Department of Orthopaedic Surgery, University of California, 400 Parnassus Avenue, MU320-W, San Francisco, CA, 94143, USA.
Department of Orthopaedics, Friedrich-Schiller University of Jena, Campus Eisenberg, 07607, Eisenberg, Germany.
Arch Orthop Trauma Surg. 2022 Sep;142(9):2173-2183. doi: 10.1007/s00402-021-03787-2. Epub 2021 Mar 2.
Gluteal tendon tears (GTT) can cause pain and weakness of the hip. We analyze the impact of gluteal muscle fatty degeneration, atrophy and tear morphology on clinical outcomes of surgical repair.
All sequential patients receiving surgical repair of GTTs via anchor sutures between 1/2015 and 11/2018 were retrospectively identified. MRIs were reviewed by a radiologist for tendon retraction, muscle atrophy and tear size. The Goutallier-Fuchs Classification (GFC) was used to quantify fatty degeneration as < 2° or ≥ 2°. Demographic and clinical variables were abstracted from the electronic records. The surveys HHS Section 1 and HOOS Jr. were obtained at last follow-up. The Pearson correlation and one-way ANOVA tests served for statistical analysis of clinical variance.
38 patients were identified, 29 (76.3%) were female. The average age was 67. Of the 11 (28.9%) patients with a prior hip arthroplasty 87.5% of primary THAs had a direct lateral approach. 29 (76.3%) patients were treated open and 9 (23.7%) arthroscopically. At an average follow-up of 20.9 months, patients reported a significant improvement in pain (97%), analgesic use (85.7%), limp (52.6%) and abduction strength (54.2%) (all: P ≤ 0.01). GFC ≥ 2° were associated with significantly worse outcomes in terms of limp (0.19/3 vs. 1.2/3, P = 0.05), HHS-S1 (58.19 vs. 71.68, P = 0.04) and complication rates (37.5% vs. 0%, P = 0.02). There was a strong correlation between tear retraction (P = 0.005), tear size (P = 0.009) and muscle atrophy (P = 0.001) with GFC ≥ 2° but not with clinical outcomes. GFC ≥ 2° was strongly related to lateral THA exposures (P < 0.001). Surgical approach had no impact on clinical outcomes.
While fatty degeneration can negatively impact functional outcomes, pain relief is reliably achieved. Tear morphology and muscle atrophy did not correlate with outcomes in this patient cohort. Patients should be counseled to expect a residual limp after surgery if they have GFC ≥ 2° on MRI.
臀肌腱撕裂（GTT）可导致臀部疼痛和无力。我们分析了臀肌脂肪变性、萎缩和撕裂形态对手术修复临床结果的影响。
回顾性分析 2015 年 1/ 月至 2018 年 11 月间接受锚钉缝合修复 GTT 的所有连续患者。放射科医生对肌腱回缩、肌肉萎缩和撕裂大小进行 MRI 复查。采用 Goutallier-Fuchs 分级（GFC）对脂肪变性进行量化，< 2°或≥ 2°。从电子病历中提取人口统计学和临床变量。最后随访时获得 HHS 第 1 节和 HOOS Jr. 调查。采用 Pearson 相关和单因素方差分析对临床变异进行统计学分析。
共确定 38 例患者，其中 29 例（76.3%）为女性，平均年龄为 67 岁。11 例（28.9%）患者既往行髋关节置换术，其中 87.5%的初次全髋关节置换术采用直接外侧入路。29 例（76.3%）采用开放式治疗，9 例（23.7%）采用关节镜治疗。平均随访 20.9 个月后，患者报告疼痛（97%）、镇痛药使用（85.7%）、跛行（52.6%）和外展肌力（54.2%）均有显著改善（均 P ≤ 0.01）。GFC≥2°与跛行（0.19/3 与 1.2/3，P=0.05）、HHS-S1（58.19 与 71.68，P=0.04）和并发症发生率（37.5%与 0%，P=0.02）的改善显著相关。撕裂回缩（P=0.005）、撕裂大小（P=0.009）和肌肉萎缩（P=0.001）与 GFC≥2°有很强的相关性，但与临床结果无关。GFC≥2°与外侧髋关节暴露（P<0.001）有很强的相关性。手术方式对临床结果无影响。
虽然脂肪变性会对功能结果产生负面影响，但疼痛缓解是可靠的。在本患者队列中，撕裂形态和肌肉萎缩与结果无相关性。如果患者 MRI 上有 GFC≥2°，应告知其术后可能残留跛行。
