Minimus Tendons Research Articles

Treatment of Gluteus Medius and Minimus Tendon Tears with a Specific Diagnostic and Surgical Technique: A Retrospective Study of 67 Patients

Treatment of Gluteus Medius and Minimus Tendon Tears with a Specific Diagnostic and Surgical Technique: A Retrospective Study of 67 Patients

Greater Trochanteric Pain Syndrome

Pain around the greater trochanter is still a common clinical problem that may be secondary to a variety of either intra-articular or periarticular pathologies. Gluteal tendon pathologies are one of the primary causes of greater trochanteric pain, with attrition of the fasciae latae against the gluteus medius and minimus tendons, and the trochanteric bursa being possible causes. Key sonographic findings of gluteal tendinopathy, bursitis, and differential diagnosis are described in this overview. Clinical diagnosis and treatment of greater trochanteric pain syndrome is still challenging; therefore ultrasound is helpful to localize the origin of pain, determine underlying pathology, and, based on these findings, to guide local aspiration and/or injection in cases of tendinopathy and/or bursitis.

A modified direct lateral approach for neck-preserving total hip arthroplasty: tips and technical notes

Tissue-sparing surgery for hip replacement aims to minimize muscle damage and conserve the femoral neck through the use of mini-prostheses. We propose a modification of the classical direct lateral access procedure that preserves the gluteus medius. Further advantages during the surgical phase include limited blood loss, visualization of the entire acetabulum, and sparing of the transverse ligament. Precise implantation is facilitated and normal biomechanics are preserved. The gluteus medius is divided longitudinally between the anterior third and posterior two-thirds to provide access to the gluteus minimus, which is detached from the femoral insertion together with a small portion of the vastus lateralis, forming a flap that exposes the underlying articular capsule. When the femoral head is revealed, a decision is made to either continue with its dislocation directly or to resect it and remove it separately to avoid damaging the gluteus medius during dislocation. Upon removal of the femoral head, with the limb flexed and slightly over-rotated, the acetabulum is completely visible. Limb length is maintained through the use of reference stitches on the gluteus minimus tendon and the proximal insertion of the vastus lateralis. In keeping with the minimally invasive philosophy, only pathological tissue is removed (marginal osteophytes, geodes, joint capsule, cartilage to the point of bleeding and pulvinar). We have performed more than 2,000 implants with this procedure since 1990. Advantages and potential critical points are discussed.

Endoscopic Repair of Full-Thickness Gluteus Medius Tears

Tears in the gluteus medius and minimus tendons recently have emerged as an important cause of chronic greater trochanteric pain syndrome. Increasing recognition of the gluteal insertion as a cause of chronic pain and weakness, as well as technologic advances in endoscopic hip surgery, has made gluteal insertional repair a rapidly emerging technique in minimally invasive surgery of the hip. We present an endoscopic double-row technique for gluteal insertional repair that allows for visualization, debridement, and repair, re-creating the normal footprint.

SPONTANEOUS RUPTURE OF THE LEFT EXTENSOR POLLICIS LONGUS-, EXTENSOR DIGITORUM- AND EXTENSOR DIGITI MINIMI TENDONS: A CASE REPORT

This case report describes a patient who experienced closed simultaneous rupture of the left extensor pollicis longus (EPL)-, extensor digitorum (ED) and extensor digiti minimi (EDM) tendons.

Treatment of a hip capsular injury in a professional soccer player with platelet-rich plasma and bone marrow aspirate concentrate therapy

This report presents a 27-year-old male professional soccer player who developed heterotopic ossification of his hip capsule and gluteus minimus tendon after an arthroscopic hip procedure. After removal of the heterotopic bone, the patient had a symptomatic deficiency of his hip capsule and gluteus minimus tendon. A series of orthobiologic treatments with platelet-rich plasma and bone marrow aspirate concentrate improved the patient's pain and strength as well as the morphologic appearance of the hip capsule and gluteus minimus tendon on magnetic resonance imaging. A series of motion analyses demonstrated significant improvement in his stance-leg ground reaction force and hip abduction, as well as linear foot velocity at ball strike and maximum hip flexion following ball strike in his kicking leg. Level of evidence IV.

Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle

To evaluate the association between hypertrophy of the tensor fasciae latae muscle and abductor tendon tears. Thirty-five patients who underwent MRI of the abductor tendons of the hip were included in this retrospective study. A subgroup of 18 patients was examined bilaterally. The area of the tensor fasciae latae muscle and the area of the sartorius muscle (size reference) were quantified at the level of the femoral head, and a ratio was calculated. Two radiologists assessed the integrity of the gluteus medius and minimus tendon in consensus. Data were analyzed with a Mann-Whitney U test. Sixteen out of 35 patients (46 %) had a tear of the gluteus medius or minimus tendon. The ratio of the area of the tensor fasciae latae to the sartorius muscle was significantly higher (p = .028) in the group with an abductor tendon tear (median 2.25; Interquartile Range [IQR] = 1.97-3.21) compared to the group without any tears (median 1.91; IQR = 1.52-2.26). The bilateral subanalysis showed that in patients without a tear, the ratio of the two areas did not differ between each side (p = .966), with a median of 1.54 (primary side) and 1.76 (contralateral side). In patients with an abductor tendon tear the ratio was significantly higher (p = .031) on the side with a tear (median 2.81) compared to the contralateral healthy side (1.67). Patients with abductor tendon tears showed hypertrophy of the tensor fasciae latae muscle when compared to the contralateral healthy side and to patients without a tear.

Acute Traumatic Tear of Gluteus Medius and Minimus Tendons in a Patient Without Antecedant Peritrochanteric Hip Pain

Morphologic similarities between the abductor mechanisms of the hip and shoulder have given rise to the term rotator cuff tear of the hip. Although the true incidence of gluteus medius and minimus tears in the general population is unknown, the association between these tears and recalcitrant lateral hip pain has been described as greater trochanteric pain syndrome. Historically, tears of the gluteus medius and minimus have been thought to be attritional, and associated with chronic peritrochanteric pain, found incidentally during fracture fixation or hip arthroplasty, or with failure of abductor repair following arthroplasty utilizing the anterolateral approach. The literature supports favorable clinical outcomes with operative repair utilizing either endoscopic or open techniques. To our knowledge, there has never been a reported case of an acute traumatic tear of the gluteus medius and minimus that occurred without antecedant peritrochanteric hip pain. In this case, the patient was treated with acute open repair of the gluteus medius and minimus tendons within 3 weeks of injury and excellent clinical results were obtained at 6-month follow-up. Of note, the patient was notified and gave consent for his case to be used in publication.

Restoration of active palmar abduction of the thumb in tetraplegia by tendon transfer of the extensor digiti minimi to abductor pollicis brevis

We describe a method to restore active palmar abduction of the thumb and report its functional impact in tetraplegia. At 54.2 (SD 42.8) months after cervical spinal cord injury (12 traumatic, 3 nontraumatic), the extensor digiti minimi (EDM) tendon was transferred to the abductor pollicis brevis (APB) through the interosseous membrane in 15 tetraplegic patients (age range 19-70 years) in addition to a mean 3.2 procedures to restore key pinch. According to International Classification, the operated upper extremities were in the OCu4 to OCu8 (1 patient X) group. The maximum distance between thumb and index finger tips during active or passive opening of the hand, maximum angle of palmar abduction, grip and key pinch strength, and active finger range of motion were measured. All patients were re-examined after 38.4 (SD 22.7) months. The active thumb-index opening increased significantly from 2.5 (SEM 1.0) cm before to 9.0 (SEM 0.8) cm after surgery. Nine patients without previous active opening of the first web space recovered a mean thumb-index opening of 9.1 (SEM 1.7) cm, whereas this distance increased by an average of 2.9 (SEM 0.8) cm in six patients who had active thumb index distance of 6.3 (SEM 1.6) cm before surgery. All but one patient were able to direct and coordinate key pinch and perform tasks using the restored APB function, including five patients whose EDM strength was rated as grade 3 before transfer. This EDM-to-APB transfer meets the theoretical requirements of architecture matching between donor and recipient muscles, the principles of tendon transfer, and our surgical expectations. We strongly recommend that an active EDM is transferred to the APB to restore opening of the hand and help in key pinch control in patients with tetraplegia.

Stun gun induced myotendinous injury of the iliopsoas and gluteus minimus

We report a 57-year-old man with a complete tear of his iliopsoas tendon at the distal myotendinous junction, a near complete tear of the iliopsoas tendon at the lesser trochanter of the femur, and a high-grade tear of his gluteus minimus tendon at the greater trochanter of the femur after being struck by a stun gun in the proximal left thigh. The stun gun discharge resulted in a forced contraction of the left hip flexor muscles, which resulted in pain, weakness and difficulty with active hip flexion. Three months after the being struck with the stun gun, the patient underwent magnetic resonance imaging (MRI) of the left hip. MRI of the left hip revealed a complete tear of the left iliopsoas tendon from the lesser trochanter with 4cm of proximal retraction and a high-grade strain of the gluteus minimus tendon at the greater trochanter. The distal iliopsoas myotendinous junction and lesser trochanter tendon insertion were surgically repaired. This case illustrates that a stun gun can cause acute rupture of the iliopsoas tendon and tear of the gluteus minimus tendon, which is well visualized on MRI.

MRI findings of gluteus minimus muscle damage in primary total hip arthroplasty and the influence on clinical outcome

The influence of surgical trauma on gluteus minimus muscle in total hip arthroplasty (THA) and the impact on functional outcome has been hardly investigated up to now. Potential risks of minimus damage during the approach or femoral preparation is due to its attachment to the anterior facet of the greater trochanter. Possible trauma-associated functional deficits of minimus muscle may result in reduced abduction force or in an unstable hip joint. The aim of the present study was to assess the pre- and post-operative gluteus minimus muscle (tendon defects and fatty atrophy) in patient with anterolateral minimally invasive and modified lateral approach by means of magnetic resonance imaging (MRI) and to investigate the associated impact on functional outcome. Thirty-eight patients [average age, 64 years (35-80); BMI, 28 kg/m(2) (19-35)] with primary coxarthrosis were prospectively enrolled in the study. A cementless hip prosthesis was implanted either via a minimally invasive anterolateral or a modified direct lateral approach. Patients were clinically and radiologically (MRI) examined preoperatively, 3, and 12 months postoperatively. Additionally, the Harris hip score, a pain score (NRS 0-10) and a satisfaction score (1-6) were recorded. To test the function of the abductor muscles the Trendelenburg's sign and the abductor muscle strength were evaluated. MRI evaluation includes the assessment of tendon defects and fatty atrophy of the minimus muscle. Tendon defects and fatty atrophy were seen in nearly 50% of the patients after THA. Harris hip-, pain-, and satisfaction scores did not correlate with the MR findings. There was also no impact on the abduction strength or the Trendelenburg's sign. Furthermore, the frequency of minimus damage was neither influenced by age, gender, BMI nor by the applied approach. Muscle atrophy and tendon defects of the minimus muscle appear frequently after THA without any favored relation to the lateral or anterolateral approach. The extent of injured minimus muscle has a minor impact on the clinical outcome particularly not on the abduction strength within the first postoperative year. The main function of the gluteus minimus is rather the centralization of the femoral head in the joint during the gait cycle than hip abduction and stabilization of the pelvis. The use of a straight stem with the associated need for lateral femoral preparation may be a risk factor for minimus tendon damage. Therefore, the surgeon should pay special attention to the prevention of surgical trauma to the gluteus minimus muscle during femoral preparation.

Acetabular Orientation: Anterolateral Approach in the Supine Position

The anterolateral approach in the supine position provides excellent visualization of the acetabulum. The main advantage of the approach, a low dislocation rate, has been demonstrated in the literature, while the purported disadvantage of abductor dysfunction has not been clearly delineated in the literature. The technique requires meticulous attention to preservation of the gluteus medius and minimus tendons. Impingement and dislocation are avoided by careful attention to the preparation of acetabulum, critical assessment of the implanted components, and intraoperative trialing. Leg lengths are assessed through direct palpation of the malleoli. Routine use of postoperative hip precautions is not necessary when this approach is utilized. The anterolateral approach in the supine position allows for a reproducible result with a low dislocation rate. Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair

Objectives (1) To compare MRI and surgical findings in patients with refractory greater trochanter pain syndrome and (2) to assess surgical outcomes. Methods All consecutive patients seen between 2002 and 2006 by a single clinician were selected for surgical treatment according to the following criteria: (1) tendinopathy confirmed by physical tests; (2) painful disability persisting for at least 6 months despite treatment; (3) on MRI: area of high signal intensity on T2-weighted images, in the area of gluteus medius and/or minimus tendon; and (4) absence of marked muscle atrophy or fatty degeneration. Two musculoskeletal radiologists interpreted images by consensus. A single surgeon operated on all patients. Results Eight patients met the criteria for surgery. All were women, aged 71.1 (SD: 9.4). Mean symptoms duration before surgery: 14.3 months (11.8). Surgery confirmed the presence of a tear of the lateral part of the gluteus medius tendon in all eight patients, with an associated tear of its main tendon in one patient, all tears revealed on MRI. An associated tear of the gluteus minimus tendon was present at surgery in five patients, of which three were not seen on MRI (false negative). Bursitis was confirmed in all eight patients. Steady complete remission of spontaneous and provoked (physical examination) pain was observed in seven patients and partial remission in one (mean follow-up: 22.4 months (SD: 16.3)). Six MRIs performed after 20 ± 12 months showed good reinsertion of the sutured tendon. Conclusion The eight MR images of tear of the lateral part of the gluteus medius tendon were all confirmed at surgery. Three of five associated tendon tears ( gluteus minimus only) were not seen on MRI. Surgical treatment was very effective in all patients but one.

Morphology of the Bursae Associated with the Greater Trochanter of the Femur

Abnormalities of the bursae in the vicinity of the greater trochanter have been implicated in the pathogenesis of lateral hip pain. The purpose of the present study was to investigate the detailed morphology of the bursae associated with the greater trochanter of the femur. The bursae deep to the tendons of each of the gluteal muscles were examined in eighteen embalmed human hips with use of macrodissection and histological techniques. The specimens were obtained from eight female and seven male donors who had had a mean age of seventy-eight years at the time of death. A total of 106 bursae were identified in ten different locations, with an average of six bursae per hip. As many as four bursae were present beneath the gluteus maximus muscle and the fascia lata, including those normally thought of as the "trochanteric" bursae and the gluteofemoral bursa. Two bursae typically were found beneath the tendon of the gluteus medius muscle: the anterior subgluteus medius bursa and the piriformis (posterior subgluteus medius) bursa. In the majority of cases, a single bursa was located deep to the gluteus minimus tendon, although two different bursae were identified: the subgluteus minimus bursa and the secondary subgluteus minimus bursa. All of these bursae demonstrated a synovial lining, which was predominantly areolar in type. The present study revealed that numerous bursae are intimately associated with the greater trochanter and that at least two bursae are associated with each of the gluteal tendons.

Surgical Treatment of Tears to the Gluetus Medius and Minimus Tendons of the Hip

Twenty-four patients underwent surgical treatment of tears to the abductors of the hip.

Gluteal tendinopathy in refractory greater trochanter pain syndrome: Diagnostic value of two clinical tests

To evaluate the value (sensitivity and specificity) of 2 modified physical tests for the diagnosis of gluteal tendinopathy in patients with refractory greater trochanter pain syndrome (GTPS). The 2 tests were prospectively evaluated by a single physician in all consecutive patients with persistent (> or =4 months) GTPS and no hip joint arthropathy seen on radiography between 2002 and 2006. The 2 tests evaluated the occurrence of pain similar to spontaneous pain during a single-leg stance held for 30 seconds and resisted external derotation in a supine position (hip flexed 90 degrees ) then prone position (hip extended). A matched control population without hip pain was examined similarly. Tendinitis, tendon tear, and associated bursitis in the target group were documented by magnetic resonance imaging (MRI) in transverse, coronal, and sagittal planes, with MRI serving as the gold standard. Seventeen patients completed the study (mean +/- SD age 68.1 +/- 10.8 years, mean duration of symptoms 13 months). MRI revealed tendinopathy and/or bursitis of the gluteus medius and/or minimus tendons in all patients, with evidence of tearing in 15. Sensitivity and specificity were 100% and 97.3%, respectively, for the single-leg stance test and 88% and 97.3%, respectively, for the resisted external derotation test in the supine position. The 30-second single-leg stance and resisted external derotation tests had very good sensitivity and specificity for the diagnosis of tendinous lesion and bursitis in patients with MRI-documented refractory GTPS.

Operative Repair of Bilateral Spontaneous Gluteus Medius and Minimus Tendon Ruptures

Spontaneous avulsion or rupture of the gluteus medius and minimus tendons may be an unrecognized source of debilitating pain in the lateral part of the hip1-3. Because of the difficulty in diagnosing the condition on the basis of routine history and physical examination, patients who present with ruptures of the gluteus medius or minimus tendons are often diagnosed as having greater trochanteric pain syndrome, which is a term used to denote trochanteric bursitis1,4. Patients with pain in the lateral part of the hip are often treated for bursitis, and therefore a ruptured tendon may go undiagnosed. As radiographic findings are generally absent, it may be necessary to acquire magnetic resonance images to make an accurate diagnosis2,5-7. Common conditions associated with greater trochanteric pain syndrome include degenerative diseases of the lumbar spine, arthritis of the hip, pelvic obliquity, iliotibial band and abductor tendinitis, and difference in the lengths of the lower limbs4,8,9. The cause of tendinosis and ruptures of the gluteus medius and minimus tendons is uncertain, but may be related to local mechanical trauma or predisposing systemic conditions10,11. The gluteus medius and minimus are part of the abductor apparatus. They can be considered analogous to the rotator cuff of the shoulder and thus are predisposed to rupture in a similar manner12-14. We report the clinical presentation, radiographic findings, and surgical management of a patient diagnosed with bilateral spontaneous ruptures of the gluteus medius and minimus tendons. Our patient is unique in that she was young and had bilateral ruptures, yet she had no known predisposing condition for tendon rupture. In addition, the ruptures occurred five years apart. Our patient was informed that …

Operative Repair of Bilateral Spontaneous Gluteus Medius and Minimus Tendon Ruptures

Operative Repair of Bilateral Spontaneous Gluteus Medius and Minimus Tendon Ruptures

Arthroscopic Anatomy and Surgical Techniques for Peritrochanteric Space Disorders in the Hip

Disorders of the lateral or peritrochanteric space (often grouped into the greater trochanteric pain syndrome), such as recalcitrant trochanteric bursitis, external snapping iliotibial band, and gluteus medius and minimus tears, are now being treated endoscopically. We outline the endoscopic anatomy of the peritrochanteric space of the hip and describe surgical techniques for the treatment of these entities. Proper portal placement is key in understanding the peritrochanteric space and should be first oriented at the gluteus maximus insertion into the linea aspera, as well as the vastus lateralis. When tears of the gluteus medius and minimus are encountered, suture anchors can be placed into the footprint of the abductor tendons in a standard arthroscopic fashion. Our initial experience indicates that recalcitrant trochanteric bursitis, external coxa saltans, and focal, isolated tears of the gluteus medius and minimus tendon may be successfully treated with arthroscopic bursectomy, iliotibial band release, and decompression of the peritrochanteric space and suture anchor tendon repair to the greater trochanter, respectively.

Sehnenrupturen beim Rheumatiker

In the course of rheumatoid arthritis, changes to tendons occur in different areas. This can lead to rupture if not prevented at an early stage. In particular, regions with extreme joint thickness, high mechanical wear and tear and narrow regions present a higher risk of synovitis. This primarily affects the tendons of the hand, where the extensor digitorum minimus tendon and the extensor and flexor pollicis tendons are most at risk. There is a high possibility of rotator cuff lesion in the shoulder area during the course of a secondary synovitis dependent raised shoulder, or by bursitis or tendonitis. A rupture of the biceps tendon is also increased by omarthritis or synovitis in the sulcus. For the foot, the posterior tibial tendon is most commonly effected, which if primarily or secondarily damaged can lead to a rheumatic flat foot. In addition, there can be partial or complete destruction in the Achilles tendon area, which is definitely pathognomonic. The narrow syndrome in the flexor hallucis and the extensor digitorum tendons are less common.