Department of Orthopedic Surgery, School of Medicine, Acibadem University, Istanbul, Turkey.
Casa di Cura Villa Betania, Rome, Italy.
Am J Sports Med. 2021 May;49(6):1570-1577. doi: 10.1177/0363546521999678. Epub 2021 Apr 1.
Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture.
Cohort study; Level of evidence, 3.
A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months).
Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant ( < .001 to = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups ( = .042); however, there was no significant difference between the SR and DR groups ( = .32) in terms of retear rates.
Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.
内镜下手术修复已成为治疗髋外展肌腱撕裂患者的常见方法。由于臀中肌和小肌肌腱修复后的再撕裂率较高，因此探索增强结构愈合的替代策略很重要。
目的/假设：本研究旨在评估在修复臀中肌和小肌肌腱时，单排修复（SR）中添加微骨折对手术修复后的结果的影响，并与不添加微骨折的 SR 和双排修复（DR）进行比较。我们假设与不添加微骨折的 SR 和 DR 相比，SR 中在转子窝添加微骨折将导致更好的临床结果和更低的临床明显再撕裂率。
队列研究；证据水平，3 级。
共纳入 50 例接受初次关节镜下修复髋部臀中肌和小肌肌腱撕裂的患者。患者分为 3 组：DR 组 16 例，SR 组 14 例，SR 加微骨折（SRM）组 20 例。患者分别采用视觉模拟评分（VAS）评估疼痛以及髋关节结局评分-日常生活活动（HOS-ADL）、髋关节结局评分-运动专项（HOS-SS）和改良 Harris 髋关节评分（mHHS），术前及至少 2 年随访（平均 30 个月）。
在 SR、SRM 和 DR 组中，SRM 组的 VAS 评分下降最大，mHHS、HOS-ADL 和 HOS-SS 评分增加最大，且所有差异均有统计学意义（<.001 至 =.006）。DR、SR 和 SRM 组的外展肌腱再撕裂率分别为 31.3%、35.7%和 15.0%。与 SR 和 DR 组相比，SRM 组的再撕裂率较低（=.042）；然而，SR 组与 DR 组之间的再撕裂率无显著差异（=.32）。
内镜下 SR 加微骨折是一种安全、实用且有效的技术，具有增强足印处生物愈合的潜在优势。与不添加微骨折的 SR 和 DR 相比，添加微骨折可显著降低再撕裂率并提供更好的功能结果。
