ABSTRACT
INTRODUCTION: We describe the surgical treatment of tears to the abductor tendons of the hip, which are typically progressive and can lead to recalcitrant pain and progressive weakness, leading to considerable difficulties with walking. STEP 1 PERFORM THE EXPOSURE AND IDENTIFY THE TEAR: Place the patient in the lateral decubitus position, expose the lateral peritrochanteric space, and then identify the extent of the tear. STEP 2 MOBILIZE THE TENDONS: Mobilize the typically scarred-in tendons from the surrounding tissue to allow the tendon to be brought back down to the trochanter. STEP 3 PREPARE THE TENDON AND GREATER TROCHANTER: Debride the tendon, and lightly burr the greater trochanter to maximize the healing of the tendon to the bone. STEP 4 LOCATE THE INSERTIONAL SITE OF THE TENDONS AND PLACE THE SUTURE ANCHORS OR DRILL HOLES INTO THIS SITE: Identify the area of the footprint for each of the tendons; all suture anchors should be placed in the footprint, and the transosseous drill holes should straddle the near and far edges of the footprint. STEP 5 REATTACH THE TENDONS: After all of the sutures are placed, tie them down, starting with the pull sutures first, to bring the tendon back to bone; then secure the tendon down with the simple sutures. STEP 6 REINFORCE LARGER TEARS: Reinforce larger tears to protect them and aid in their healing. STEP 7 POSTOPERATIVE PROTOCOL: The postoperative protocol period consists of partial weight-bearing for specific periods of time, followed by vigorous physical therapy for strengthening and gait retraining. RESULTS: Surgical repair can improve function and reliably decreases pain in patients with a hip abductor tear.IndicationsContraindicationsPitfalls & Challenges.
ABSTRACT
BACKGROUND: Greater trochanteric pain syndrome is a common orthopaedic condition related to underlying bursitis, but it may reflect gluteal tendinopathy with tendon disruption from the greater trochanter. Our goal was to evaluate our clinical experience with surgical repair of these tears. METHODS: We retrospectively evaluated a consecutive series of twenty-two patients (twenty-three hips) with a tear of the hip abductor tendons who underwent surgical reconstruction and were followed for a minimum of five years. The preoperative evaluation revealed chronic lateral hip pain, a positive Trendelenburg sign, and a tear documented by magnetic resonance imaging (MRI). The tears were defined intraoperatively with a four-tiered scheme that accounted for the dimension of the tear ranging from partial-thickness undersurface tears to complete tears of the gluteus muscle tendon insertion. RESULTS: The mean Harris hip score improved from 53 points preoperatively to 87 points at one year and 88 points at five years. The mean Lower-Extremity Activity Scale score improved from 6.7 points preoperatively to 8.9 points at one year and 8.8 points at five years. With the numbers available, no significant difference in the degree of clinical improvement was found on the basis of the severity of the tear. However, the three patients with poor results were in the group with the largest tears. Overall, sixteen of nineteen patients were satisfied with their surgical result and were willing to undergo the procedure again if necessary. CONCLUSIONS: Surgical repair of torn abductor tendons of the hip is a viable option when MRI and clinical findings are consistent with tendon disruption and weakness. There was substantial and durable improvement in strength and clinical performance in most cases. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
