Lateral hip pain affects up to 20 percent of people over the age of 65. Historically this pain has been attributed to a specific type of bursitis called greater trochanter bursitis. However, in 1997 Dr. T.D. Bunker published an article entitled “Rotator cuff tear of the hip” in which Bunker found that recalcitrant hip pain that is unable to be treated conservatively may actually be caused by tears to the gluteus medius and minimus tendons, also known as the abductors. The population of patients who have sustained a tear of the abductors is similar to the population of patients who sustain rotator cuff tears with respect to age and gender, with the incidence peaking between patients aged from 40 to 60. The condition is more common in females.
While tendinitis and tendinopathy are common and will often respond to conservative measures such as physiotherapy and corticosteroid injections, there are partial and full thickness tears of the gluteus medius and minimus tendons that are commonly missed. These tendon tears can cause significant disability and can be commonly misdiagnosed both clinically and radiographically, as MRIs will often miss a diagnosis. Recognizing this issue early in my practice, I began treating my patients presenting with these symptoms both surgically and nonsurgically.
Although technically demanding, endoscopic repair has been shown to provide good outcomes with decreased overall morbidity when compared to open repair. Though endoscopic hip abductor tendon repair is becoming more popular, failure rates have been reported to be as high as 35 percent, likely due to the poor tissue quality found in the older patient population. Simply repairing the tendon led to an unacceptably high re-tear rate. The limited healing potential of these repairs has been an extremely vexing issue for both patients and physicians.
Because of this, and to improve outcomes, I developed a new surgical technique to repair the tendon, and then augment the repair with acellular human dermal allograft. This technique repairs the tendon and utilizes allograft cadaver tissue to reinforce the repair. The allograft cadaver tissue provides excellent biocompatibility when compared to other grafting agents, such as a bovine or porcine xenograft. Importantly, it provides immediate structural support to the repaired tendon tissue and also allows the surgeon to customize the graft to provide ideal coverage to match the patient’s greater trochanter. Utilization of this new surgical technique aids improved healing of the abductor tendons and has led to a 95 percent success rate in my patients last year, with prospective data collection. More information on this technique can be found in the February 2018 issue of the Arthroscopy Techniques journal.
Dr. Jovan Laskovski is board-certified in orthopaedic surgery and orthopaedic sports medicine. He specializes in hip arthroscopy, with a focus on preservation of the native hip joint. He also specializes in sports medicine with an interest in arthroscopic surgery of the hip, shoulder, and knee, as well as shoulder and hip arthroplasty.
Dr. Laskovski is an active member of the Arthroscopy Association of North America where he serves as an Associate Master Instructor of Arthroscopic Surgery. He is also an Ordinary Member of the International Hip Arthroscopy Society; currently he is one of only two surgeons in Ohio and one of 26 in the U.S. with this membership .
Dr. Laskovski has earned numerous honors and awards, and he has conducted research and has been published in a number of areas of orthopaedic care. Dr. Laskovski lectures both nationally and internationally on arthroscopic and endoscopic surgery of the hip, shoulder and knee.
He is also involved in teaching multiple surgical courses on arthroscopic surgery throughout the country. He presented these outcomes at the International Society for Hip Arthroscopy (ISHA) meeting in Santiago, Chile and will present updated outcomes this fall at the ISHA meeting in Melbourne, Australia. He has begun teaching the technique to surgeons in America and around the world.