Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients

Maslaris, Alexander; Vail, Thomas P.; Zhang, Alan L.; Patel, Rina; Jäger, Markus; Bini, Stefano A.

doi:10.1016/j.arth.2020.03.013

Cited by 16 publications

(10 citation statements)

References 60 publications

(7 reference statements)

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“…However, we believe that the high-resolution rate of poor sleep quality in the postoperative period is strong evidence that open HAT repair played an essential role in improving sleep.There was also a high proportion of female patients in our cohort, limiting the magnitude to male patients. However, these results are consistent with previous studies [ 1 , 11 , 42 ] and demonstrate the higher prevalence of this pathology in female patients. To date, the PSQI has not yet been fully implemented in orthopedic surgery, however, it is used in the majority of studies examining sleep quality [ 23 , 24 , 25 , 26 ].…”

Section: Limitationssupporting

confidence: 93%

Open Hip Abductor Repair Hitting the Sack-Abductor Tendon Repair Significantly Improves Sleep Quality

Zimmerer

Navas

Pfeil

et al. 2021

JCM

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Purpose: To (1) describe the prevalence of abnormal sleep quality in patients with hip abductor tears (HAT), to (2) determine whether sleep quality improves after open HAT repair, and to (3) to report clinical short-term outcomes in patients undergoing open HAT repair. Methods: The data of 28 patients (29 hips) who underwant open HAT repair were prospectively analyzed at midterm follow-up. The Pittsburgh Sleep Quality Index (PSQI), modified Harris Hip Score (mHHS), the University of California, Los Angeles activity scale (UCLA), and Visual Analog Scale (VAS) for pain were determined via questionnaire. Paired t-tests were applied to compare preoperative and post-operative Patient-reported Outcome Measures (PROMs). Logistic regression was performed to determine the association between PSQI improvement achievement and demographic variables (laterality, sex, age, body-mass-index (BMI), and preoperative mHHS). The minimal clinically important difference (MCID) was calculated for the mHHS. Results: A total of 28 patients were included. Four patients (14.3%) suffered post-operative complications after open HAT repair. The predominance of patients was female (77.4%), with a mean age of 60 ± 13 years. The average follow-up was 30.35 ± 16.62 months. Preoperatively, 27 (96.4%) patients experienced poor sleep quality (PSQI > 5); at follow-up, 7 (25%) patients experienced poor sleep quality. Univariate logistical regression analysis demonstrated no significant association between preoperative demographic data and achieving postoperative PSQI < 5. The MCID of mHHS was calculated to be 12.5. Overall, 90% of patients achieved MCID for mHHS. Conclusion: Preoperative sleep quality was impaired in 96.4% of HAT patients (PSQI > 5). However, these patients showed an improvement in sleep disturbances after open HAT repair in the early postoperative period. Ninety percent of patients showed significant improvements in mHHS and achieved the corresponding MCID. Level of Evidence: Case series; Level IV.

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Section: Limitationssupporting

confidence: 93%

Open Hip Abductor Repair Hitting the Sack-Abductor Tendon Repair Significantly Improves Sleep Quality

Zimmerer

Navas

Pfeil

et al. 2021

JCM

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“…Rates of improvement (%) Fig. 3 Percentage of the overall cases with verified improvement of the main outcome objectives after surgical treatment of GTT Current data indicates that endoscopic and open surgical approaches are both equally successful [54]. However, there are some fundamental differences between these two approaches to consider when choosing the proper treatment strategy: endoscopic approach is better suited to smaller tears and tears of the gluteus minimus (cite our prior paper here) and has the benefit of also being able to address articular-side pathologies during the same procedure.…”

Section: Discussionmentioning

confidence: 99%

Impact of fatty degeneration on the functional outcomes of 38 patients undergoing surgical repair of gluteal tendon tears

Maslaris

Vail

Zhang

et al. 2021

Arch Orthop Trauma Surg

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Background Gluteal tendon tears (GTT) can cause pain and weakness of the hip. We analyze the impact of gluteal muscle fatty degeneration, atrophy and tear morphology on clinical outcomes of surgical repair. Methods All sequential patients receiving surgical repair of GTTs via anchor sutures between 1/2015 and 11/2018 were retrospectively identified. MRIs were reviewed by a radiologist for tendon retraction, muscle atrophy and tear size. The Goutallier-Fuchs Classification (GFC) was used to quantify fatty degeneration as < 2° or ≥ 2°. Demographic and clinical variables were abstracted from the electronic records. The surveys HHS Section 1 and HOOS Jr. were obtained at last follow-up. The Pearson correlation and one-way ANOVA tests served for statistical analysis of clinical variance. Results 38 patients were identified, 29 (76.3%) were female. The average age was 67. Of the 11 (28.9%) patients with a prior hip arthroplasty 87.5% of primary THAs had a direct lateral approach. 29 (76.3%) patients were treated open and 9 (23.7%) arthroscopically. At an average follow-up of 20.9 months, patients reported a significant improvement in pain (97%), analgesic use (85.7%), limp (52.6%) and abduction strength (54.2%) (all: P ≤ 0.01). GFC ≥ 2° were associated with significantly worse outcomes in terms of limp (0.19/3 vs. 1.2/3, P = 0.05), HHS-S1 (58.19 vs. 71.68, P = 0.04) and complication rates (37.5% vs. 0%, P = 0.02). There was a strong correlation between tear retraction (P = 0.005), tear size (P = 0.009) and muscle atrophy (P = 0.001) with GFC ≥ 2° but not with clinical outcomes. GFC ≥ 2° was strongly related to lateral THA exposures (P < 0.001). Surgical approach had no impact on clinical outcomes. Conclusion While fatty degeneration can negatively impact functional outcomes, pain relief is reliably achieved. Tear morphology and muscle atrophy did not correlate with outcomes in this patient cohort. Patients should be counseled to expect a residual limp after surgery if they have GFC ≥ 2° on MRI.

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“…Likewise, the post-operative pain reported in the present series (median, 1) is one of the greatest (lowest) values reported in the literature, which ranges from 0.5 to 3.4 points [ 13 , 14 , 17 , 18 , 20 , 38 , 39 , 41–43 ]. This is of particular interest because such a low post-operative pain level is known to be associated with a considerable reduction of opioid consumption [ 44 ]. Improvements in PROMs seem to be associated with functional results given that all our patients (100%) improved their abduction strength by at least one grade, which is greater than the proportions reported by Maldonado et al [ 18 ] (44%), Nazal et al [ 41 ] (53%) and Hartigan et al [ 39 ] (64%).…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes following mini-open repair of chronic gluteus medius tendon tears using a double-row technique

Barrera

Bothorel

Poultsides

et al. 2021

Journal of Hip Preservation Surgery

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Gluteal tendon tears represent a common but underreported cause of lateral hip pain and dysfunction. In case of conservative management failure, a surgical procedure must be performed to relieve patient symptoms. Current operative treatments, either open or endoscopic, have been however associated with different drawbacks which led to the introduction of the mini-open technique. The aim of this study was to evaluate and report the short-term outcomes of patients operated through the aforementioned surgical technique for gluteus medius (GM) chronic tears. We retrospectively analysed the records of 14 consecutive patients operated at the La Tour hospital by mini-open repair using a double-row technique for full-thickness GM chronic tears. Intra- and post-operative complications were recorded. The pre- and post-operative pain on visual analogue scale (pVAS), modified Harris Hip score (mHHS), abduction strength and gait dysfunction were assessed for all patients. Pre- and post-operative values were compared to evaluate whether improvements were statistically significant and clinically relevant. The study cohort comprised 13 women (93%) and 1 man (3%) aged 62.4 ± 18.0 at index surgery. No intra- or post-operative complications were noted. Compared to pre-operative values, patients reported a significant improvement in mHHS (59.1 ± 7.1 vs 92.7 ± 4.6) and pVAS (7.4 ± 1.0 vs 1.3 ± 1.3) at last follow-up. Patients exhibited a perfect improvement in muscle strength (3.6 ± 0.5 vs 5.0 ± 0.0), and the proportion of patients with a positive Trendelenburg sign decreased from 71% to 0%. Mini-open repair of chronic GM tendon tears using a double-row technique demonstrated excellent clinical and functional outcomes at short follow-up. Level of Evidence: IV.

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Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients

Cited by 16 publications

References 60 publications

Open Hip Abductor Repair Hitting the Sack-Abductor Tendon Repair Significantly Improves Sleep Quality

Open Hip Abductor Repair Hitting the Sack-Abductor Tendon Repair Significantly Improves Sleep Quality

Impact of fatty degeneration on the functional outcomes of 38 patients undergoing surgical repair of gluteal tendon tears

Short-term outcomes following mini-open repair of chronic gluteus medius tendon tears using a double-row technique

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