Both open and endoscopic gluteal tendon repairs lead to functional improvement with similar failure rates: a systematic review

Importance Operative treatment of gluteal tendon tears is becomingly increasingly more common with varying surgical techniques and rehabilitation protocols. Objective To perform a systematic review of gluteal tendon repair as it relates to tear characteristics, rehabilitation protocols, patient-reported outcomes, satisfaction, resolution of gait deviation and complication rates. Evidence review A comprehensive literature search of PubMed and Embase/MEDLINE was used to identify all literature pertaining to gluteal tendon repair. A total of 389 articles were identified. Findings A total of 22 studies (611 hips) were included in this review. The majority of tears were noted to be partial thickness (77.9% vs 22.1%). Both arthroscopic and open repair demonstrated improvements in functional outcomes. Within studies documenting gait deviation, 54% were noted to have gait deviation preoperatively, of which approximately 70% had resolution following repair. On average, abduction strength increased almost one whole grade (0.84) following repair. Overall complication rate was found to be 5.2% (20 of 388 hips). Endoscopic repair demonstrated a decreased complication rate compared with open (0.7% vs 7.8%). Retear rate was found to be 3.8%, with open repair having a slightly increased rate compared with endoscopic repair (3.4% vs 4.1%). Conclusions and relevance The majority of tears tend to be partial thickness with involvement of gluteus medius in almost all cases and concomitant involvement of gluteus minimus in close to half of cases. Both endoscopic and open gluteal tendon repairs resulted in improvements in outcomes and functional improvement. Retear rates were similar between the two repair techniques, while endoscopic repair demonstrated a lower complication rate. Level of evidence Level IV, systematic review.

[1]  B. Domb,et al.  Endoscopic Repair of Partial-Thickness Undersurface Tears of the Abductor Tendon: Clinical Outcomes With Minimum 2-Year Follow-up. , 2018, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[2]  B. Sonnery-Cottet,et al.  Influence of Muscle Fatty Degeneration on Functional Outcomes After Endoscopic Gluteus Medius Repair. , 2018, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  K. Issa,et al.  Abductor Tendon Tears of the Hip. , 2018, JBJS reviews.

[4]  J. Ebert,et al.  Clinical and functional outcomes after augmented hip abductor tendon repair , 2018, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[5]  E. Makhni,et al.  The Effect of Platelet-Rich Fibrin Matrix at the Time of Gluteus Medius Repair: A Retrospective Comparative Study. , 2017, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[6]  Leslie C. Yuen,et al.  Endoscopic Gluteus Medius Repair With Concomitant Arthroscopy for Labral Tears: A Case Series With Minimum 5-Year Outcomes. , 2017, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[7]  B. Domb,et al.  Radiographic Risk Factors and Signs of Abductor Tears in the Hip. , 2017, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[8]  T. Ackland,et al.  Clinical outcomes and frontal plane two‐dimensional biomechanics during the 30‐second single leg stance test in patients before and after hip abductor tendon reconstructive surgery , 2017, Clinical biomechanics.

[9]  B. Domb,et al.  Radiographic Risk Factors and Signs of Abductor Tears in the Hip , 2017, Orthopaedic Journal of Sports Medicine.

[10]  Benedict U. Nwachukwu,et al.  Defining the “Substantial Clinical Benefit” After Arthroscopic Treatment of Femoroacetabular Impingement , 2017, The American journal of sports medicine.

[11]  J. W. Byrd,et al.  Endoscopic repair of hip abductor tears: outcomes with two-year follow-up , 2017, Journal of hip preservation surgery.

[12]  D. Reid.  The management of greater trochanteric pain syndrome: A systematic literature review. , 2016, Journal of orthopaedics.

[13]  R. Mather,et al.  Application of the Goutallier/Fuchs Rotator Cuff Classification to the Evaluation of Hip Abductor Tendon Tears and the Clinical Correlation With Outcome After Repair. , 2015, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[14]  Sivashankar Chandrasekaran,et al.  Outcomes of Open Versus Endoscopic Repair of Abductor Muscle Tears of the Hip: A Systematic Review. , 2015, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[15]  M. Hutchinson,et al.  Outcomes of Endoscopic Gluteus Medius Repair: Study of Thirty-four Patients with Minimum Two-Year Follow-up. , 2015, The Journal of bone and joint surgery. American volume.

[16]  B. Vicenzino,et al.  Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management , 2015, Sports Medicine.

[17]  Kyle Alpaugh,et al.  Outcomes after primary open or endoscopic abductor tendon repair in the hip: a systematic review of the literature. , 2015, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[18]  Sivashankar Chandrasekaran,et al.  Clinical Features That Predict the Need for Operative Intervention in Gluteus Medius Tears , 2015, Orthopaedic journal of sports medicine.

[19]  W. Breidahl,et al.  MRI and Clinical Analysis of Hip Abductor Repair , 2015, HIP International.

[20]  M. Lequesne,et al.  Clinical and MRI results in 67 patients operated for gluteus medius and minimus tendon tears with a median follow-up of 4.6 years. , 2014, Orthopaedics & traumatology, surgery & research : OTSR.

[21]  J. Ebert,et al.  Gluteal Tendon Repair Augmented with a Synthetic Ligament: Surgical Technique and a Case Series , 2014, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[22]  Benedict U. Nwachukwu,et al.  Endoscopic repair of full-thickness abductor tendon tears: surgical technique and outcome at minimum of 1-year follow-up. , 2013, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[23]  B. Sonnery-Cottet,et al.  Endoscopic repair of partial-thickness undersurface tears of the gluteus medius tendon. , 2013, Orthopaedics & traumatology, surgery & research : OTSR.

[24]  K. Crossley,et al.  Psychometric Properties of Patient-Reported Outcome Measures for Hip Arthroscopic Surgery , 2013, The American journal of sports medicine.

[25]  J. Stiehl,et al.  Surgical treatment of hip abductor tendon tears. , 2013, The Journal of bone and joint surgery. American volume.

[26]  B. Giordano,et al.  Outcomes of Endoscopic Gluteus Medius Repair With Minimum 2-Year Follow-up , 2013, The American journal of sports medicine.

[27]  J. Walton,et al.  Surgical repair of the gluteal tendons: a report of 72 cases. , 2011, The Journal of arthroplasty.

[28]  Paul N. Smith,et al.  Does Ultrasound Correlate with Surgical or Histologic Findings in Greater Trochanteric Pain Syndrome? A Pilot Study , 2010, Clinical orthopaedics and related research.

[29]  Hywel Davies,et al.  Surgical Repair of Chronic Tears of the Hip Abductor Mechanism , 2009, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[30]  B. Kelly,et al.  Endoscopic Repair of Gluteus Medius Tendon Tears of the Hip , 2009, The American journal of sports medicine.

[31]  S. Berven,et al.  Defining substantial clinical benefit following lumbar spine arthrodesis. , 2008, The Journal of bone and joint surgery. American volume.

[32]  M. Lequesne,et al.  Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair. , 2008, Joint, bone, spine : revue du rhumatisme.

[33]  M. Lequesne,et al.  Gluteal tendinopathy in refractory greater trochanter pain syndrome: diagnostic value of two clinical tests. , 2008, Arthritis and rheumatism.

[34]  James G Wright,et al.  Grades of recommendation , 2005, The Journal of bone and joint surgery. American volume.

[35]  P. Gleyze,et al.  Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. , 2003, Journal of shoulder and elbow surgery.

[36]  K. Slim,et al.  Methodological index for non‐randomized studies (MINORS): development and validation of a new instrument , 2003, ANZ journal of surgery.

[37]  B. Kirkham,et al.  Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. , 2001, Arthritis and rheumatism.

[38]  A. Kagan.  Rotator cuff tears of the hip. , 1999, Clinical orthopaedics and related research.

[39]  J. A. Cameron,et al.  Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings. , 1999, AJR. American journal of roentgenology.

[40]  C. Esler,et al.  Rotator-cuff tear of the hip. , 1997, The Journal of bone and joint surgery. British volume.

[41]  O. Cvitanic,et al.  MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). , 2004, AJR. American journal of roentgenology.