Association of Preoperative Gluteal Muscle Fatty Infiltration With Patient Outcomes in Women After Hip Abductor Tendon Repair Augmented With LARS

Jay R. Ebert, Anne Smith, William Breidahl, Michael Fallon, Gregory C. Janes

Research output: Contribution to journalArticle

Abstract

Background: Hip abductor tendon repair has demonstrated encouraging outcomes. The influence of fatty infiltration (FI) on outcome has not been explored. Purpose: To investigate the association between preoperative hip abductor FI and clinical outcome after hip abductor tendon repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 84 women underwent hip abductor tendon repair. The mean age was 64.6 years (range, 43-84 years); body mass index, 27.7 (range, 20.0-40.2); and duration of symptoms, 3.4 years (range, 6 months–20 years). The 6-minute walk test, isometric hip abduction strength assessment, and patient-reported outcome measures, including the Harris Hip Score and Oxford Hip Score, were completed presurgery and 2 years after surgery. Patient satisfaction and perceived improvement were assessed 2 years after surgery. All patients underwent preoperative magnetic resonance imaging on the affected hip, and the Goutallier system was used to grade the degree of FI in the anterior, middle, and posterior thirds of the gluteus medius and minimus on a 0-4 ordinal scale. A single FI score for the gluteus medius and minimus was calculated, as was a combined FI score. Results: All clinical scores significantly improved over time (P <.001). Preoperatively, FI was more severe in the gluteus minimus, with the most severe FI (grades 2-4) demonstrated in the middle (n = 56, 66.7%) and anterior (n = 17, 20.2%) portions of the gluteus minimus and the middle (n = 27, 32.1%) and anterior (n = 12, 14.3%) portions of the gluteus medius. Older age was associated with greater FI (combined FI score: r = 0.529, P <.001), although duration of symptoms (r = 0.035, P =.753) and body mass index (r = 0.089, P =.464) were not. Greater FI was associated with less improvement in hip strength of the unaffected leg (coefficient, –1.6, 95% CI: −2.8 to −0.4), although no other significant associations were observed between FI and pre- or postoperative clinical scores. Conclusion: Preoperative FI was not associated with pertinent parameters of patient outcome after hip abductor tendon repair, including pain, symptoms, functional capacity, perceived improvement, and satisfaction. Based on these outcomes, surgical repair may be considered in the presence of more severe FI.

Original languageEnglish
JournalAmerican Journal of Sports Medicine
DOIs
Publication statusE-pub ahead of print - 12 Sep 2019

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Tendons
Hip
Muscles
Body Mass Index
Patient Satisfaction
Leg
Magnetic Resonance Imaging
Pain

Cite this

@article{a54a793aedeb496c9fff4b899341ee52,
title = "Association of Preoperative Gluteal Muscle Fatty Infiltration With Patient Outcomes in Women After Hip Abductor Tendon Repair Augmented With LARS",
abstract = "Background: Hip abductor tendon repair has demonstrated encouraging outcomes. The influence of fatty infiltration (FI) on outcome has not been explored. Purpose: To investigate the association between preoperative hip abductor FI and clinical outcome after hip abductor tendon repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 84 women underwent hip abductor tendon repair. The mean age was 64.6 years (range, 43-84 years); body mass index, 27.7 (range, 20.0-40.2); and duration of symptoms, 3.4 years (range, 6 months–20 years). The 6-minute walk test, isometric hip abduction strength assessment, and patient-reported outcome measures, including the Harris Hip Score and Oxford Hip Score, were completed presurgery and 2 years after surgery. Patient satisfaction and perceived improvement were assessed 2 years after surgery. All patients underwent preoperative magnetic resonance imaging on the affected hip, and the Goutallier system was used to grade the degree of FI in the anterior, middle, and posterior thirds of the gluteus medius and minimus on a 0-4 ordinal scale. A single FI score for the gluteus medius and minimus was calculated, as was a combined FI score. Results: All clinical scores significantly improved over time (P <.001). Preoperatively, FI was more severe in the gluteus minimus, with the most severe FI (grades 2-4) demonstrated in the middle (n = 56, 66.7{\%}) and anterior (n = 17, 20.2{\%}) portions of the gluteus minimus and the middle (n = 27, 32.1{\%}) and anterior (n = 12, 14.3{\%}) portions of the gluteus medius. Older age was associated with greater FI (combined FI score: r = 0.529, P <.001), although duration of symptoms (r = 0.035, P =.753) and body mass index (r = 0.089, P =.464) were not. Greater FI was associated with less improvement in hip strength of the unaffected leg (coefficient, –1.6, 95{\%} CI: −2.8 to −0.4), although no other significant associations were observed between FI and pre- or postoperative clinical scores. Conclusion: Preoperative FI was not associated with pertinent parameters of patient outcome after hip abductor tendon repair, including pain, symptoms, functional capacity, perceived improvement, and satisfaction. Based on these outcomes, surgical repair may be considered in the presence of more severe FI.",
keywords = "clinical outcomes, fatty atrophy, gluteal tendon repair, greater trochanteric pain syndrome, hip abductor tendon repair",
author = "Ebert, {Jay R.} and Anne Smith and William Breidahl and Michael Fallon and Janes, {Gregory C.}",
year = "2019",
month = "9",
day = "12",
doi = "10.1177/0363546519873672",
language = "English",
journal = "The American Journal of Sports Medicine",
issn = "0363-5465",
publisher = "SAGE Publications Ltd",

}

Association of Preoperative Gluteal Muscle Fatty Infiltration With Patient Outcomes in Women After Hip Abductor Tendon Repair Augmented With LARS. / Ebert, Jay R.; Smith, Anne; Breidahl, William; Fallon, Michael; Janes, Gregory C.

In: American Journal of Sports Medicine, 12.09.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association of Preoperative Gluteal Muscle Fatty Infiltration With Patient Outcomes in Women After Hip Abductor Tendon Repair Augmented With LARS

AU - Ebert, Jay R.

AU - Smith, Anne

AU - Breidahl, William

AU - Fallon, Michael

AU - Janes, Gregory C.

PY - 2019/9/12

Y1 - 2019/9/12

N2 - Background: Hip abductor tendon repair has demonstrated encouraging outcomes. The influence of fatty infiltration (FI) on outcome has not been explored. Purpose: To investigate the association between preoperative hip abductor FI and clinical outcome after hip abductor tendon repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 84 women underwent hip abductor tendon repair. The mean age was 64.6 years (range, 43-84 years); body mass index, 27.7 (range, 20.0-40.2); and duration of symptoms, 3.4 years (range, 6 months–20 years). The 6-minute walk test, isometric hip abduction strength assessment, and patient-reported outcome measures, including the Harris Hip Score and Oxford Hip Score, were completed presurgery and 2 years after surgery. Patient satisfaction and perceived improvement were assessed 2 years after surgery. All patients underwent preoperative magnetic resonance imaging on the affected hip, and the Goutallier system was used to grade the degree of FI in the anterior, middle, and posterior thirds of the gluteus medius and minimus on a 0-4 ordinal scale. A single FI score for the gluteus medius and minimus was calculated, as was a combined FI score. Results: All clinical scores significantly improved over time (P <.001). Preoperatively, FI was more severe in the gluteus minimus, with the most severe FI (grades 2-4) demonstrated in the middle (n = 56, 66.7%) and anterior (n = 17, 20.2%) portions of the gluteus minimus and the middle (n = 27, 32.1%) and anterior (n = 12, 14.3%) portions of the gluteus medius. Older age was associated with greater FI (combined FI score: r = 0.529, P <.001), although duration of symptoms (r = 0.035, P =.753) and body mass index (r = 0.089, P =.464) were not. Greater FI was associated with less improvement in hip strength of the unaffected leg (coefficient, –1.6, 95% CI: −2.8 to −0.4), although no other significant associations were observed between FI and pre- or postoperative clinical scores. Conclusion: Preoperative FI was not associated with pertinent parameters of patient outcome after hip abductor tendon repair, including pain, symptoms, functional capacity, perceived improvement, and satisfaction. Based on these outcomes, surgical repair may be considered in the presence of more severe FI.

AB - Background: Hip abductor tendon repair has demonstrated encouraging outcomes. The influence of fatty infiltration (FI) on outcome has not been explored. Purpose: To investigate the association between preoperative hip abductor FI and clinical outcome after hip abductor tendon repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 84 women underwent hip abductor tendon repair. The mean age was 64.6 years (range, 43-84 years); body mass index, 27.7 (range, 20.0-40.2); and duration of symptoms, 3.4 years (range, 6 months–20 years). The 6-minute walk test, isometric hip abduction strength assessment, and patient-reported outcome measures, including the Harris Hip Score and Oxford Hip Score, were completed presurgery and 2 years after surgery. Patient satisfaction and perceived improvement were assessed 2 years after surgery. All patients underwent preoperative magnetic resonance imaging on the affected hip, and the Goutallier system was used to grade the degree of FI in the anterior, middle, and posterior thirds of the gluteus medius and minimus on a 0-4 ordinal scale. A single FI score for the gluteus medius and minimus was calculated, as was a combined FI score. Results: All clinical scores significantly improved over time (P <.001). Preoperatively, FI was more severe in the gluteus minimus, with the most severe FI (grades 2-4) demonstrated in the middle (n = 56, 66.7%) and anterior (n = 17, 20.2%) portions of the gluteus minimus and the middle (n = 27, 32.1%) and anterior (n = 12, 14.3%) portions of the gluteus medius. Older age was associated with greater FI (combined FI score: r = 0.529, P <.001), although duration of symptoms (r = 0.035, P =.753) and body mass index (r = 0.089, P =.464) were not. Greater FI was associated with less improvement in hip strength of the unaffected leg (coefficient, –1.6, 95% CI: −2.8 to −0.4), although no other significant associations were observed between FI and pre- or postoperative clinical scores. Conclusion: Preoperative FI was not associated with pertinent parameters of patient outcome after hip abductor tendon repair, including pain, symptoms, functional capacity, perceived improvement, and satisfaction. Based on these outcomes, surgical repair may be considered in the presence of more severe FI.

KW - clinical outcomes

KW - fatty atrophy

KW - gluteal tendon repair

KW - greater trochanteric pain syndrome

KW - hip abductor tendon repair

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U2 - 10.1177/0363546519873672

DO - 10.1177/0363546519873672

M3 - Article

JO - The American Journal of Sports Medicine

JF - The American Journal of Sports Medicine

SN - 0363-5465

ER -