Outcomes of Concomitant Hip Arthroscopic Surgery for Intra-articular Abnormalities and Endoscopic Abductor Tendon Repair at a Minimum 2-Year Follow-up: A Systematic Review.

Abstract

Background: Hip labral and chondral lesions are commonly found as co-occurring conditions in patients with abductor tendon tears. Concomitant hip arthroscopic surgery for the correction of intra-articular abnormalities and endoscopic abductor tendon repair has therefore emerged as a strategy to address these conditions simultaneously.

Purpose: To systematically review the existing literature assessing clinical outcomes after endoscopic abductor tendon repair with concomitant hip arthroscopic surgery for the treatment of intra-articular abnormalities.

Study design: Systematic review; Level of evidence, 4.

Methods: Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the PubMed, CENTRAL, and Scopus databases were queried in May 2023 to conduct this systematic review using the keywords "hip arthroscopy,""gluteal,""abductor,""gluteus,""minimus," and "medius." Articles were included if they reported preoperative and postoperative patient-reported outcome measure (PROM) scores for patients undergoing endoscopic abductor tendon repair for gluteus medius and/or gluteus minimus tears with concomitant hip arthroscopic surgery for the treatment of labral tears and/or femoroacetabular impingement. We identified a total of 404 articles after our initial search. Title, author, publication date, study design, patient characteristics, preoperative radiographic findings (lateral center-edge angle, alpha angle, and Tönnis grade), concomitant surgical procedures performed, preoperative and postoperative PROM scores, measures of clinical benefit, and secondary surgery performed (revision arthroscopic surgery, revision abductor tendon repair, and conversion to total hip arthroplasty) were recorded. P values were extracted from the articles included in our review, all of which defined statistical significance as P < .05. We were unable to create forest plots for these data, given that no single PROM (preoperative and postoperative scores in means and standard deviations) was reported in ≥3 articles. This also prevented us from further analyzing heterogeneity. We calculated the total rate of secondary surgical procedures by dividing the instances of these events by the total number of patients across the 4 studies that included these outcome measures.

Results: After duplicate articles were removed, 270 articles entered the abstract screening phase, and 11 full-text articles were reviewed. Overall, 5 articles were included in the systematic review. A total of 223 hips were included, with mean follow-up times ranging from 26 to 74 months. All studies reported a significant improvement (P < .05) on all reported PROMs from preoperative to latest postoperative time points. There were 2 studies that compared combined endoscopic abductor tendon repair and labral treatment with a matched group undergoing hip arthroscopic surgery alone and found no significant differences (P > .05) between groups. Among studies reporting secondary surgical procedures, there was 1 case (0.9%) of revision abductor tendon repair and 5 cases (4.3%) of conversion to total hip arthroplasty.

Conclusion: Our systematic review demonstrated that patients who underwent concomitant endoscopic abductor tendon repair and hip arthroscopic surgery had significant improvements on PROMs with low rates of secondary surgery at a minimum 2-year follow-up. Longer-term studies are needed for us to understand concomitant treatment methods for multiple abnormalities in patients undergoing hip arthroscopic surgery in the future.