14,22,37,47 actually documented outcomes in more than 30 patients, with a recent review summarizing the surgical outcomes of patients undergoing HAT repair reporting that many studies lack detail on the patient cohort, postoperative care, and clinical follow-up. 13 Furthermore, despite the encouraging published outcomes, satisfaction rates vary across studies, ranging from 66% to 90%, 3,10,36,[38][39][40]42 and surgical failure rates as high as 31% and 33% have been cited.…”

“…The current study is an extension (in postoperative follow-up and patient numbers) of a previous patient cohort that underwent HAT repair with 12-month postoperative outcomes. 14 It was hypothesized that (1) patients in the current 24-month cohort would demonstrate significant clinical improvement over the study period, with a low rerupture rate (<10%) and a high satisfaction rate (>85%), and (2) no significant clinical differences would exist between 12 and 24 months.…”