41-75% of Patients Achieve a Patient Acceptable Symptomatic State After Endoscopic Repair of Hip Abductor Tendon Tears: A Systematic Review

Muzammil Akhtar; Daniel Razick; Sonia Aamer; Osamah Baig; Anand Dhaliwal; Khizur Kamran; Shaheryar Asad; Trevor Shelton

doi:10.1016/j.arthro.2024.01.001

41-75% of Patients Achieve a Patient Acceptable Symptomatic State After Endoscopic Repair of Hip Abductor Tendon Tears: A Systematic Review

Arthroscopy. 2024 Jan 5:S0749-8063(24)00001-X. doi: 10.1016/j.arthro.2024.01.001. Online ahead of print.

Authors

Muzammil Akhtar¹, Daniel Razick², Sonia Aamer³, Osamah Baig⁴, Anand Dhaliwal², Khizur Kamran², Shaheryar Asad², Trevor Shelton⁵

Affiliations

¹ California Northstate University College of Medicine, Elk Grove, California, U.S.A.. Electronic address: makhtar@ucdavis.edu.
² California Northstate University College of Medicine, Elk Grove, California, U.S.A.
³ Southern California Orthopedic Institute, Bakersfield California, U.S.A.
⁴ Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, U.S.A.
⁵ Utah Valley Orthopedics and Sports Medicine, Intermountain Health, Utah, U.S.A.

PMID: 38185183
DOI: 10.1016/j.arthro.2024.01.001

Abstract

Purpose: To systematically review clinical and functional outcomes of endoscopic repairs of hip abductor tendon tears.

Methods: A search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed in the PubMed, Embase, and Cochrane databases using variations of the terms "endoscopy," "gluteus medius," "hip abductor," "outcome," "success," and "failure." Data for patient demographics, tear severity and location, patient-reported outcomes (PROs), clinical benefit, and rates of retears and revision surgery were collected and tabulated. Forest plots depicting preoperative versus postoperative PROs were generated. Quality assessment was performed using the modified Coleman Methodology Score.

Results: In total, 13 studies, 3 Level III and 10 Level IV, were included in this review, with a total of 272 patients whose ages ranged from 46.0 to 66.9 years and follow-up times from 16.4 to 46.7 months. Most tears were isolated to the gluteus medius, with the number of partial- versus full-thickness tears being similar. Trendelenburg gait, reported by 4 studies, persisted in 0% to 13.6% of patients after repair. Of 9 studies reporting both preoperative and postoperative PROs at latest follow-up, 8 reported significant improvements in all PROs (P < .05). In 5 studies, rates of achieving minimal clinically important difference and patient-acceptable symptomatic state ranged from 50.0% to 93.3% and 40.7% to 75.0%, respectively. Surgical complication rates were 0% in 11 studies and 4.3% and 18.2% in 2 studies. Retear rates were 0% in 10 studies and ranged from 6.7% to 33.3% in 3 studies. Rates of revision due to retear, reported by 12 studies, were 0% in 8 studies and ranged from 2.2% to 13.0% in 4studies.

Conclusions: Endoscopic repairs of both partial- and full-thickness hip abductor tendon tears have good-to-excellent PROs and low complication, retear, and revision rates. However, rates of minimal clinically important difference and patient-acceptable symptomatic state achievement rates are highly variable and less than favorable.

Level of evidence: Level IV, a systematic review of Level III and IV studies.

Publication types

Review