Knotenlose Doppelreihenrefixation bei Glutealsehnenruptur

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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“…The technique performed was recently described [ 27 ]. All operations were conducted by the senior author (M.H.)…”

Section: Methodsmentioning

confidence: 99%

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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“…Hence, repair techniques successfully implemented to the shoulder rotator cuff (SpeedBridge™, Arthrex) were also employed for the hip. The knotless double-row re xation (so-called Hip Bridge technique, HB) described by the authors represents a minimally invasive technique for a broad-based re xation of the tendons of the GMed and/or GMin to their anatomic footprint (3). Some publications have already demonstrated mostly short-term good results after double-row repair of gluteal tendon tears (8-12).…”

Section: Introductionmentioning

confidence: 99%

“…In more than 50% greater trochanteric pain syndrome (GTPS) is caused by a manifest insu ciency of the gluteal muscles M. gluteus medius (GMed) and minimus (GMin) (1). Its prevalence is indicated as approximately 10% in native hips in a patient collective mostly older than 60 years with a remarkably higher rate following (revision) total hip arthroplasty (THA) (2,3). Nowadays gluteal insu ciency is believed to be responsible for a relevant percentage of patients with painful THA (4).…”

Section: Introductionmentioning

confidence: 99%

Superior Primary Stability of a Knotless Double-Row Construct Compared to Mason-Allen Repair for Anatomical Refixation of Gluteal Tendons – Biomechanical Human Cadaver Study

Twardy,

Warnecke,

Banke

et al. 2023

Preprint

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Background Hip abductor tendon tears are still an underrated diagnosis. This may lead to inefficient conservative therapy with only temporary pain relief and potential permanent disability. In clinical settings surgical treatments especially double-row repair techniques show good short-term results. However, sufficient biomechanical data are still lacking. Therefore, the aim of this study was to prove the superiority of knotless double-row (Hip Bridge) repair over still frequently used standard Mason-Allen technique in a cadaver study. Methods Gluteus minimus and medius were released in 12 fresh-frozen human cadaveric specimens and reattached to their footprints either with transosseous Mason-Allen (MA) or knotless double-row Hip Bridge (HB) technique. HB consisted of two proximal PEEK anchors, each preloaded with double-V shaped tapes, crossed, and distally fixated with two additional anchors. Femurs were fixated in a custom-made sample holder and gluteal muscles were clamped using a cryo-jaw. The construct underwent a cyclic loading test between 10 and 125 N for 150 cycles at 2.5 Hz (preload 10 N), followed by a pull-to-failure test. Failure mode and elongation were determined, the latter by a 3D optical measurement system. Statistical analysis was performed using a one-tailed t-test with a significance level set to p ≤0.05. Results HB resulted in significantly higher ultimate failure loads (339.1 ± 144.4 N) than MA (209.6 ± 62.1 N, p = 0.0381). HB failed ultimately only due to tendon failure, while MA showed different failure modes: tendon failure (1/6), bone cutting (4/6), and muscle rupture (1/6). During prior cyclic loading, the calculated final plastic elongation was 4.4 ± 0.5 mm for MA and 3.4 ± 1.4 mm for HB (p = 0.0731). During pull-to-failure testing, stiffness of 59.7 ± 12.5 N/mm and 66.8 ± 18.4 N/mm were observed for MA and HB (p = 0.247). Conclusion Hip Bridge technique provides a biomechanical stability superior to the standard Mason-Allen repair technique showing significantly higher ultimate failure loads and a trend of less elongation. A reason for this might be greater contact restoration of the anatomical footprint, a crucial advantage in the treatment of the typically weakened tendons and bones of elderly patients. Level of Evidence Laboratory study.

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Modifizierter Gluteus-maximus-Transfer zur Therapie der glutealen Insuffizienz

Zimmerer,

Nonnemacher,

Fischer

et al. 2024

Oper Orthop Traumatol

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Zusammenfassung Operationsziel Durchführung eines Transfers des M. gluteus maximus mit Refixation am Trochanter major zur Therapie der glutealen Insuffizienz. Indikationen Symptomatische gluteale Insuffizienz mit Atrophie und fettiger Degeneration der Glutealmuskeln > 50 % (Grad 3 nach Quartile) bei guter Kraftentwicklung des M. gluteus maximus. Kontraindikationen Geringe Atrophie oder fettige Degeneration von weniger als 50 % der Glutealmuskulatur, eingeschränkte Kraft des M. gluteus maximus, Infektionen. Operationstechnik Zunächst wird die Fascia lata dorsal des M. tensor fasciae latae inzidiert, wobei die Inzision bis ca. 1,5 cm proximal des Beckenkammes reicht. Eine zweite Inzision halbiert den M. gluteus maximus in Längsrichtung der Muskelfasern und wird in Richtung der Fascia lata nach distal des Trochanter major fortgesetzt. Durch die Inzisionen resultiert ein dreieckiger Muskellappen, welcher angehoben und in einen vorderen und einen hinteren Teil geteilt wird. Der posteriore Lappen wird über den Schenkelhals nach ventral gelegt und an der vorderen Kapsel und vorderen Kante des Trochanter major fixiert. Der anteriore Lappen wird direkt auf das proximale Femur platziert. Hierfür wird mit einer Kugelfräse eine Rinne im Bereich des proximalen Femurs präpariert, um den künftigen Footprint anzufrischen. Der anteriore Lappen wird von der Spitze des Trochanter major in Richtung des Ansatzes des M. vastus lateralis positioniert. Anschließend wird der anteriore Lappen mit transossären Nähten an der geschaffenen Rinne und unter dem angehobenen M. vastus lateralis in 15° Abduktion des Beines fixiert. Zur zusätzlichen Stabilisierung des sehnigen Teils des anterioren Lappens wird distal des Trochanter major eine Schraube eingebracht. Der M. vastus lateralis wird an der distalen Spitze des anterioren Lappens befestigt, und der verbleibende M. gluteus maximus wird mit der Fascia lata vernäht, um den anterioren Lappen abzudecken. Ergänzend kann ein Lappen des M. tensor fasciae latae mobilisiert und auf die Rekonstruktion adaptiert werden. Schichtweiser Wundverschluss. Ergebnisse Die gezeigte Technik eines M.-gluteus-maximus-Transfers stellt eine Methode zur Behandlung chronischer glutealer Insuffizienzen dar und verbessert in kurzzeitigen Follow-ups die Abduktionsfunktion sowie das Gangbild. Es wurden 15 Patienten (durchschnittliches Alter zum Operationszeitpunkt 62 Jahre) nach einem durchschnittlichen Follow-up von 2,5 Jahren nachuntersucht. Der modified Harris Hip Score (mHHS) verbesserte sich von 48 Punkten präoperativ auf 60 Punkte zum Follow-up. Präoperativ wiesen 100 % ein positives Trendelenburg-Zeichen auf, zum Follow-up Zeitpunkt waren es ca. 50 %.

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Knotenlose Doppelreihenrefixation bei Glutealsehnenruptur

Cited by 6 publications

References 16 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

Superior Primary Stability of a Knotless Double-Row Construct Compared to Mason-Allen Repair for Anatomical Refixation of Gluteal Tendons – Biomechanical Human Cadaver Study

Modifizierter Gluteus-maximus-Transfer zur Therapie der glutealen Insuffizienz

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