Clinical Outcomes of Hip Abductor Repair Using Transosseous Sutures Versus Suture Anchors: A Systematic Review and Meta-analysis.

Abstract

Background: Hip abductor tendon tears have been identified as a common cause of greater trochanteric pain syndrome. While abductor tendon tears are often managed surgically, the optimal tendon attachment technique remains controversial.

Purpose: To compare the outcomes of hip abductor tendon repair between the suture anchor (SA) and transosseous suture (TS) techniques.

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

Methods: A literature search was performed in June 2023 in Embase, PubMed, and Web of Science databases. Studies reporting pre- and postoperative clinical outcomes of hip abductor repairs using SA or TS fixation with a minimum follow-up of 12 months were included in our analysis. From 608 studies initially identified, 21 studies (14 SA and 7 TS) with a total of 680 patients met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist guided the reporting and data abstraction, and the quality of the studies was assessed using the methodological index for non-randomized studies checklist. The results were presented as a narrative summary using descriptive statistics such as ranges and agreement statistics.

Results: Significant pre- to postoperative improvement in pain scores and functional outcomes were reported on all included studies. The mean improvement on the Harris Hip Score/modified Harris Hip Score was 32.5 (95% CI, 28.4-36.7) for the SA technique versus 21.9 (95% CI, 6.7-37.0) for the TS technique, while mean improvement in pain according to the visual analog scale was 5.1 ± 2.3 for SA and 4.8 ± 2.2 for TS (P = .9). There was a trend toward statistical significance regarding retear rates, with higher rates for SA (6.7% ± 7.6%) versus TS (1.3% ± 4.7%) (t[13.9] = 2.0; P = .06).

Conclusion: We observed no significant difference between SA and TS regarding improvements in patient-reported hip outcome and pain scores. However, SA trended toward a higher retear rate. Future research should propose a classification scheme that considers tear size and morphology, the extent of associated muscle degeneration, and the distance of tendon retraction to provide more context for the understanding of expected functional outcomes.