[Gluteus medius tendon tear and degenerative hip disease].

Service de Chirurgie Orthopédique et Traumatologique, CHU Nord, place Victor-Pauchet, 80000 Amiens.
Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur (Impact Factor: 0.55). 12/2003; 89(7):640-2.
Source: PubMed

ABSTRACT We report three cases of gluteus medius tendon tears discovered fortuitously in patients undergoing total hip arthroplasty. The tears were not suspected from the initial clinical presentation. Sutures were possible in only one patient. Outcome of the hip arthroplasty was very good in all three patients despite lack of tendon repair in two.

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    ABSTRACT: Objectifs Recueillir l'expérience des chirurgiens orthopédistes français du diagnostic et du traitement chirurgical des ruptures de la coiffe tendineuse de la hanche. Méthodes Enquête postale menée en 2003 auprès de 459 chirurgiens orthopédistes français. Résultats Parmi les 84 répondeurs, 38 (45 %) ne connaissaient pas l'entité, et 11 sur 84 (13 %) la connaissaient mais ne l'avaient jamais évoquée. Parmi les 35 sur 84 chirurgiens (42 %) ayant déjà réparé au moins une fois un tendon glutéal, 24 (29 %) l'avaient fait en raison de la découverte fortuite d'une rupture au cours d'un acte chirurgical résultant d'un autre motif (pose d'une prothèse totale de hanche). Seulement 11 chirurgiens (13 %) étaient intervenus sur des ruptures d'un muscle glutéal diagnostiquées avant la chirurgie (20 moyens glutéaux, six grands glutéaux, trois petits glutéaux, soit 29 cas en tout). Celle-ci n'avait consisté en la réparation d'un tendon que dans 14 cas (par six chirurgiens [7 %]), les autres réparations ayant été faites dans le contexte de la pose d'une prothèse de hanche. Le caractère rétrospectif de l'enquête et l'absence de suivi à moyen terme de ces patients empêchent de tirer des conclusions solides quant au résultat final de ces gestes. Conclusion La possibilité de déchirures–ruptures des tendons glutéaux semble très peu connue, et leur réparation chirurgicale exceptionnelle, malgré la fréquence de ces déchirures dans les études anatomiques ou d'imagerie (au moins 10 % des sujets de plus de 60 ans).
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    ABSTRACT: Although various techniques can be used to repair gluteal tendon tears, the long-term outcome is unclear and published studies typically involve only a small number of patients. The goals of this study were to determine (1) if functional improvement can be obtained, (2) if the repairs are continuous based on MRI, and (3) which factors determine success. Gluteus medius and minimus tears can be repaired effectively with an open double-row technique. Seventy-three patients were operated on between 2003 and 2010. Of these patients, 67 (62 women, 5 men) were available for review consisting of functional clinical tests and MRI of the hip and pelvis. A double-row repair was performed on all tendon tears, no matter the type of injury. Age, body mass index (BMI), fatty degeneration and muscle atrophy were also evaluated to determine if these variables affected the outcome. The average follow-up was 4.6 years (range 1-8). The pre-operative scores had improved at the last follow-up: (1) pain (VAS): 8.7±1.1 versus 1.7±2.7 at the follow-up, (P<0.001), (2) Lequesne index: 12.3±2.6 versus 4.0±4.0 at the follow-up, (P<0.001), (3) Harris Hip Score: 50.5±8 versus 87.9±15.5 at the follow-up, (P<0.001). There were 11 failures (16%) including two repeat tears that were reoperated successfully. In the other 56 patients, the MRI showed no signs of the initial tear or bursitis. Of the four factors (age, BMI, fatty degeneration, muscle atrophy) that were potential predictors of the outcome, only muscle atrophy had a negative impact on functional outcome (P<0.05). Using an open double-row technique to repair gluteal tendon tears led to 85% of patients having good clinical results with significant improvement in symptoms and disappearance of abnormal findings on MRI. This technique can be used with all types of tendon tears, but should be performed before muscle atrophy sets in. Level IV-retrospective study. Copyright © 2014. Published by Elsevier Masson SAS.
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    ABSTRACT: In the recent years there has been an increase in the number of tendon tears (TT) seen in routine daily outpatient practice secondary to the increasing popularity of sport activities. Tears require early diagnosis to ensure proper treatment and reduce functional impairment. Since local pain, edema and reflex muscle contraction can significantly limit the usefulness of clinical examination, imaging is usually required to confirm the clinical diagnosis, differentiate between partial and complete tear, and localize the retracted tendon stump. Several imaging modalities can be used in the evaluation of TT. Ultrasound is an efficient, dynamic, low cost and non invasive modality that is being increasingly utilized in the evaluation of the musculoskeletal system. It is well accepted by the acutely injured patient. The aim of this review article is to describe the ultrasound findings of the most common tendon tears.
    Journal de Radiologie 12/2005; 86(12):1845-1856. DOI:10.1016/S0221-0363(05)81534-3 · 0.57 Impact Factor