Full-Thickness Gluteus Medius Tears With or Without Concomitant Hip Arthroscopy: Minimum 2-Year Outcomes Using an Open Approach and Contemporary Tendon Repair Techniques

Maldonado, David R.; Annin, Shawn; Chen, Jeffrey; Rosinsky, Philip J.; Shapira, Jacob; Lall, Ajay C.; Domb, Benjamin G.

doi:10.1177/2325967120929330

Cited by 15 publications

(17 citation statements)

References 43 publications

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“…The short-term clinical outcomes of the present series were excellent. The improvement in mHHS (34 points) was comparable to those reported in the recent literature at a minimum of 2 years of follow-up for open or endoscopic repair of gluteal tendon tears (18.4–46.5 points; Table III ) [ 13 , 18 , 20 , 38–43 ]. All patients included in the present series (100%) met the PASS in terms of mHHS, which compares favourably with the results of Maldonado et al [ 18 ] (69%) and Kirby et al [ 40 ] (88%).…”

Section: Discussionsupporting

confidence: 80%

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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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Section: Discussionsupporting

confidence: 80%

“…Maldonado et al . reported a pre-operative mHHS of 54.7 ± 15.9 points for patients with full thickness GM tears [ 18 ]. The minimal clinically important difference (MCID) of the mHHS at short follow-up was reported to be 13 points [ 19 ].…”

Section: Methodsmentioning

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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“…Gluteus medius tears have increasingly been shown to contribute to chronic lateral hip pain 8 , 22 . Once diagnosed on physical examination and MRI, the modalities to treat gluteus medius tears that are large and retracted with signs of major fatty atrophy are scarce 11 , 12 , 23 .…”

Section: Discussionmentioning

confidence: 99%

“…With nonoperative treatment, approximately 90% of cases are resolved 2 ; however, in patients who experience continuous and recalcitrant lateral hip pain, abductor weakness, and a Trendelenburg gait, clinical suspicion should be raised for spontaneous avulsion of the gluteus medius tendon 3 . Open repair of the gluteus medius is often successful; however, the failure rate can be high if what remains is a deficient muscle or tendon 4 - 8 . Moreover, even successful repairs may show fatty degeneration on magnetic resonance imaging (MRI), a predisposing factor for retears 7 , 9 .…”

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confidence: 99%

Combined Transfer of the Gluteus Maximus and Tensor Fasciae Latae for Irreparable Gluteus Medius Tear Using Contemporary Techniques

et al. 2020

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Background: Combined transfer of the gluteus maximus and tensor fasciae latae (TFL) has been acknowledged as a treatment for irreparable full-thickness gluteus medius tears; yet, there is a paucity of reports on outcomes for this topic in the current literature. The purpose of the present study was to report short-term patient-reported outcome scores in patients who underwent combined transfer of the gluteus maximus and TFL in the setting of an irreparable gluteus medius tear. Methods: Data for patients who underwent hip preservation and hip arthroplasty between July 2011 and November 2017 were prospectively collected and retrospectively reviewed. Patients were considered for this study if they had undergone combined transfer of the gluteus maximus and TFL for irreparable gluteus medius tears. Inclusion criteria consisted of patients who had a minimum 1-year follow-up for the modified Harris hip score, Non-Arthritic Hip Score, Hip Outcome Score Sports Specific Subscale, visual analog scale score for pain, and patient satisfaction. The exclusion criterion was Workers’ Compensation status. Results: The study included 18 hips in 18 patients who underwent combined transfer of the gluteus maximus and TFL, with a mean follow-up of 39.75 months (range, 12.04 to 93.88 months). The average age was 68.48 ± 11.05 years, the average body mass index was 29.54 ± 6.23 kg/m 2 , and 13 patients were female. Abductor strength improved in 7 of 17 patients, with abduction data unavailable for 1 patient. Significant improvements were observed in modified Harris hip score from 49.73 ± 16.85 to 74.94 ± 17.91 (p < 0.001), Non-Arthritic Hip Score from 55.02 ± 22.53 to 72.78 ± 19.17 (p = 0.032), and visual analog scale for pain from 5.42 ± 3.42 to 1.57 ± 1.68 (p = 0.0004). No secondary surgeries were reported. Conclusions: Significant improvements in patient-reported outcomes were observed in patients who underwent combined transfer of the gluteus maximus and TFL for the treatment of irreparable full-thickness gluteus medius tears at short-term follow-up. Level of Evidence: Level IV . See Instructions for Authors for a complete description of levels of evidence.

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“…8 Throughout the study period, the diagnostic portion of the endoscopy remained consistent despite various modifications in the tendon repair techniques. 5,9,11,17,30…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2021

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Background: Patients presenting with lateral hip pain may pose a difficult diagnostic challenge, as pain can be due to various causes. Purpose/Hypothesis: The purpose was to identify risk factors and predictors for symptomatic hip abductor tears in a cohort of patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome. We hypothesized that body mass index (BMI), female sex, age, and presence of chondral damage would be significant predictors of hip abductor pathologies. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed. Patients were included if they underwent primary hip arthroscopy between March 2009 and December 2019. Patients with Tönnis grade >1, previous hip conditions, incomplete radiographic data, or open procedures were excluded. All demographic variables, intraoperative measurements, and radiographic measurements were assessed using a bivariate analysis. A stepwise logistic regression was used to determine predictive variables. Results: In total, 255 hips with a hip abductor tear that underwent hip arthroscopy and 2106 hips without a tear that underwent hip arthroscopy were included. The stepwise logistic regression successfully created a predictive model using age, sex, BMI, lateral joint space, and alpha angle as variables. The efficiency of the predictive model was 90.7%, with an area under the curve of 0.894. The odds of having a hip abductor tear were 7.41 times higher in females (odds ratio [OR], 7.41; 95% CI, 4.61-11.9). Each additional year of age was associated with a 13.7% (OR, 1.137; 95% CI, 1.12-1.16) increase in the odds of having a tear. Similarly, with each 1-unit increase in BMI, the odds of having a tear increased by 3.4% (OR, 1.034; 95% CI, 1.01-1.06). Conclusion: This study successfully created a predictive model that identified female sex (OR, 7.41), increasing age (OR, 1.137 for each year), and increased BMI (OR, 1.034 for each unit of BMI) as significant independent predictors of the presence of hip abductor tears in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. This model can be used in support of physical examination and imaging suggestive of hip abductor pathology to preoperatively identify the probability of a symptomatic hip abductor tear in these patients.

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Full-Thickness Gluteus Medius Tears With or Without Concomitant Hip Arthroscopy: Minimum 2-Year Outcomes Using an Open Approach and Contemporary Tendon Repair Techniques

Cited by 15 publications

References 43 publications

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

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

Combined Transfer of the Gluteus Maximus and Tensor Fasciae Latae for Irreparable Gluteus Medius Tear Using Contemporary Techniques

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

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