Repair of gluteus medius tears with bioinductive collagen patch augmentation: initial evaluation of safety and imaging

Comparable Pain Levels and Functional Outcomes With and Without the Use of Dermal Allograft Augmentation in Endoscopic Gluteus Medius Repair

PURPOSE

To compare retrospectively the clinical outcomes of patients undergoing endoscopic gluteal tendon repair with and without the use of dermal allograft augmentation.

METHODS

A retrospective review of prospectively collected data, single-surgeon cohort study was performed on all patients undergoing endoscopic gluteus medius repair (GMR) and GMR with augmentation (GMR-A) between April 2017 and April 2022. Dermal allograft augmentation was used in cases where intraoperative gluteus tissue quality was poor. An electronic survey of patient-reported outcome measures (PROMs) was completed at a minimum of 1 year postoperatively. PROMs included a visual analog scale (VAS) for pain; the University of California, Los Angeles (UCLA) Activity Scale; the modified Harris Hip Score (mHHS); the Hip Outcome Score-Sport-Specific Subscale (HOS-SSS); and the Single Assessment Numeric Evaluation (SANE). The proportion of patients achieving the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for each PROM were compared between groups.

RESULTS

Sixty-four patients were reached for follow-up (26 GMR, 38 GMR-A). No differences were found between the groups in terms of demographics. There was a significantly longer time to follow-up in the GMR group (39.4 ± 26.9 vs 24.2 ± 11.7 months, P = .003). There were no differences between the GMR and GMR-A groups in terms of postoperative PROMs including VAS (3.3 ± 2.6 vs 3.3 ± 2.8, P = .99), UCLA (5.8 ± 2.1 vs 5.1 ± 2.0, P = .17), mHHS (70.1 ± 18.1 vs 68.9 ± 17.8, P = .80), HOS-SSS (67.7 ± 28.9 vs 62.5 ± 30.2, P = .50), and SANE (71.7 ± 27.9 vs 71.3 ± 22.8, P = .95). A significantly greater proportion of patients in the GMR group achieved a PASS for UCLA (64% vs 34%, P = .02). One patient each in the GMR (3.8%) and GMR-A (2.6%) groups underwent revision gluteus medius repair with dermal allograft augmentation at the final follow-up.

CONCLUSIONS

Our study demonstrates comparable clinical outcomes with and without the use of dermal allograft augmentation in endoscopic gluteus medius repairs.

LEVEL OF EVIDENCE

Level III, retrospective comparative series.

Surgical Treatment and Outcomes for Gluteal Tendon Tears

PURPOSE OF REVIEW

Gluteus medius and minimus tears, or hip abductor tendon tears, are increasingly identified as a source of lateral hip pain. Once underappreciated and undertreated, they are now recognized as a cause of greater trochanteric pain syndrome and a pathology amenable to both nonoperative and operative modalities. This review summarizes relevant anatomy, clinical presentation, and treatment options for gluteus medius tears, focusing on surgical options.

RECENT FINDINGS

When surgical intervention is indicated, repair, reconstruction, or tendon transfer may be considered. Open and endoscopic repair techniques demonstrate similar outcomes with improvements in patient-reported outcomes and low complication and retear rates for both partial and full thickness tears. Variations in fixation construct and graft augmentations have been described, though clinical evidence remains limited to support specific techniques. Gluteus maximus transfer via open approach is a salvage option for the severely atrophied, retracted, or revision gluteus tendon; however, persistent limitations in abduction strength and gait abnormalities are common. Emerging evidence continues to evolve our understanding of surgical decision-making for gluteus tendon tears. The current literature supports either open or endoscopic repair techniques and open tendon transfer as a salvAage option. Further study is needed to determine the optimal fixation construct, the role of graft augmentation, and patient-related factors that influence postoperative outcomes.

Repair of Full-Thickness Gluteus Maximus Tear With Suture Anchors

Gluteal tendon tears are a common cause of hip pain. Most commonly, tears occur in the gluteus medius and minimus, and there are well-established nonoperative or operative treatment pathways. In this Technical Note, we describe our technique for repair of a full-thickness gluteus maximus tendon tear using anchor fixation.

Good clinical outcomes, a high level of patient satisfaction and an acceptable re-operation rate are observed 7-10 years after augmented hip abductor tendon repair

PURPOSE

To investigate the clinical outcome, level of patient satisfaction, re-injury and re-operation rates of patients 7-10 years after augmented hip abductor tendon repair.

METHODS

Between October 2012 and May 2015, 146 patients were referred to the senior author with symptomatic hip abductor tendon tears, of which 110 (101 female, 92%) were included in the current study and underwent hip abductor tendon repair augmented with LARS. Patients had a mean age of 63.2 years (range 43-82), body mass index of 27.8 (range 20.0-40.2) and duration of symptoms of 3.6 years (range 6 months-18 years). Patient-reported outcome measures (PROMs) were evaluated pre-operatively and at 3, 6, 12 and 24 months, as well as 7-10 years post-operatively, including the Oxford Hip Score (OHS), 12-item Short Form Health Survey (SF-12), a Visual Analogue Pain Scale (VAS) evaluating the frequency (VAS-F) and severity (VAS-S) of hip pain, and patient satisfaction. Adverse events, surgical failures, revisions and subsequent treatments on the ipsilateral hip were reported.

RESULTS

A significant improvement (p < 0.05) was observed for all PROMs and, while a mean deterioration was observed for all PROMs from 24 months to final review (7-10 years), these were not significant (n.s.). In the 90 patients retained and assessed at final review, 93% were satisfied with their hip pain relief and 89% with their ability to participate in recreational activities. Overall, 9 (of 110, 8.2%) surgical failures were observed over the 7-10-year follow-up period.

CONCLUSIONS

Good clinical scores, a high level of patient satisfaction and an acceptable re-injury rate were observed at 7-10 years after augmented hip abductor tendon repair, demonstrating satisfactory repair longevity.

LEVEL OF EVIDENCE

IV.