Rehabilitation After Gluteus Medius and Minimus Treatment

Use and Effectiveness of Physical Therapy After Primary Gluteus Medius and/or Minimus Repair: A Duration- and Session-Sensitive Analysis

BACKGROUND

Gluteus medius and/or minimus (GM) repair has been shown to provide improved patient-reported outcomes (PROs), yet few studies have established how postoperative physical therapy (PT) after GM repair affects patient recovery.

PURPOSE

To (1) evaluate the trajectory of patient improvement after GM repair during PT and (2) identify how the duration of PT influences minimum 2-year PROs.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Patients who underwent primary GM repair between September 2012 and September 2021 were identified. The trajectory of their Lower Extremity Function Scale (LEFS) score improvement during PT was evaluated with regression modeling. The times of greatest change in LEFS improvement were identified, and the rate of improvement (ROI) per postoperative day and per PT session was recorded. Preoperative, 6-month, 1-year, and 2-year PROs were evaluated for the length of postoperative recovery. Patients were then stratified by their PT duration, and their preoperative characteristics and postoperative outcomes were compared. Correlations between LEFS scores at discharge and 2-year outcomes were evaluated.

RESULTS

In total, 69 patients were included with a mean age of 59.7 ± 9.2 years and a body mass index of 28.6 ± 6.1 kg/m2. The ROI was 1.89 LEFS points per session for sessions 0 to 21 and 0.04 LEFS/session after session 21. From postoperative day 0 to 81, the ROI was 0.56 LEFS/day, decreasing to 0.16 LEFS/day between days 81 and 134, and 0.03 LEFS/day after day 134. Nevertheless, significant postoperative improvements were observed until 1 year for all PROs (P≤ .023). Patients who completed between 3 and 6 months of PT showed superior 2-year Hip Outcome Score-Activities of Daily Living (HOS-ADL) and visual analog scale-pain (VAS-Pain) scores compared with patients who completed a shorter PT duration (P≤ .028).

CONCLUSION

This study demonstrates that patients derived the greatest improvement during the first 21 PT sessions and 81 days after GM repair, with continued improvements after PT discharge up to 1 year. Patients who had <3 months of PT showed worse outcomes on LEFS scores at PT discharge and on 2-year HOS-ADL and VAS-Pain scores compared with patients who completed a longer PT duration. LEFS scores at discharge showed significant moderate and strong correlations with 2-year function and satisfaction scores.

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

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, systematic review of Level III and IV studies.

Satisfactory results after endoscopic gluteus medius repair combined with selective gluteus maximus reflected tendon release for the treatment of a full-thickness tear of gluteus medius

PURPOSE

The current study aimed to report the mid-term follow-up results of endoscopic gluteus medius repair combined with a systematic release of the gluteus maximus reflected tendon.

METHODS

Twenty-two patients with a symptomatic full-thickness tear of the gluteus medius tendon, as diagnosed by clinical examination and imaging (MRI), and who had a failure of conservative treatment for at least 6 months, were retrospectively enrolled for this study. An endoscopic repair of gluteus medius was performed for all patients in combination with gluteus maximus reflected tendon release according to the Polesello technique. The Visual Analogue Scale (VAS) for pain, Modified Harris Hip Score (mHHS), Lower Extremity Functional Scale (LEFS), Hip Outcome Score-Activity Daily Life (HOS-ADL), and Hip Outcome Score-Sport Specific Subscale (HOS-SSS) were administered to each patient before surgery for 6 months, 1 year, and every following year after surgery.

RESULTS

All analysed hip scores (mHHS, LEFS, HOS-ADL, and HOS-SSS) showed statistically significant improvements between the pre-operative and post-operative values at 6 months, 1 year, and the latest follow-up appointments after surgery (p < 0.001). The mean pre-operative pain was 8.6 ± 1.0 on the VAS. After surgical treatment, the pain was significantly reduced (p < 0.001) on the VAS at 6 months (5.4 ± 1.5), 1 year (4.4 ± 1.8) and the latest follow-up control visit (3.6 ± 2.2). No patient-reported major complications (re-rupture, deep infection or neurovascular injury). Eleven (50%) patients indicated the results as excellent, 7 (32%) as good, 2 (9%) as fair, and 2 (9%) as poor.

CONCLUSION

The use of abductor tendon repair in combination with a systematic release of the reflected tendon of the gluteus maximus according to the Polesello technique seems to be a safe and effective endoscopic way of treating a full-thickness tear of the gluteus medius.

LEVEL OF EVIDENCE

Level IV.