Radiofrequency Microdebridement as an Adjunct to Arthroscopic Surgical Treatment for Recalcitrant Gluteal Tendinopathy: A Double-Blind, Randomized Controlled Trial

Caroline M Blakey, John O'Donnell, Ianiv Klaber, Parminder Singh, Manit Arora, Amir Takla, Jane Fitzpatrick, Caroline M Blakey, John O'Donnell, Ianiv Klaber, Parminder Singh, Manit Arora, Amir Takla, Jane Fitzpatrick

Abstract

Background: Recalcitrant greater trochanteric pain is increasingly recognized as an indication for surgical intervention. The arthroscopic approach has become rapidly more common than the open alternative.

Hypothesis: Patients undergoing radiofrequency microdebridement (RFMD) as an adjunct to arthroscopic gluteal bursectomy (AGB) and iliotibial band release (ITBR) will experience better functional improvement than AGB and ITBR alone at 1 year.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: A total of 33 patients with failed nonoperative treatment of gluteal tendinopathy were randomly allocated to undergo AGB/ITBR or AGB/ITBR + RFMD. Full-thickness tears were excluded. The primary outcome measure was the modified Harris Hip Score (mHHS) at 52 weeks. Secondary outcome measures included the mHHS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and 12-item Short Form Health Survey (SF-12), which were evaluated at 0, 6, 12, 24, and 52 weeks. Statistical significance was defined as P < .05.

Results: A total of 33 participants (33 hips; 30 female and 3 male; mean age, 58 years) were randomized; 16 patients underwent AGB/ITBR + RFMD, and 17 underwent AGB/ITBR. Participants' functionality improved in both groups at all time intervals. The mean mHHS score improved from 57.49 ± 10.61 to 77.76 ± 18.40 (P = .004) and from 58.98 ± 12.33 to 79.96 ± 18.86 (P = .001) at 52 weeks in the AGB/ITBR and AGB/ITBR + RFMD groups, respectively, although there was no statistically significant difference between groups. There were no device-related adverse events.

Conclusion: AGB/ITBR led to significant improvements in patients with recalcitrant gluteal tendinopathy. In this small RCT, the addition of RFMD showed no additional benefit to AGB/ITBR but provided a safe adjunct for the surgical management of recalcitrant gluteal tendinopathy.

Registration: NCT01562366 (ClinicalTrials.gov identifier).

Keywords: bursitis; gluteal tendinopathy; gluteal tendon tear; greater trochanteric pain syndrome; hip arthroscopic surgery; radiofrequency microdebridement.

Conflict of interest statement

One or more of the authors declared the following potential conflict of interest or source of funding: J.O. has received consulting fees from Medacta and Smith & Nephew. J.F. has been on the medical advisory board for Bioventus Global. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2020.

Figures

Figure 1.
Figure 1.
Arthroscopic radiofrequency microdebridement (RFMD) of the superior surface of the gluteal tendons of the hip.
Figure 2.
Figure 2.
Flowchart of study patients. AGB, arthroscopic gluteal bursectomy; F-U, follow-up; ITBR, iliotibial band release; mHHS, modified Harris Hip Score; RFMD, radiofrequency microdebridement.
Figure 3.
Figure 3.
Modified Harris Hip Score (mHHS) at baseline and 6, 12, 24, and 52 weeks. AGB, arthroscopic gluteal bursectomy; ITBR, iliotibial band release; RFMD, radiofrequency microdebridement.

References

    1. Baker CL, Massie RV, Hurt WG, Savory CG. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. 2007;23(8):827–832.
    1. Barratt PA, Brookes N, Newson A. Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med. 2017;51(2):97–104.
    1. Bowden K, Ball S, Amiel D. Structural and angiogenic response to bipolar radiofrequency treatment of normal rabbit Achilles tendon: a potential application for the treatment of tendinosis. Trans Orthop Res Soc. 2003;28:819.
    1. Brooker AF. The surgical approach to refractory trochanteric bursitis. Johns Hopkins Med J. 1979;145(3):98–100.
    1. Byrd JWT, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy. 2017;19(10):1055–1060.
    1. Chahal J, Van Thiel GS, Mather RC, 3rd, et al. The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement. Am J Sports Med. 2015;43(8):1844–1849.
    1. Chou ACC, Ng SYC, Su DHC, Singh IR, Koo K. Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis. Foot Ankle Surg. 2017;22(4):270–273.
    1. Del Buono A, Papalia R, Khanduja V, Denaro V, Maffulli N. Management of the greater trochanteric pain syndrome: a systematic review. Br Med Bull. 2012;102:115–131.
    1. Drummond J, Fary C, Tran P. The outcome of endoscopy for recalcitrant greater trochanteric pain syndrome. Arch Orthop Trauma Surg. 2016;136(11):1547–1554.
    1. Farr D, Selesnick H, Janecki C, Cordas D. Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis. Arthroscopy. 2007;23(8):905.e1-5.
    1. Fitzpatrick J, Bulsara M, Zheng MH. The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials. Am J Sports Med. 2016;45(1):226–233.
    1. Fitzpatrick J, Bulsara MK, O’Donnell J, McCrory PR, Zheng MH. The effectiveness of platelet-rich plasma injections in gluteal tendinopathy: a randomized, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection. Am J Sports Med. 2018;46(4):933–939.
    1. Fitzpatrick J, Bulsara MK, O’Donnell J, Zheng MH. Leucocyte-rich platelet-rich plasma treatment of gluteus medius and minimus tendinopathy: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2019;47(5):1130–1137.
    1. Fox J. The role of arthroscopic bursectomy in the treatment of trochanteric bursitis. Arthroscopy. 2002;18(7):E34.
    1. Govaert LHM, van Dijk CN, Zeegers AVCM, Albers GHR. Endoscopic bursectomy and iliotibial tract release as a treatment for refractory greater trochanteric pain syndrome: a new endoscopic approach with early results. Arthrosc Tech. 2012;1(2):e161–e164.
    1. Gunes T, Bilgic E, Erdem M, et al. Effect of radiofrequency microtenotomy on degeneration of tendons: an experimental study on rabbits. Foot Ankle Surg. 2014;20(1):61–66.
    1. Lustenberger DP, Ng VY, Best TM, Ellis TJ. Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011;21(5):447–453.
    1. Meknas K, Al Hassoni TN, Odden-Miland Å, Castillejo M, Kartus J. Medium-term results after treatment of recalcitrant lateral epicondylitis: a prospective, randomized study comparing open release and radiofrequency microtenotomy. Orthop J Sport Med. 2013;1(4):2325967113505433.
    1. Mellor R, Bennell K, Grimaldi A, et al. Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. Br J Sports Med. 2018;52(22):1464–1472.
    1. Morrison RJM, Brock TM, Reed MR, Muller SD. Radiofrequency microdebridement versus surgical decompression for Achilles tendinosis: a randomized controlled trial. J Foot Ankle Surg. 2017;56(4):708–712.
    1. Ochiai N, Tasto JP, Ohtori S, Takahashi N, Moriya H, Amiel D. Nerve regeneration after radiofrequency application. Am J Sports Med. 2007;35(11):1940–1944.
    1. O’Donnell JM, Devitt BM, Arora M. The role of the ligamentum teres in the adult hip: redundant or relevant? A review. J Hip Preserv Surg. 2018;5(1):15–22.
    1. Reid D. The management of greater trochanteric pain syndrome: a systematic literature review. J Orthop. 2016;13(1):15–28.
    1. Slawski DP, Howard RF. Surgical management of refractory trochanteric bursitis. Am J Sports Med. 1997;25(1):86–89.
    1. Sorensen MD, Hyer CF, Philbin TM. Percutaneous bipolar radiofrequency microdebridement for recalcitrant proximal plantar fasciosis. J Foot Ankle Surg. 2011;50(2):165–170.
    1. Takahashi N, Tasto JP, Ritter M, et al. Pain relief through an antinociceptive effect after radiofrequency application. Am J Sports Med. 2007;35(5):805–810.
    1. Taverna E, Battistella F, Sansone V, Perfetti C, Tasto JP. Radiofrequency-based plasma microtenotomy compared with arthroscopic subacromial decompression yields equivalent outcomes for rotator cuff tendinosis. Arthroscopy. 2007;23(10):1042–1051.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅