Greater trochanteric pain syndrome is increasingly being diagnosed in patients with lateral hip pain. Surgical repair of the gluteal tendon tears is generally indicated after a trial of nonoperative management. Both open and endoscopic techniques are used, each with potential advantages and limitations. The purpose of this study was to compare demographic, intraoperative findings, and early patient-reported outcome measures (PROMs) between open versus endoscopic hip abductor tendon repair using a multicentre registry. A retrospective analysis of prospectively collected data from the Hip Surgical Treatment Registry (HipSTR) (February 2023-March 2025) was performed. Adults (>= 18 years) undergoing primary or revision open or endoscopic gluteal tendon repair were included. Demographics, intraoperative findings, and PROMs were compared, and logistic regression identified factors associated with open repair. A total of 171 patients were included (54 open, 117 endoscopic). Open repair patients were significantly older (67 vs 63 years; P = .02) and had a higher prevalence of osteoarthritis (70.4% vs 47.9%). Tear severity and size were similar, although open repairs trended towards larger anterior-posterior tears (3.3 +/- 1.6 cm vs 2.6 +/- 1.1 cm; P = .054). Open repairs used more anchors (4.3 vs 3.5) and more frequently involved double-row fixation (88.9% vs 58.1%) and augmentation (65.4% vs 41.0%). Both groups showed significant PROM improvement at 6 and 12 months. Larger proximal-distal tear size trended towards association with open repair (OR 2.26; P = .051), while higher Milwaukee grade was independently associated (P = .035). In this multicentre cohort, open and endoscopic techniques showed comparable early PROM improvements. Open repair was more common in older patients with greater degeneration, likely reflecting selection bias. Surgical approach appears driven by patient and intraoperative factors rather than expected outcome differences. Longer-term follow-up is needed to assess durability and repair integrity.
Gluteus medius tendinopathy encompasses a spectrum of injuries, from partial to full thickness tears, often associated with tendon retraction and fatty degeneration, and remains a common cause of lateral hip pain. This study aimed to describe an intraoperative classification system for gluteus medius tears that integrates focal degenerative lesions, tendon involvement, tear retraction, tissue quality, and fatty degeneration with corresponding surgical and rehabilitation strategies. A focused literature review identified five previously described classification systems and their limitations, including magnetic resonance imaging-based and intraoperative frameworks. Based on these findings, a novel classification was developed, categorizing tears from type 0 (normal) to type 4c (full-thickness tear with retraction and fatty degeneration), with each type linked to suggested surgical techniques, including single or double-row anchor repair, augmentation with bioinductive patches, or gluteus maximus transfer, and general postoperative rehabilitation considerations with proposed timelines for weight bearing and physical therapy. These recommendations reflect expert-guided considerations rather than evidence-based protocols. This classification is applicable to both endoscopic and open repairs. Compared with previous systems, this approach emphasizes intraoperative therapeutic guidance, potentially facilitating real-time intraoperative decision-making and more standardized surgical assessment, regardless of preoperative imaging availability. In conclusion, the proposed intraoperative classification provides a practical framework for the assessment and management of gluteus medius tears. By incorporating clinically relevant intraoperative and degenerative features, the system may facilitate more standardized surgical assessment and support future investigation of functional and clinical outcomes. This classification has not yet undergone validation; further studies should assess reproducibility, interobserver reliability, and prognostic utility.
Abstract Background Femoroacetabular impingement (FAI) is a common clinical syndrome with a high prevalence among athletes. Arthroscopy for FAI boasts excellent patient-reported outcomes (PROs) and return to sport (RTS), but predictors of outcomes have been identified. Existing studies suggest that delayed arthroscopy may be associated with inferior PROs, but evidence for sport-specific outcomes is lacking. Aim Our aim was to analyze the impact of timing on (i) postoperative outcomes and (ii) return to sport following primary hip arthroscopy for FAI through a systematic review. Methods Our systematic review queried Pubmed, Embase, and Cochrane Library. Studies examining patients aged 16 or older underdoing primary arthroscopy for FAI that stratified outcomes based on time to surgery were included. Studies that were unavailable in English, not primary research, or analyzing revision procedures or FAI secondary to other lesions were excluded. The heterogeneity inherent to the populations studied precluded meta-analysis. Results Of 849 studies identified, 24 met inclusion criteria, representing a population of 23 742. Late surgery was associated with lower rates of RTS, RTS at lower play levels, and lower HOS-SS scores but not with time to RTS. Studies reported inferior improvements in non-sport PROs in delayed arthroscopy compared to earlier intervention. Later surgery was associated with greater postoperative opioid use and greater rates of total hip arthroplasty. Conclusions Delayed arthroscopy for FAI may be associated with inferior sport-related outcomes and improvements in PROs compared to earlier intervention. Substantial heterogeneity existed between the included studies, but these associations were consistent across analytic methods.
Anteroposterior (AP) pelvic and lateral hip radiographs are the first-line diagnostic imaging used for athletes with longstanding hip/groin pain. Reliable radiographic parameters are essential for research and clinical decision-making; however, relative and absolute reliability data for these procedures are lacking. This study investigated relative and absolute intra- and inter-rater reliability of hip- and pubic-related radiographic parameters in male athletes. AP and cross-table lateral radiographs from 46 footballers with hip/groin pain and 40 asymptomatic athletes were independently rated by two blinded radiologists. Hip-related parameters included alpha angle, lateral center-edge angle, acetabular index angle, hip joint space width, ischial spine sign, cross-over sign, and posterior wall sign. Pubic-related parameters included bone lucency, proliferation, fragmentation, sclerosis, and pubic joint space width. Relative reliability was quantified using intraclass correlation coefficients (ICC) and Cohen's kappa; absolute reliability with minimal detectable change (MDC) and overall agreement. Relative reliability for hip-related parameters ranged from ICC: 0.69-0.78 and kappa: 0.51-0.81 for intra-rater, and ICC: 0.17-0.77 and kappa 0.53-0.86 for inter-rater reliability. Relative reliability for pubic-related parameters ranged from kappa: 0.49-0.63 (intra-rater) and kappa: 0.34-0.45 (inter-rater). Absolute reliability for hip-related parameters ranged from MDC: 7.2 degrees-14.7 degrees (intra-rater) and 6.5 degrees-33.1 degrees (inter-rater). For pubic-related parameters, overall agreement ranged from 82%-93% (intra-rater) and 64%-89% (inter-rater). Most hip- and pubic-related radiographic parameters showed relative intra- and inter-rater reliability sufficient for use in group-level and research. However, absolute reliability shows considerable variability for hip-related parameters, which warrants caution when using radiographic measurements and cut-offs for individual clinical decision-making.
