A roadmap to develop clinical guidelines for open surgery of acute and chronic tears of hip abductor tendons
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A roadmap to develop clinical guidelines for open surgery of acute and chronic tears of hip abductor tendons Eustathios Kenanidis1,2 · Bent Lund3 · Panayiotis Christofilopoulos4 Received: 6 July 2020 / Accepted: 2 October 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose Abductor tendon tears are increasingly recognised as a common cause of lateral hip pain. Surgical treatment of these tears has been recommended, but the indications and types of open surgery have not been precisely elucidated yet. This manuscript aimed to critically review the literature concerning all open treatment options for this condition while identifying knowledge gaps and introducing a treatment algorithm. Methods Literature search was conducted, including PubMed, Cochrane library, ScienceDirect and Ovid MEDLINE from 2000 to May 2020. Inclusion criteria were set as: (i) clinical studies reporting outcomes following open surgical treatment of acute or chronic hip abductor tendon tears, (ii) studies reporting an open direct or augmented suturing or muscle transfer procedure, (iii) acute or chronic tears found in native or prosthetic hips. Results A total of 34 studies published between 2004 and 2020 were included. The vast majority of studies were uncontrolled case series of a single treatment method. A total of 970 patients (76% women) with an age range between 48 and 76 years were involved. Women between 60 and 75 years old were most commonly treated. Preoperative evaluation of patients and reporting of open surgical technique and outcomes are inconsistent. All studies reported variable improvement of pain, functional outcomes and gait of patients. Overall, complication rates ranged from 0 to 31.2%. Conclusion The current literature on this topic is highly heterogeneous, and the overall level of the available evidence is low. A roadmap to develop practical guidelines for open surgery of acute and chronic tears of abductor tendons is provided. The anatomy and chronicity of the lesion, the extent of fatty infiltration and neurologic integrity of hip abductor muscles may influence both treatment choice and outcome. Further high-quality studies with standardisation of preoperative evaluation of patients and reporting of outcomes will help delineate best treatments. Level of evidence IV. Keywords Hip abductor tears · Gluteus medius · Gluteus minimus · Gluteus maximus · Muscle transfer, open surgery, open reconstruction Abbreviations MRI Magnetic resonance imaging THA Total hip arthroplasty
PROMS Patient-related outcome measures LARS Ligament Augmentation and Reconstruction System
* Panayiotis Christofilopoulos [email protected]
(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, 57001 Thessaloniki, Greece
Eustathios Kenanidis [email protected]
3
Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark
Bent Lund [email protected]
4
Hospital de la Tour, Geneva, Av. J.D. Maillard 3, 1217 Meyrin
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