Microfracturing the trochanteric footprint reduces risk of retear and improves functional outcomes better than single-row or double-row repair of the hip abductor without microfracture, a new study shows.
The Effect of Microfractures on Clinical Outcomes
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Researchers involved in the study, “Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes,” published online April 1, 2021 in The American Journal of Sports Medicine, sought to see if adding microfracture to single-row repair of hip abductor tendon tears resulted in better outcomes than single-row or double-row repair alone provided.
“Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important,” study authors wrote.
The study authors collected data from 50 patients who had received treatment using primary arthroscopic repair of hip gluteus medius and minimus tendon tears. Sixteen of the patients received double-row repair, 14 patients single-row repair, and 20 patients single-row repair with microfracture of the trochanteric footprint.
Primary outcome measures were Visual Analog Scale for pain, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport Specific, and modified Harris Hip Score. Scores were measured preoperatively and again at a minimum 2-year follow-up.
Overall, the greatest decrease in visual analog scale for pain and increase in hip outcome scores was seen in the single-row repair with microfracture group (p < .001 to p = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the double-row, single-row and single-row with microfracture groups, respectively.
The researchers did note, however, that while the retear rates were lowest in the microfracture group, there was no significant difference in retear rates between single and double-row repair.
They wrote, “Endoscopic single-row repair with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than single-row repair and double-row repair without microfracture.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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