Background:

Gluteal tendons tears are increasingly being recognised as a cause of recalcitrant trochanteric pain, but there is a paucity of robust studies analysing the type of tears, results and predictors of outcome.

Methods:

Patients with gluteal tendon tears resistant to conservative treatment who underwent isolated open repair (IR) or total hip arthroplasty and concomitant repair (THA+repair) with a minimum 1-year follow-up were retrospectively assessed separately. Type of tear, surgical approach, and fixation methods were registered. Complications and postoperative outcomes were analysed: visual analogue scale (VAS) of pain, VAS satisfaction, and activity level. Univariate regressions and multivariable models were developed.

Results:

90 cases were included: 62 cases underwent IR and 28 cases THA+repair, with an average follow-up of 3.9 years and 2.6 years, respectively. 13 complications were found (n = 5 IR, n = 8 THA+repair), including 9 re-operations (n = 4 IR, n = 5 THA+repair). Mean VAS pain score was 3.02 (SD 2.74) for the IR and 2.32 (SD 2.43) for THA+repair group. Mean VAS satisfaction was 7.09 (SD 3.07) and 7.68 (SD 2.71) for the IR and THA+repair group, respectively. In the IR group 61.4% returned to all pre-injury activities, whereas in the THA+repair group 79% did. Full-thickness tears had higher VAS pain scores (p = 0.0175), and there was trend (p > 0.05) towards higher complications, re-tears and lower VAS satisfaction in this type of tears in both groups. No statistically significant differences were found in outcomes when comparing THA+repair through direct anterior (DAA) with lateral approach (LA).

Conclusions:

Isolated gluteal tendon repair or THA+repairs seem to be safe procedures with high levels of satisfaction at short- to mid-term follow-up. The presence of a full-thickness tear is a predictor of inferior outcomes.

中文翻译：

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髋外展肌腱前外侧入路开放修复效果分析

背景：

臀肌腱撕裂越来越多地被认为是顽固性转子疼痛的原因，但缺乏强有力的研究来分析撕裂的类型、结果和结果的预测因素。

方法：

对保守治疗抵抗的臀肌腱撕裂患者进行了单独的开放式修复（IR）或全髋关节置换术和伴随修复（THA+修复）并至少随访 1 年的患者分别进行回顾性评估。记录撕裂类型、手术入路和固定方法。分析并发症和术后结果：疼痛视觉模拟评分 (VAS)、VAS 满意度和活动水平。开发了单变量回归和多变量模型。

结果：

纳入90例：IR修复62例，THA+修复28例，平均随访时间分别为3.9年和2.6年。共发现 13 例并发症（n  = 5 IR，n  = 8 THA+修复），其中 9 例再次手术（n  = 4 IR，n  = 5 THA+修复）。IR 组的平均 VAS 疼痛评分为 3.02 (SD 2.74)，THA+修复组为 2.32 (SD 2.43)。IR 和 THA+修复组的平均 VAS 满意度分别为 7.09 (SD 3.07) 和 7.68 (SD 2.71)。在 IR 组中，61.4% 的人恢复了所有受伤前的活动，而在 THA+修复组中，79% 的人恢复了。全层撕裂的VAS疼痛评分较高（p  = 0.0175），并且有趋势（p > 0.05）对两组此类撕裂的更高并发症、再撕裂和更低的 VAS 满意度。在比较通过直接前路 (DAA) 与外侧入路 (LA) 进行 THA+修复时，结果没有发现统计学上的显着差异。

结论：

孤立的臀肌腱修复或 THA+ 修复似乎是安全的手术，在中短期随访中具有很高的满意度。全层撕裂的存在是较差结果的预测因素。