Clinical and MRI results in 67 patients operated for gluteus medius and minimus tendon tears with a median follow-up of 4.6 years - 07/11/14

Doi : 10.1016/j.otsr.2014.08.004

K.G. Makridis ^a,^⁎ , M. Lequesne ^b, H. Bard ^c, P. Djian ^d
^a Clinique Nollet, 23, rue Brochant, 75017 Paris, France
^b 33, rue Guilleminot, 75014 Paris, France
^c 4, rue Léon Vaudoyer, 75007 Paris, France
^d Cabinet Goethe, 23, rue avenue Niel, 75017 Paris, France

^⁎Corresponding author. Tel.: +33147206262; fax: +33147206241.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 07 November 2014
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Abstract

Introduction

Although various techniques can be used to repair gluteal tendon tears, the long-term outcome is unclear and published studies typically involve only a small number of patients. The goals of this study were to determine (1) if functional improvement can be obtained, (2) if the repairs are continuous based on MRI, and (3) which factors determine success.

Hypothesis

Gluteus medius and minimus tears can be repaired effectively with an open double-row technique.

Material and methods

Seventy-three patients were operated on between 2003 and 2010. Of these patients, 67 (62 women, 5 men) were available for review consisting of functional clinical tests and MRI of the hip and pelvis. A double-row repair was performed on all tendon tears, no matter the type of injury. Age, body mass index (BMI), fatty degeneration and muscle atrophy were also evaluated to determine if these variables affected the outcome.

Results

The average follow-up was 4.6 years (range 1–8). The pre-operative scores had improved at the last follow-up: (1) pain (VAS): 8.7±1.1 versus 1.7±2.7 at the follow-up, (P<0.001), (2) Lequesne index: 12.3±2.6 versus 4.0±4.0 at the follow-up, (P<0.001), (3) Harris Hip Score: 50.5±8 versus 87.9±15.5 at the follow-up, (P<0.001). There were 11 failures (16%) including two repeat tears that were reoperated successfully. In the other 56 patients, the MRI showed no signs of the initial tear or bursitis. Of the four factors (age, BMI, fatty degeneration, muscle atrophy) that were potential predictors of the outcome, only muscle atrophy had a negative impact on functional outcome (P<0.05).

Conclusion

Using an open double-row technique to repair gluteal tendon tears led to 85% of patients having good clinical results with significant improvement in symptoms and disappearance of abnormal findings on MRI. This technique can be used with all types of tendon tears, but should be performed before muscle atrophy sets in.