What is Endoscopic Abductor Tendon Repair?
The abductor muscles are located on the outer side of the hip and are essential for moving the leg away from the body (abduction). These muscles, particularly the gluteus medius and gluteus minimus, attach to the outer side of the pelvis and help stabilize the hip, especially when walking, running, or standing on one leg.
An injury to the abductor tendon can occur due to overuse, trauma, or degeneration, and is commonly seen in individuals with hip instability or those involved in high-impact activities. When the abductor tendon is torn or damaged, it can cause significant pain, weakness, and difficulty performing everyday tasks.
Endoscopic abductor tendon repair is a minimally invasive surgical procedure used to repair torn or damaged abductor tendons using small incisions and specialized instruments. The procedure is performed with the help of an endoscope (a small camera) to guide the repair, allowing for a faster recovery time and reduced risk of complications compared to traditional open surgery.
Why is Endoscopic Abductor Tendon Repair Needed?
Endoscopic abductor tendon repair is indicated for patients who experience:
- Pain in the hip: This pain is often felt on the outer part of the hip and may worsen with activities like walking, climbing stairs, or standing on one leg.
- Weakness: Difficulty with movements that require the hip muscles to stabilize the leg, such as squatting or walking long distances.
- Abductor Tendon Tear: This may be a result of trauma (such as a fall or direct injury), overuse, or degenerative changes, which can lead to the tendon becoming weakened or torn.
- Hip instability: The inability to properly stabilize the hip joint, especially in activities like walking or running, due to damage to the abductor tendon.
When conservative treatments such as physical therapy, rest, and anti-inflammatory medications fail to provide relief, surgical intervention may be necessary to restore tendon function and alleviate pain.
How is Endoscopic Abductor Tendon Repair Performed?
Endoscopic abductor tendon repair is a minimally invasive procedure performed using arthroscopy, a technique that involves inserting a small camera (arthroscope) and surgical instruments into the body through small incisions. This method allows the surgeon to view the tendon and surrounding structures in high detail on a monitor, guiding the repair process.
Steps of the Procedure:
- Anesthesia: The procedure is typically done under general anesthesia, although regional anesthesia (spinal block) may also be used, depending on the patient and surgeon’s preference.
- Incisions and Arthroscope Insertion: The surgeon makes small incisions (typically 2-3) around the hip area. An arthroscope is inserted into one of the incisions, providing a real-time view of the damaged tendon on a monitor.
- Inspection and Tendon Repair: The surgeon uses specialized surgical instruments to repair the torn or damaged tendon. This may involve:
- Reattaching the tendon to its original attachment site on the pelvis using sutures, anchors, or other fixation devices.
- Debriding (cleaning) any damaged tissue around the tendon to promote better healing.
- Releasing scar tissue or other factors that may be contributing to hip pain and dysfunction.
- Closure: Once the tendon is repaired, the incisions are closed with sutures, and the area is cleaned. The surgeon may apply a bandage to the incision sites, and the patient is moved to the recovery area.
The entire procedure typically takes about 1-2 hours, depending on the complexity of the tendon tear and repair.
Post-Surgery Care and Recovery:
Immediate Post-Surgery (First Few Days):
- Pain Management: You may experience some pain and swelling in the hip after surgery, which can be managed with prescribed pain medications, ice, and elevation.
- Rest and Mobility: Resting and elevating the leg during the first few days will help reduce swelling. Most patients are advised to use crutches or a walker to avoid putting weight on the affected leg during the initial phase of recovery.
- Wound Care: Keep the incision sites clean and dry, and follow your surgeon’s instructions for caring for the wounds to avoid infection.
Rehabilitation (Physical Therapy):
Rehabilitation is a crucial component of recovery, helping to restore strength, mobility, and function to the hip joint.
- Phase 1 (0-6 weeks): Focus on reducing pain and swelling. During this phase, you will work on gentle range-of-motion exercises to avoid stiffness. Weight-bearing is usually limited, and you may use crutches or a walker to avoid stressing the tendon.
- Phase 2 (6-12 weeks): As healing progresses, you will begin light strengthening exercises to restore strength to the hip muscles, especially the gluteus medius and minimus. You will also work on improving flexibility and range of motion.
- Phase 3 (3-6 months): More intense strengthening exercises will be introduced. The goal is to build endurance in the abductor muscles and restore full functionality to the hip joint.
- Phase 4 (6-12 months): By this point, most patients are able to resume normal activities. However, sports and high-impact exercises should be reintroduced gradually to avoid putting too much stress on the tendon prematurely.
Long-Term Recovery:
It may take 6-12 months for full recovery, particularly if you engage in sports or high-intensity activities. During this period, it is essential to follow the physical therapy protocol to avoid re-injury and to maximize the healing process.
Potential Risks and Complications:
As with any surgical procedure, there are risks associated with endoscopic abductor tendon repair, including:
- Infection: There is a risk of infection at the incision sites, which may require antibiotics or additional treatments.
- Blood Clots: Rarely, blood clots may form in the legs after surgery, especially if the patient is not mobilized early enough.
- Nerve or Blood Vessel Injury: Injury to nerves or blood vessels near the surgical site could occur, though this is rare.
- Re-tear or Failure of the Repair: In some cases, the repaired tendon may re-tear or fail to heal properly, requiring further treatment.
- Stiffness or Limited Range of Motion: Some patients may experience stiffness or difficulty moving the hip joint after surgery, which can be addressed with physical therapy.
- Scarring or Adhesions: Formation of scar tissue may lead to restricted movement or discomfort, although this is less common with endoscopic techniques.
Benefits of Endoscopic Abductor Tendon Repair:
- Minimally Invasive: Endoscopic repair involves smaller incisions compared to traditional open surgery, resulting in less tissue disruption and a faster recovery.
- Faster Recovery: Patients generally experience a shorter recovery time, with many being able to return to light activities within a few weeks and normal activities within a few months.
- Less Pain and Scarring: Due to the smaller incisions, the procedure is associated with less post-operative pain and minimal scarring.
- Improved Hip Function: The primary goal of surgery is to restore the function and strength of the abductor muscles, allowing for better hip stability and improved ability to perform everyday tasks and sports.
Long-Term Outlook:
The long-term outcome for patients who undergo endoscopic abductor tendon repair is generally positive. Most patients experience significant pain relief, restored hip function, and a return to normal activities. However, it is important to follow the post-surgery rehabilitation plan and avoid high-impact activities during the early stages of recovery to ensure the tendon heals properly.
Full recovery may take up to 6-12 months, but many patients notice improvements in their ability to walk, run, and perform other daily activities much sooner, depending on the severity of the tear and adherence to rehabilitation.
When to Contact Your Surgeon:
You should contact your surgeon if you experience:
- Signs of infection, such as fever, redness, swelling, or discharge from the incision site.
- Severe pain that doesn’t respond to prescribed pain medications.
- Increased swelling or bruising around the hip that doesn’t improve.
- Numbness or tingling in the hip, thigh, or leg.
- Difficulty moving the hip or any changes in your ability to perform basic movements.
Conclusion:
Endoscopic abductor tendon repair is a highly effective, minimally invasive procedure for treating abductor tendon injuries, providing pain relief and restoring function. With proper rehabilitation and adherence to recovery protocols, most patients can expect to regain full strength, mobility, and stability in their hip joint.
If you have a torn abductor tendon and conservative treatments have not been effective, we are happy to take care of you!