Abstract：
To identify patient preoperative history, examination, and imaging characteristics that increase the risk of postoperative failure of gluteus medius/minimus repair, and to develop a decision-making aid predictive of clinical outcomes for patients undergoing gluteus medius/minimus repair.
Patients from 2012 to 2020 at a single institution undergoing gluteus medius/minimus repair with minimum 2-year follow-up were identified. MRIs were graded according to the \"three-grade\" classification system: grade 1: partial-thickness tear, grade 2: full-thickness tears with <2 cm of retraction, grade 3: full-thickness tears with ≥2 cm retraction. Failure was defined as undergoing revision within 2 years postoperatively or not achieving both a cohort-calculated minimal clinically important difference (MCID) and responding \"no\" to patient acceptable symptom state (PASS). Inversely, success was defined as reaching both an MCID and responding \"yes\" to PASS. Predictors of failure were verified on logistic regression and a predictive scoring model, the Gluteus-Score-7, was generated to guide treatment-decision making.
In total, 30 of 142 patients (21.1%) were clinical failures at mean ± SD follow-up of 27.0 ± 5.2 months. Preoperative smoking (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.0-8.4; P = .041), lower back pain (OR, 2.8; 95% CI, 1.1-7.3; P = .038), presence of a limp or Trendelenburg gait (OR, 3.8; 95% CI, 1.5-10.2; P = .006), history of psychiatric diagnosis (OR, 3.7; 95% CI, 1.3-10.8; P = .014), and increased MRI classification grades (P ≤ .042) were independent predictors of failure. The Gluteus-Score-7 was generated with each history/examination predictor assigned 1 point and MRI classes assigned corresponding 1-3 points (min 1, max 7 score). A score of ≥4/7 points was associated with risk of failure and a score ≤2/7 points was associated with clinical success.
Independent risk factors for revision or not achieving either MCID or PASS after gluteus medius and/or minimus tendon repair include smoking, preoperative lower back pain, psychiatric history, Trendelenburg gait, and full-thickness tears, especially tears with ≥2 cm retraction. The Gluteus-Score-7 tool incorporating these factors can identify patients at risk of both surgical treatment failure and success, which may be useful for clinical decision-making.
Level IV, prognostic case series.
Patients from 2012 to 2020 at a single institution undergoing gluteus medius/minimus repair with minimum 2-year follow-up were identified. MRIs were graded according to the \"three-grade\" classification system: grade 1: partial-thickness tear, grade 2: full-thickness tears with <2 cm of retraction, grade 3: full-thickness tears with ≥2 cm retraction. Failure was defined as undergoing revision within 2 years postoperatively or not achieving both a cohort-calculated minimal clinically important difference (MCID) and responding \"no\" to patient acceptable symptom state (PASS). Inversely, success was defined as reaching both an MCID and responding \"yes\" to PASS. Predictors of failure were verified on logistic regression and a predictive scoring model, the Gluteus-Score-7, was generated to guide treatment-decision making.
In total, 30 of 142 patients (21.1%) were clinical failures at mean ± SD follow-up of 27.0 ± 5.2 months. Preoperative smoking (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.0-8.4; P = .041), lower back pain (OR, 2.8; 95% CI, 1.1-7.3; P = .038), presence of a limp or Trendelenburg gait (OR, 3.8; 95% CI, 1.5-10.2; P = .006), history of psychiatric diagnosis (OR, 3.7; 95% CI, 1.3-10.8; P = .014), and increased MRI classification grades (P ≤ .042) were independent predictors of failure. The Gluteus-Score-7 was generated with each history/examination predictor assigned 1 point and MRI classes assigned corresponding 1-3 points (min 1, max 7 score). A score of ≥4/7 points was associated with risk of failure and a score ≤2/7 points was associated with clinical success.
Independent risk factors for revision or not achieving either MCID or PASS after gluteus medius and/or minimus tendon repair include smoking, preoperative lower back pain, psychiatric history, Trendelenburg gait, and full-thickness tears, especially tears with ≥2 cm retraction. The Gluteus-Score-7 tool incorporating these factors can identify patients at risk of both surgical treatment failure and success, which may be useful for clinical decision-making.
Level IV, prognostic case series.
摘要：
目的：确定患者术前病史，考试,和影像学特征增加臀中肌/小肌修复术后失败的风险，并为接受臀中肌/最小肌修复的患者制定决策辅助预测临床结果。
方法：确定了2012-2020年在单一机构接受臀中肌/小肌修复和至少两年随访的患者。MRI根据“三级”分类系统进行分级：1级：局部厚度撕裂，2级：全厚度撕裂，收缩<2cm，3级:全厚度撕裂,回缩≥2cm。失败定义为术后两年内进行翻修或未达到队列计算的最小临床重要差异（MCID）和对患者可接受的症状状态（PASS）的响应。相反，成功定义为达到MCID并响应“是”通过。在逻辑回归和预测评分模型上验证了失败的预测因素，生成Gluteus-Score-7用于指导治疗决策。
结果：30/142例患者（21.1％）在平均±SD随访27.0±5.2个月时临床失败。术前吸烟(OR,3.0；95%CI，1.0-8.4；p=0.041），下背部疼痛（或，2.8；95%CI，1.1-7.3；p=0.038），出现跛行或特伦德伦堡步态(或，3.8；95%CI，1.5-10.2；p=0.006），精神病诊断史（OR，3.7；95%CI，1.3-10.8；p=0.014)，MRI分级分级增加(p<0.042)是失败的独立预测因子。生成Gluteus评分7，每个病史/检查预测因子分配1分，MRI类别分配相应的1-3分（最小1分，最大7分）。≥4/7分与失败风险相关，<2/7分与临床成功相关。
结论：臀中肌和/或小肌腱修复后翻修或未达到MCID或PASS的独立危险因素包括吸烟，术前腰痛,精神病史,特伦德伦伯格步态，和全厚的眼泪，尤其是收缩≥2cm的泪液。结合这些因素的Gluteus-Score-7工具可以识别有手术治疗失败和成功风险的患者。这可能对临床决策有用。
方法：预后：IV级（病例系列）。
方法：确定了2012-2020年在单一机构接受臀中肌/小肌修复和至少两年随访的患者。MRI根据“三级”分类系统进行分级：1级：局部厚度撕裂，2级：全厚度撕裂，收缩<2cm，3级:全厚度撕裂,回缩≥2cm。失败定义为术后两年内进行翻修或未达到队列计算的最小临床重要差异（MCID）和对患者可接受的症状状态（PASS）的响应。相反，成功定义为达到MCID并响应“是”通过。在逻辑回归和预测评分模型上验证了失败的预测因素，生成Gluteus-Score-7用于指导治疗决策。
结果：30/142例患者（21.1％）在平均±SD随访27.0±5.2个月时临床失败。术前吸烟(OR,3.0；95%CI，1.0-8.4；p=0.041），下背部疼痛（或，2.8；95%CI，1.1-7.3；p=0.038），出现跛行或特伦德伦堡步态(或，3.8；95%CI，1.5-10.2；p=0.006），精神病诊断史（OR，3.7；95%CI，1.3-10.8；p=0.014)，MRI分级分级增加(p<0.042)是失败的独立预测因子。生成Gluteus评分7，每个病史/检查预测因子分配1分，MRI类别分配相应的1-3分（最小1分，最大7分）。≥4/7分与失败风险相关，<2/7分与临床成功相关。
结论：臀中肌和/或小肌腱修复后翻修或未达到MCID或PASS的独立危险因素包括吸烟，术前腰痛,精神病史,特伦德伦伯格步态，和全厚的眼泪，尤其是收缩≥2cm的泪液。结合这些因素的Gluteus-Score-7工具可以识别有手术治疗失败和成功风险的患者。这可能对临床决策有用。
方法：预后：IV级（病例系列）。
