DISCLOSURE. The contributing authors have no financial relationships to disclose.

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2 DISCLOSURE The contributing authors have no financial relationships to disclose.

3 INTRODUCTION Greater trochanteric pain syndrome (GTPS); formerly trochanteric bursitis Common condition, wide differential diagnosis Prevalence estimated to be 17.6% in the community Conservative measures: a mainstay of therapy Physical therapy Anti-inflammatory drugs Corticosteroid injections Open surgical repair of abductor tendons Well defined for recalcitrant cases Evaluation of the role of endoscopy in repairing abductor tendon tears Paucity of evidence

4 PURPOSE Outcomes of a small cohort of patients GTPS treatment Secondary to abductor tendon tears Endoscopic surgical technique Developed by the senior author (SDM)

5 METHODS Retrospective outcome analysis (12 patients) Endoscopic abductor tendon repair Gluteus medius and/or gluteus minimus Performed by high volume hip arthroscopist (SDM) Final cohort (7 patients) 3 patients did not meet inclusion criteria 12 months follow-up 1 patient excluded based on post-operative protocol noncompliance Primary outcomes Assessed by modified Harris Hip (mhhs) Hip Outcome Scores (HOS) Secondary outcomes Patient satisfaction Change in measured abduction strength on physical exam Post-operative complication rate

6 PATIENT CHARACTERISTICS Gender Male (3) Female (4) Cumulative Mean Age (years) 65.3 (range, 60-74) 63.5 (range, 62-66) 64.3 (range, 60-74) BMI 28.0 (±2.8) 32.8 (±1.9) 30.7 (±3.3) Idiopathic Tear 2 (67%) 4(100%) 6 (86%) Concomitant Gluteus Minimus Tear 1 (33%) 2 (50%) 3 (43%) Surgery to Outcome Score (months) 21.8 (±6.3) 15.0 (±3.4) 17.9 (±5.7) All patients Abductor muscle weakness, antalgic gait, pain over the greater trochanter Refractory to exhaustive treatment by conservative measures All diagnoses were subsequent to extensive physical exam, standard imaging, and T2 weighted MRI

7 SURGICAL TECHNIQUE

8 PRIMARY OUTCOMES Gender Male (3) Female (4) Cumulative Mean MHHS 89.1 (±13.7) 75.6 (±19.8) 81.4 (±17.6) HOS-ADL 74.0 (±25.8) 78.8 (±12.3) 76.7 (±17.4) ADL-SA* 94.0 (±5.3) 84.8(±10.5) 88.7 (±9.4) HOS-Sports 91.6 (±10.0) 61.1 (±25.0) 74.2 (±24.7) Sports-SA* 92.7 (±11.0) 88.7 (±14.3) 90.4 (±12.1) Primary outcomes: minimum 12 month follow-up After endoscopic repair of abductor tendon tears *Self Assessment: Each patient s subjective assessment of how they fair when performing ADLs or recreational activities

9 SECONDARY OUTCOMES Gender Male (3) Female (4) Cumulative Mean Pre-operative abductor strength 4/5 2 (67%) 75.6 (±19.8) 4 (58%) Post-operative abductor strength 4/5 3 (100%) 4 (100%) 7 (100%) Would have the surgery again 3 (100%) 3 (75%) 6 (86%) Secondary outcomes: minimum 12 month follow-up After endoscopic repair of abductor tendon tears No post-surgical complications were reported in this cohort

10 CONCLUSIONS Endoscopic repair of abductor tendon tears Effective surgical intervention After failed conservative management At short term follow-up The majority of patients: Obtain good to excellent outcomes (mhhs > 80) See improved strength Experience high satisfaction At low risk for complications

11 LIMITATIONS Observational study Insufficient numbers to perform statistical comparisons Does not assess patient outcomes at long-term follow-up Prospective studies To compare this endoscopic technique vs. others performed

12 CLINICAL RELEVANCE Gluteal tendinopathy Specifically tears of the gluteus medius & minimus Are established sources of pain in recalcitrant GTPS If conservative measures fail to significantly reduce pain In the setting of proven radiographic pathology, surgical options including endoscopic repair exist

13 REFERENCES 1. Byrd JWT. Operative Hip Arthroscopy. Springer, New York. 2005; Bunker TD. Esler CAN, Leach WJ: Rotator-cuff tear of the hip. J Bone Joint Surg. 1997; 79(B): Cormier G, Berthelot JM, Maugars Y, SRO (Societe de Rhumatologie de l Ouest). Gluteus tendon rupture is underrecognized by French orthopedic surgeons: results of a mail survey. Joine Bone Spine 2006; 73: Craig RA, Gwynne Jones DP, Oakley AP, Dunbar JD. Iliotibial band z-lengthening for refractory trochanteric bursitis (greater trochanter pain syndrome). ANZ J Surg. 2007; 77: Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). AJR. 2004; 182: Davies H, Zhaeentan S, Tavakkolizadeh A, Janes G. Surgical repair of chronic tears of the hip abductor mechanism. Hip Int 2009; 19: Domb BG, Nasser RM, Botser IB. Partial thickness tears of the gluteus medius: rationale and technique for transtendinous endoscopic repair. Arthroscopy. 2010; 26(12): Flack N, Nicholson HD, Woodley SJ. A review of the anatomy of the ip abductor muscles, gluteus medius, gluteus minimus, and tensor fascia lata. Clin Anat. 2012; 00: Kagan A. Five cases of disruptions of the abductor mechanism of the ip. Orthop Trans 1996; 20: Kagan A. Rotator cuff tears of the hip. Clin Orthop. 1999; 368: Kingzett-Taylor A, Tirman PFJ, Feller J, McGann W, Prieto V, Wischer T, Cameron JA, Cvitanic O, Genant HK. Tendinosis and tears of the gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings, AJR. 1999; 173: LaBan MM, Weir SK, Taylor RS. Bald trochanter spontaneous rupture of the conjoined tendons of the gluteus medius and minimus presenting as trochanteric bursitis. Am J Phys Med Rehabil. 2004; 83(10): Martin RL, Kelly BT, Phillipon MJ. Evidence of validity for the hip outcome score. Arthroscopy. 2006; 22(12): Roberston WJ, Gardner MJ, Barker JU, Boraiah S, Lorich DJ, Kelly BT. Anatomy and dimensions of the gluteus medius tendon insertion. Arthrocopy 2008; 24: Segal NA, Felson DT, Torner JC, Zhu Y, Curtis JR, Niu J, Nevitt MC. Greater Trochanteric Pain Syndrome: Epidemiology and Associated Factors. Arch Phys Med Rehabil 2007; 88: Shindle MK, Voos JE, Heyworth BE, Mintz DN, Moya LE, Buly RL, Kelly, BT. Hip arthroscopy in the athletic patient: current techniques and spectrum of disease. J Bone Joint Surg Am. 2007; 89(Suppl 3): Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical treatment for peritrochanteric space disorders in the hip. Arthroscopy. 2007; 23(11):1246.el-1246.e Voos JE, Shindle MK, Pruett A, Asnis PD, Kelly BT. Endoscopic repair of gluteus medius tendon tears of the hip. Am J Sports Med. 2009; 47(4): Walsh MJ, Walton JR, Walsh NA. Surgical repair of gluteal tendons: a report of 72 cases. J Arthroplasty. 2001; 26(8): Williams BS; Cohen SP. Greater trochanteric pain syndrome: a review of anatomy diagnosis and treatment. Anesth Analg 2009; 108: Tibor LM, Sekiya JK. Differential diagnosis of pain around the hip joint. Arthroscopy Dec;24(12):

Clinical Features That Predict the Need for Operative Intervention in Gluteus Medius Tears

Clinical Features That Predict the Need for Operative Intervention in Gluteus Medius Tears Sivashankar Chandrasekaran,* MBBS, FRACS, S. Pavan Vemula,* MA, Chengcheng Gui,* BSE, Carlos Suarez-Ahedo,* MD,