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

Chandrasekaran S, Vemula SP, Gui C, Suarez-Ahedo C, Lodhia P, Domb BG - Orthop J Sports Med (2015)

Bottom Line: Abnormal gait was found in 75% of the operative cohort, compared with 33% of the matched cohort (P < .05).Specifically, 83.3% of the surgical cohort had a Trendelenburg gait, compared with 25% of the matched cohort (P = .002).There were no significant differences in the other parameters.

View Article: PubMed Central - PubMed

Affiliation: American Hip Institute, Westmont, Illinois, USA.

ABSTRACT

Background: Gluteus medius tears are a common cause of lateral hip pain. Operative intervention is usually prescribed for patients with pain despite physical therapy and/or peritrochanteric injections.

Purpose: To identify clinical features that predict operative intervention in gluteus medius tears.

Study design: Case control study; Level of evidence, 3.

Methods: A matched-pair controlled study was conducted on patients who underwent endoscopic gluteus medius repairs from June 2008 to August 2014 for full-thickness tears. The exclusion criterion was previous hip disorders (eg, Legg-Calve-Perthes disease, avascular necrosis). The control group contained patients with full-thickness gluteus medius tears on magnetic resonance imaging (MRI) who did not require operative intervention. Both groups had a minimum trial of 3 months of nonoperative management. Matching criteria included age within 5 years, sex, and body mass index (BMI) class. The following clinical parameters were analyzed: presence of lateral-sided hip pain, duration of symptoms, power of resisted hip abduction, gait deviation (antalgic or Trendelenburg), greater trochanter tenderness, and hip passive range of abduction.

Results: Twenty-four patients who underwent isolated endoscopic gluteus medius repairs were identified; all patients were females, with a mean age of 65 years (range, 52-82 years) and mean BMI of 29.2 kg/m(2) (range, 21.55-44.398 kg/m(2)). The matched control cohort contained 12 females treated nonoperatively for gluteus medius tears with mean age of 66 years (range, 52-81 years) and mean BMI of 29.9 kg/m(2) (range, 20.20-43.59 kg/m(2)). There were significant differences between the groups in power of resisted abduction and presence of gait deviation. The operative cohort had a mean power grading of 3.63 (95% CI, 3.28-3.98) compared with 4.58 (95% CI, 4.29-4.87) for the matched cohort (P < .05). Abnormal gait was found in 75% of the operative cohort, compared with 33% of the matched cohort (P < .05). Specifically, 83.3% of the surgical cohort had a Trendelenburg gait, compared with 25% of the matched cohort (P = .002). The odds of requiring surgical intervention was 14-fold higher for patients with a gluteus medius tear and gait deviation compared with those without gait deviation. There were no significant differences in the other parameters.

Conclusion: Reduced power of resisted abduction and the presence of gait deviation on initial evaluation of patients with gluteus medius tears increases the likelihood of surgical intervention.

No MeSH data available.


Related in: MedlinePlus

Comparison of abductor strength values for surgery versus no surgery. Abductor strength was graded on a 0 to 5 scale (5 being strongest) based on the Medical Research Council classification.9
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fig1-2325967115571079: Comparison of abductor strength values for surgery versus no surgery. Abductor strength was graded on a 0 to 5 scale (5 being strongest) based on the Medical Research Council classification.9

Mentions: There was a statistically significant difference found between the cohorts for power of resisted abduction. The mean power of abduction of the surgical cohort was 3.3 (95% CI, 3.28-3.98) and for the matched cohort 4.58 (95% CI, 4.29-4.87; P = .001) (Figure 1). There was no statistical difference in passive hip abduction between cohorts (Table 3).


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

Chandrasekaran S, Vemula SP, Gui C, Suarez-Ahedo C, Lodhia P, Domb BG - Orthop J Sports Med (2015)

Comparison of abductor strength values for surgery versus no surgery. Abductor strength was graded on a 0 to 5 scale (5 being strongest) based on the Medical Research Council classification.9
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555614&req=5

fig1-2325967115571079: Comparison of abductor strength values for surgery versus no surgery. Abductor strength was graded on a 0 to 5 scale (5 being strongest) based on the Medical Research Council classification.9
Mentions: There was a statistically significant difference found between the cohorts for power of resisted abduction. The mean power of abduction of the surgical cohort was 3.3 (95% CI, 3.28-3.98) and for the matched cohort 4.58 (95% CI, 4.29-4.87; P = .001) (Figure 1). There was no statistical difference in passive hip abduction between cohorts (Table 3).

Bottom Line: Abnormal gait was found in 75% of the operative cohort, compared with 33% of the matched cohort (P < .05).Specifically, 83.3% of the surgical cohort had a Trendelenburg gait, compared with 25% of the matched cohort (P = .002).There were no significant differences in the other parameters.

View Article: PubMed Central - PubMed

Affiliation: American Hip Institute, Westmont, Illinois, USA.

ABSTRACT

Background: Gluteus medius tears are a common cause of lateral hip pain. Operative intervention is usually prescribed for patients with pain despite physical therapy and/or peritrochanteric injections.

Purpose: To identify clinical features that predict operative intervention in gluteus medius tears.

Study design: Case control study; Level of evidence, 3.

Methods: A matched-pair controlled study was conducted on patients who underwent endoscopic gluteus medius repairs from June 2008 to August 2014 for full-thickness tears. The exclusion criterion was previous hip disorders (eg, Legg-Calve-Perthes disease, avascular necrosis). The control group contained patients with full-thickness gluteus medius tears on magnetic resonance imaging (MRI) who did not require operative intervention. Both groups had a minimum trial of 3 months of nonoperative management. Matching criteria included age within 5 years, sex, and body mass index (BMI) class. The following clinical parameters were analyzed: presence of lateral-sided hip pain, duration of symptoms, power of resisted hip abduction, gait deviation (antalgic or Trendelenburg), greater trochanter tenderness, and hip passive range of abduction.

Results: Twenty-four patients who underwent isolated endoscopic gluteus medius repairs were identified; all patients were females, with a mean age of 65 years (range, 52-82 years) and mean BMI of 29.2 kg/m(2) (range, 21.55-44.398 kg/m(2)). The matched control cohort contained 12 females treated nonoperatively for gluteus medius tears with mean age of 66 years (range, 52-81 years) and mean BMI of 29.9 kg/m(2) (range, 20.20-43.59 kg/m(2)). There were significant differences between the groups in power of resisted abduction and presence of gait deviation. The operative cohort had a mean power grading of 3.63 (95% CI, 3.28-3.98) compared with 4.58 (95% CI, 4.29-4.87) for the matched cohort (P < .05). Abnormal gait was found in 75% of the operative cohort, compared with 33% of the matched cohort (P < .05). Specifically, 83.3% of the surgical cohort had a Trendelenburg gait, compared with 25% of the matched cohort (P = .002). The odds of requiring surgical intervention was 14-fold higher for patients with a gluteus medius tear and gait deviation compared with those without gait deviation. There were no significant differences in the other parameters.

Conclusion: Reduced power of resisted abduction and the presence of gait deviation on initial evaluation of patients with gluteus medius tears increases the likelihood of surgical intervention.

No MeSH data available.


Related in: MedlinePlus