Open Hip Abductor Tendon Repair into a Bone Trough

Abstract

Background: Hip abductor tendon tears are a well-recognized entity that results in progressive lateral hip pain, weakness, and limping. These can occur in patients with native hips or in patients following total hip arthroplasty. However, treatment of these 2 distinct groups does not differ. We describe a new repair technique utilizing a longitudinal bone trough in the greater trochanter. We compare our results (focusing on gluteus medius tendon avulsions) and traditional repair with suture anchors or transosseous bone tunnels. Additionally, we propose a classification system that attempts to describe the different types of tears to guide treatment, as the current classification system is not helpful in defining pathology or guiding treatment. Our proposed classification will help to better describe tear types anatomically and thereby guide appropriate surgical interventions based on these types. Description: Abductor tears were classified, according to our system, as Type I when there was no gluteus medius avulsion from bone (with subtype A indicating a partial tear of the gluteus minimus or gluteus medius; B, a complete tear of the gluteus minimus; and C, a longitudinal tear of the gluteus medius) or Type II when there was a gluteus medius avulsion (with subtype A indicating an avulsion of <50% of the insertion into the greater trochanter, and B, an avulsion of ≥50% of the insertion). Repair into a bone trough involves (1) freeing up and mobilizing the tendon from overlying fascia, (2) placing 2 evenly spaced Krackow stitches in the tendon, (3) creating a bone trough using a burr in the midline of the greater trochanter, (4) creating bone tunnels out the lateral wall of the trough to pass sutures, and (5) passing sutures through the bone tunnels to allow inset of the tendon into the trough, and later tying the sutures over the lateral osseous bridge. Alternatives: Alternative treatment options include nonoperative and operative management. Nonoperative treatment choices include physical therapy, nonsteroidal anti-inflammatory drugs, and activity modification with assistive walking devices. Surgical alternatives include endoscopic or open direct soft-tissue repair, suture anchor repair, bone tunnel repair, graft jacket reconstruction, or gluteus maximus muscle transfer. Rationale: Because of discouraging outcomes experienced by us and others, a new technique (a greater trochanter longitudinal bone trough) was developed to improve surgical results. This technique, utilizing an abductor tendon repair into a bone trough, improved our surgical outcomes for abductor tendon avulsions. We found that outcomes after surgical treatment of abductor tendon tears without avulsion are superior to those after repairs of abductor tendon avulsions, which is an important distinction compared with previous literature on abductor tendon repairs.

Outcomes analysis of anterior and lateral approach for open repair of hip abductor tendons

“…Most published literature reports cohorts of <30 patients analysing IR or <24 cases studying THA+repairs, with a follow-up <1 year, 1,5,14–17 and the most comprehensive series report different repair methods and outcomes. 2,6,7,18 Despite disparities, most demonstrate improvement in PROMs after IR and THA+repair, 6–9,14–18 which is in line with our findings. Studies reporting VAS pain scores in both groups report an average result of 1.8–2.2.…”

“…1,4 Over the last decade, studies have been published analysing gluteal tendon tears and their management. [5][6][7][8][9][10][11][12][13][14][15] There is growing evidence that where conservative treatment fails, surgical repair is an effective and safe treatment. 1,5 Nevertheless, most published studies consist of small cohorts, lack definition of the type of tears, complications, re-tears, and report follow-up periods shorter than 12 months.…”

Hip Abductor Reconstruction with the Use of Mesh and Distal Cerclage Cable Fixation

“…Nine patients had good results with strong postoperative abduction and no limp, whereas 1 patient had weak abduction and a slight limp and 1 with a severe limp. Incavo and Harper described a technique in which the abductors are repaired through a vertical bone trough rather than a suture anchor or transosseous repair 14 . We have found that one of the challenges with these techniques can be reliable and robust distal fixation to the femur, which led to the modification using augmentation with mesh and distal fixation with cerclage cable.…”

JBJS Essential Surgical Techniques: Celebrating 10 Years of Innovation

“…When evaluating the impact of these changes, 1 metric to assess the value of an article is the interest that it generates. For that, we also present the top-10 most viewed JBJS Essential Surgical Techniques articles 3-12 . Although the frequency with which a procedure is performed plays a role in the viewership metrics, all of these articles are outstanding examples of the high-quality content we aim to provide.…”

“…• Migrating from a largely written article to an all-video, online format featuring an enhanced abstract • Adding English-language captioning to broaden outreach internationally and provide greater accessibility When evaluating the impact of these changes, 1 metric to assess the value of an article is the interest that it generates. For that, we also present the top-10 most viewed JBJS Essential Surgical Techniques articles [3][4][5][6][7][8][9][10][11][12] . Although the frequency with which a procedure is performed plays a role in the viewership metrics, all of these articles are outstanding examples of the high-quality content we aim to provide.…”