School of Human Sciences (Exercise and Sport Science), University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
HFRC, 117 Stirling Highway, Nedlands, WA, 6009, Australia.
Arch Orthop Trauma Surg. 2022 Nov;142(11):3165-3182. doi: 10.1007/s00402-021-03952-7. Epub 2021 May 13.
Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is hip abductor tendon (HAT) tears. Traditionally, these patients have been managed non-operatively, often with temporary pain relief. More recently, there has been an increase in published work presenting the results of surgical intervention. A variety of open and endoscopic transtendinous, transosseous and/or bone anchored suture surgical techniques have been reported, with and without the use of tendon augmentation for repair reinforcement. While patient outcomes have demonstrated improvements in pain, symptoms and function, post-operative rehabilitation guidelines are often vague and underreported, providing no guidance to therapists.
A systematic search of the literature was initially undertaken to identify published clinical studies on patients undergoing HAT repair, over a 3-year period up until May 2020. Following the application of strict inclusion and exclusion criteria, studies were identified and the detail relevant to rehabilitation was synthesized and presented. Published detail was combined with the authors clinical experience, with a detailed overview of rehabilitation proposed for this patient cohort.
A total of 17 studies were included, reporting varied detail on components of rehabilitation including post-operative weight bearing (WB) restrictions, the initiation of passive/active hip range of motion (ROM) and resistance exercises. A detailed rehabilitation guide is proposed.
In combining the current published literature on rehabilitation after HAT repair and our own clinical experience in the surgical management and post-operative rehabilitation of these patients, we present an evidence-based, structured rehabilitation protocol to better assist surgeons and therapists in treating these patients. This rehabilitation protocol has been implemented for several years through our institutions with encouraging published clinical outcomes.
先进的髋关节影像学和手术发现表明，臀大肌肌腱（HAT）撕裂是导致大转子疼痛综合征（GTPS）的常见原因。传统上，这些患者采用非手术治疗，通常可以暂时缓解疼痛。最近，越来越多的文献报道了手术干预的结果。已经报道了各种开放式和内镜经肌腱、经骨和/或骨锚定缝线手术技术，其中一些技术使用肌腱增强物进行修复加强，而另一些则没有。虽然患者的疼痛、症状和功能都有所改善，但术后康复指南通常比较模糊，报道也较少，无法为治疗师提供指导。
最初进行了系统的文献检索，以确定在 3 年期间截止到 2020 年 5 月发表的关于接受 HAT 修复的患者的临床研究。应用严格的纳入和排除标准后，确定了研究，并综合和呈现了与康复相关的详细信息。将发表的详细信息与作者的临床经验相结合，为该患者群体提出了详细的康复概述。
共纳入 17 项研究，报告了康复的各个方面，包括术后负重（WB）限制、被动/主动髋关节活动范围（ROM）和阻力运动的开始。提出了详细的康复指南。
综合当前关于 HAT 修复后康复的文献以及我们在这些患者的手术管理和术后康复方面的临床经验，我们提出了一个基于证据的结构化康复方案，以更好地帮助外科医生和治疗师治疗这些患者。该康复方案已在我们的机构中实施了数年，并取得了令人鼓舞的临床结果。
