Abstract
Background: To investigate if a tiered, 6-phase prehabilitation/rehabilitation physical therapy (PT) protocol improves functional outcomes for patients undergoing endoscopic abductor tendon repair. Methods: This prospective study queried patients older than 50 years with minimum 2-year follow-up who underwent endoscopic repair for symptomatic gluteus medius and/or minimus tendon tears. All patients followed a standard 6-phase prehabilitation/rehabilitation PT protocol that consisted of: 1) Prehabilitation (3 months pre-operatively); 2) Immediate Post-Op Recovery (0-6 weeks post-operatively); 3) Endurance and Strength (6-12 weeks post-operatively); 4) Balance, Coordination, and ROM (3-6 months post-operatively); 5) Home Exercise/PT (6-12 months post-operatively); and 6) Gradual Return to Sport/Recreational Activity (12-24 months post-operatively). The Gluteus-Score-7 (GS7) was calculated to assess the risk of post-operative clinical failure. Outcomes were assessed pre-operatively and at 3-, 6-, 12-, 24-, and 60-month post-operative timepoints; they included VAS pain, hip abduction strength, Trendelenburg sign, and the following PROMs: mHHS, HOS-ADL, HOS-SSS, NAHS, and iHOT-33. Results: Overall, 26 patients (age, 67.5±7.2 (range: 50-81); BMI, 28.8±4.1; 76.9% female) met inclusion criteria. Most patients (n=23; 88.5%) had full-thickness tears, of which 52.2% (n=12) were retracted more than 2 cm. Patients had an average GS7 of 4.8±1.2, indicating a high risk of post-operative failure. Despite this, patients experienced significant improvements for VAS pain and all PROMs except for HOS-SSS at 3-, 6, 12-, 24-, and 60-month timepoints. Additionally, the MCID achievement rates were good at 2-year follow-up (n=25) (mHHS (76.0%); HOS-ADL (72.0%); HOS-SSS (60.0%); and iHOT-33 (76.0%)) and excellent at 5 years (n=9) (mHHS (100.0%); HOS-ADL (100.0%); HOS-SSS (77.8%); and iHOT-33 (100.0%)). Discussion/Conclusions: Patients older than 50 years who underwent endoscopic abductor tendon repair achieved significant improvements in functional outcomes following a 6-phase prehabilitation/rehabilitation PT protocol. PROM improvements began as early as 3-months post-operatively and were sustained at long-term follow-up with excellent 5-year MCID achievement rates.