Abstract
INTRODUCTION: We describe the surgical treatment of tears to the abductor tendons of the hip, which are typically progressive and can lead to recalcitrant pain and progressive weakness, leading to considerable difficulties with walking. STEP 1 PERFORM THE EXPOSURE AND IDENTIFY THE TEAR: Place the patient in the lateral decubitus position, expose the lateral peritrochanteric space, and then identify the extent of the tear. STEP 2 MOBILIZE THE TENDONS: Mobilize the typically scarred-in tendons from the surrounding tissue to allow the tendon to be brought back down to the trochanter. STEP 3 PREPARE THE TENDON AND GREATER TROCHANTER: Debride the tendon, and lightly burr the greater trochanter to maximize the healing of the tendon to the bone. STEP 4 LOCATE THE INSERTIONAL SITE OF THE TENDONS AND PLACE THE SUTURE ANCHORS OR DRILL HOLES INTO THIS SITE: Identify the area of the footprint for each of the tendons; all suture anchors should be placed in the footprint, and the transosseous drill holes should straddle the near and far edges of the footprint. STEP 5 REATTACH THE TENDONS: After all of the sutures are placed, tie them down, starting with the pull sutures first, to bring the tendon back to bone; then secure the tendon down with the simple sutures. STEP 6 REINFORCE LARGER TEARS: Reinforce larger tears to protect them and aid in their healing. STEP 7 POSTOPERATIVE PROTOCOL: The postoperative protocol period consists of partial weight-bearing for specific periods of time, followed by vigorous physical therapy for strengthening and gait retraining. RESULTS: Surgical repair can improve function and reliably decreases pain in patients with a hip abductor tear.IndicationsContraindicationsPitfalls & Challenges.