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Offene Refixation von Gluteus medius und minimus in Double-Row-Technik

Klinische und radiologische Ergebnisse

Open repair of gluteus medius and minimus tendons tears with double-row technique

Clinical and radiological results

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Zusammenfassung

Hintergrund

Bei frustraner konservativer Therapie eines trochantären Schmerzsyndroms (TPS) und Läsion der Hüftabduktoren in der Magnetresonanztomographie (MRT) ist die operative Refixation eine neue Therapieoption.

Ziel der Arbeit

Es erfolgten die Evaluation der klinischen und radiologischen Ergebnisse nach offener M.- gluteus-medius- und -minimus-Rekonstruktion.

Material und Methoden

Eingeschlossen wurden Patienten mit einem therapieresistenten TPS und in der MRT nachgewiesener Läsion der Hüftabduktoren, die operativ refixiert wurden. Die Patienten wurden prä- und postoperativ (Mindest-Follow-up 12 Monate) mittels modified Harris Hip Score (mHHS) und einem subjektiven Score (Subjective Hip Value [SHV]) evaluiert. In der prä- und postoperativen MRT wurden Muskeldurchmesser, -querschnittsfläche und fettige Degeneration evaluiert.

Ergebnisse

Es wurden 12 konsekutive Fälle mit offener Rekonstruktion in Double-Row-Technik eingeschlossen. Es zeigte sich eine signifikante Verbesserung des mHHS und des SHV. Bei 1 Fall zeigte sich eine atraumatische Reruptur im Bereich der proximalen Knotenreihe. Die MRT zeigte einen signifikanten Anstieg des Muskeldurchmessers und der -querschnittsfläche für den M. gluteus medius der betroffenen und der Gegenseite, während sich die fettige Degeneration nicht verbesserte. Die fettige Degeneration korrelierte signifikant mit den postoperativen Ergebnissen im mHHS und dem SHV.

Diskussion

Die operative Rekonstruktion bei Läsionen der Hüftabduktoren stellt eine Therapieoption mit signifikanter Verbesserung der Funktionsscores und Patientenzufriedenheit sowie des Muskeldurchmessers und der -querschnittsfläche des M. gluteus medius dar. Das Ausmaß der fettigen Degeneration und mögliche Differenzialdiagnosen sollten berücksichtigt werden.

Abstract

Background

Operative refixation is a new therapeutic option in cases of failed conservative treatment for trochanteric pain syndrome (TPS) and lesions of the hip abductors in magnetic resonance imaging (MRI).

Objective

Evaluation of the clinical and radiological results after open gluteus medius and minimus tendon reconstruction with a double-row technique was carried out.

Material and methods

Patients with failed conservative treatment for TPS and confirmed lesions of the hip abductors in MRI were treated by open hip abductor tendon reconstruction with a double-row technique. The patients were evaluated preoperatively and postoperatively (minimum follow-up 12 months) using the modified Harris hip score (mHHS) and a subjective score (subjective hip value, SHV). Preoperative and postoperative MRI evaluation included measurement of hip abductor muscle diameter and cross-sectional area as well as fatty degeneration.

Results

In this study 12 consecutive cases of open reconstruction of the hip abductor tendons were included. There was a significant improvement in the mHHS. In one case the patient showed an atraumatic rupture in the proximal anchor row. The MRI showed a significant improvement in muscle diameter and cross-sectional area for the gluteus medius muscle of the affected and the contralateral side, while the degree of fatty degeneration did not improve. The fatty degeneration showed a significant correlation with the postoperative results in the mHHS and the SHV.

Conclusion

Operative reconstruction of lesions in the hip abductor tendons is a therapy option with significant improvement of patient satisfaction and functional scores as well as muscle diameter and cross-sectional area for the gluteus medius. The degree of fatty degeneration and possible differential diagnoses need to be taken into consideration.

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Abbreviations

BT:

Bursa trochanterica

GM:

Musculus gluteus medius

LWS:

Lendenwirbelsäule

M:

Musculus

mHHS:

modified Harris Hip Score

MM:

Musculi

MRT:

Magnetresonanztomographie

PD-TSE:

Protonendichte Turbo-Spinecho (Sequenz)

SHV:

Subjective Hip Value

TM:

Trochanter major

TPS:

„Trochanteric pain syndrome“

Literatur

  1. Baums MH, Spahn G, Buchhorn GH et al (2012) Biomechanical and magnetic resonance imaging evaluation of a single- and double-row rotator cuff repair in an in vivo sheep model. Arthroscopy 28:769–777. https://doi.org/10.1016/j.arthro.2011.11.019

    Article  PubMed  Google Scholar 

  2. Bogunovic L, Lee SX, Haro MS et al (2015) Application of the Goutallier/Fuchs rotator cuff classification to the evaluation of hip abductor tendon tears and the clinical correlation with outcome after repair. Arthroscopy 31:2145–2151. https://doi.org/10.1016/j.arthro.2015.04.101

    Article  PubMed  Google Scholar 

  3. Bunker TD, Esler CN, Leach WJ (1997) Rotator-cuff tear of the hip. J Bone Joint Surg Br 79:618–620

    Article  CAS  PubMed  Google Scholar 

  4. Byrd JW (2013) Gluteus medius repair with double-row fixation. Arthrosc Tech 2:e247–e250. https://doi.org/10.1016/j.eats.2013.02.015

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chandrasekaran S, Gui C, Hutchinson MR et al (2015) Outcomes of endoscopic gluteus medius repair: study of thirty-four patients with minimum two-year follow-up. J Bone Joint Surg Am 97:1340–1347. https://doi.org/10.2106/JBJS.N.01229

    Article  PubMed  Google Scholar 

  6. Chi AS, Long SS, Zoga AC et al (2015) Prevalence and pattern of gluteus medius and minimus tendon pathology and muscle atrophy in older individuals using MRI. Skeletal Radiol 44:1727–1733. https://doi.org/10.1007/s00256-015-2220-7

    Article  PubMed  Google Scholar 

  7. Domb BG, Botser I, Giordano BD (2013) Outcomes of endoscopic gluteus medius repair with minimum 2‑year follow-up. Am J Sports Med 41:988–997. https://doi.org/10.1177/0363546513481575

    Article  PubMed  Google Scholar 

  8. Engelken F, Wassilew GI, Köhlitz T et al (2014) Assessment of fatty degeneration of the gluteal muscles in patients with THA using MRI: reliability and accuracy of the Goutallier and quartile classification systems. J Arthroplasty 29:149–153. https://doi.org/10.1016/j.arth.2013.04.045

    Article  PubMed  Google Scholar 

  9. Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 16(6):717–721

  10. Gladstone JN, Bishop JY, Lo IK et al (2007) Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35:719–728. https://doi.org/10.1177/0363546506297539

    Article  PubMed  Google Scholar 

  11. Glynn AA, Barattiero FY, Albers CE et al (2014) Surgical hip dislocation does not result in atrophy or fatty infiltration of periarticular hip muscles. J Hip Preserv Surg 1:82–95. https://doi.org/10.1093/jhps/hnu008

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gollwitzer H, Opitz G, Gerdesmeyer L et al (2014) Peritrochantäre Schmerzsyndrome. Orthopäde 43:105–116. https://doi.org/10.1007/s00132-013-2208-8 (quiz 117–8)

    Article  CAS  PubMed  Google Scholar 

  13. Goutallier D, Postel JM, Bernageau J et al (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    Google Scholar 

  14. Jo CH, Park JW, Shin JS (2016) Changes of muscle atrophy according to the immediate postoperative time point in magnetic resonance imaging after arthroscopic rotator cuff repair. Arthroscopy 32:2477–2487. https://doi.org/10.1016/j.arthro.2016.04.032

    Article  PubMed  Google Scholar 

  15. Kagan A (1999) Rotator cuff tears of the hip. Clin Orthop Relat Res 368:135–140

    Article  Google Scholar 

  16. Lachiewicz PF (2011) Abductor tendon tears of the hip: evaluation and management. J Am Acad Orthop Surg 19:385–391

    Article  PubMed  Google Scholar 

  17. Lequesne M (2006) From „periarthritis“ to hip „rotator cuff“ tears. Trochanteric tendinobursitis. Joint Bone Spine 73:344–348. https://doi.org/10.1016/j.jbspin.2006.04.002

    Article  PubMed  Google Scholar 

  18. Lindner D, Shohat N, Botser I et al (2015) Clinical presentation and imaging results of patients with symptomatic gluteus medius tears. J Hip Preserv Surg 2:310–315. https://doi.org/10.1093/jhps/hnv035

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lo IK, Gonzalez DM, Burkhart SS (2002) The bubble sign: an arthroscopic indicator of an intratendinous rotator cuff tear. Arthroscopy 18:1029–1033

    Article  PubMed  Google Scholar 

  20. Lorbach O, Bachelier F, Vees J et al (2008) Cyclic loading of rotator cuff reconstructions: single-row repair with modified suture configurations versus double-row repair. Am J Sports Med 36:1504–1510. https://doi.org/10.1177/0363546508314424

    Article  PubMed  Google Scholar 

  21. Ma CB, Comerford L, Wilson J et al (2006) Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am 88:403–410. https://doi.org/10.2106/JBJS.D.02887

    PubMed  Google Scholar 

  22. Makridis KG, Lequesne M, Bard H et al (2014) Clinical and MRI results in 67 patients operated for gluteus medius and minimus tendon tears with a median follow-up of 4.6 years. Orthop Traumatol Surg Res 100:849–853. https://doi.org/10.1016/j.otsr.2014.08.004

    Article  CAS  PubMed  Google Scholar 

  23. McCormick F, Alpaugh K, Nwachukwu BU et al (2013) Endoscopic repair of full-thickness abductor tendon tears: surgical technique and outcome at minimum of 1‑year follow-up. Arthroscopy 29:1941–1947. https://doi.org/10.1016/j.arthro.2013.08.024

    Article  PubMed  Google Scholar 

  24. Schapira D, Nahir M, Scharf Y (1986) Trochanteric bursitis: a common clinical problem. Arch Phys Med Rehabil 67:815–817

    CAS  PubMed  Google Scholar 

  25. Segal NA, Felson DT, Torner JC et al (2007) Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 88:988–992. https://doi.org/10.1016/j.apmr.2007.04.014

    Article  PubMed  PubMed Central  Google Scholar 

  26. Silva F, Adams T, Feinstein J et al (2008) Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol 14:82–86. https://doi.org/10.1097/RHU.0b013e31816b4471

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    J. H. Schröder, M. Schütz, C. Perka & D. Krüger

  2. Klinik für Orthopädie und Unfallchirurgie, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland

    M. Geßlein

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  1. J. H. Schröder
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  4. C. Perka
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Correspondence to J. H. Schröder.

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Interessenkonflikt

J.H. Schröder, M. Geßlein, M. Schütz, C. Perka und D. Krüger geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission (EA2/136/16), im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Schröder, J.H., Geßlein, M., Schütz, M. et al. Offene Refixation von Gluteus medius und minimus in Double-Row-Technik. Orthopäde 47, 238–245 (2018). https://doi.org/10.1007/s00132-017-3524-1

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