Abductor tendon tears

Torn G Med 3

 

Epidemiology

 

Women > men

4th - 6th decade of life

 

Aetiology

 

Acute trauma

 

Degenerative tears - 60% of > 70 year old patients have partial tears

 

Hip osteoarthritis

 

Hendry et al Arch Orthop Trauma Surg 2012

- 835 consecutive THA

- 25% had abductor mechanism tears

 

Post THA via anterolateral approach

 

Anatomy

 

Gluteus medius

 

Origin:  Iliac crest from ASIS to PSIS

Insertion:

- greater trochanter

- superoposterior facet

- lateral facet

Action:

- three muscle components

- anterior and middle are vertical and aid in initiating hip abduction

- posterior is horizontal and stabilizes the hip during gait

Innervation: Superior gluteal nerve

 

Gluteus minimus

 

Origin: AIIS to PIIS along superior gluteal line

Insertion: hip capsule and lateral facet of the greater trochanter under insertion of G medius

Action: Muscle is horizontal and stabilizes the hip joint during gait

Innervation: Superior gluteal nerve

 

Symptoms

 

Lateral pain

Limp

Trendelenburg gait

 

Signs

 

Hip lag sign

- patient on sign, asked to hold the affected leg abducted

 

30 second single leg stance

- lateral hip pain

 

Xray

 

Torn abductors xray

Greater trochanter cortical irregularities

 

MRI

 

Intact gluteus medius MRI

Intact gluteus medius insertion

 

Torn abductors MRITorn abductors MRI 2Torn abductors axial MRI

Torn gluteus medius and minimus

 

Torn G Med 3Torn G Med 2Torn G Med 1

Acute tear gluteus medius

 

Non operative Management

 

Physiotherapy

 

Cortisone

 

Platelet rich plasma

 

Shock wave therapy

 

Operative Management

 

Options

 

Open v Arthroscopic

 

Longstaffe et al J ISAKOS 2021

- systematic review of open v arthroscopic repair of abductor tendon tears

- 22 studies with 611 hips

- 78% of cases were partial tears

- complication rate 1% endoscopic versus 8% open

- retear rate 3% endoscopic versus 4% open

 

Open

 

Makridis et al Orthop Traumatol Surg Res 2014

- open double row repair in 67 patients followed for 4.5 years

- 16% failure rate

- increased risk with muscle atrophy

 

Arthroscopic

 

Vumedi video 1

 

Vumedi video 2

 

Results

 

Parker et al. Orthop Journal Sports Med 2020

- systematic review and meta-analysis of arthroscopic abductor tendon repair

- ITB split versus ITB sparing

- 13 studies

- improved outcomes and reduced failure rate with ITB split

- however, ITB sparing patients tended to be younger

 

Post Total Hip Arthoplasty

 

Miozzari et al J Arthroplasty 2010

- late abductor repair in 12 patients following transgluteal THA

- 25% failure rate

 

Reconstruction

 

Indication

 

Chronic, retracted, atrophied tears

Typically seen after total hip arthroplasty

 

Options

 

Synthetic ligament

Collage patch

Allograft

Gluteus maximus transfer

 

Patella tendon allograftPatella tendon allograftPost allograft reconstruction

Patella tendon allograft reconstruction of chronic gluteus medius tear