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Endoscopic repair of a gluteus medius tear at the musculotendinous junction.

ABSTRACT: Abductor tendon tears are an increasingly recognized clinical entity in patients with lateral thigh pain and weakness. These "rotator cuff tears of the hip" typically result from chronic, nontraumatic rupture of the anterior fibers of the gluteus medius. Although the abductor tendon typically tears from the osseous insertion, the case discussed here ruptured at the musculotendinous junction. This is the first report of this abductor tear subtype and its endoscopic repair.

SUBMITTER: Yanke AB

PROVIDER: S-EPMC3716196 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

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Endoscopic repair of a gluteus medius tear at the musculotendinous junction.

Yanke Adam B AB Hart Michael A MA McCormick Frank F Nho Shane J SJ

Arthroscopy techniques 20130301 2

Abductor tendon tears are an increasingly recognized clinical entity in patients with lateral thigh pain and weakness. These "rotator cuff tears of the hip" typically result from chronic, nontraumatic rupture of the anterior fibers of the gluteus medius. Although the abductor tendon typically tears from the osseous insertion, the case discussed here ruptured at the musculotendinous junction. This is the first report of this abductor tear subtype and its endoscopic repair. ...[more]

PMID: 23875152

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Satisfactory results after endoscopic gluteus medius repair combined with selective gluteus maximus reflected tendon release for the treatment of a full-thickness tear of gluteus medius.

Project description:PurposeThe current study aimed to report the mid-term follow-up results of endoscopic gluteus medius repair combined with a systematic release of the gluteus maximus reflected tendon.MethodsTwenty-two patients with a symptomatic full-thickness tear of the gluteus medius tendon, as diagnosed by clinical examination and imaging (MRI), and who had a failure of conservative treatment for at least 6 months, were retrospectively enrolled for this study. An endoscopic repair of gluteus medius was performed for all patients in combination with gluteus maximus reflected tendon release according to the Polesello technique. The Visual Analogue Scale (VAS) for pain, Modified Harris Hip Score (mHHS), Lower Extremity Functional Scale (LEFS), Hip Outcome Score-Activity Daily Life (HOS-ADL), and Hip Outcome Score-Sport Specific Subscale (HOS-SSS) were administered to each patient before surgery for 6 months, 1 year, and every following year after surgery.ResultsAll analysed hip scores (mHHS, LEFS, HOS-ADL, and HOS-SSS) showed statistically significant improvements between the pre-operative and post-operative values at 6 months, 1 year, and the latest follow-up appointments after surgery (p < 0.001). The mean pre-operative pain was 8.6 ± 1.0 on the VAS. After surgical treatment, the pain was significantly reduced (p < 0.001) on the VAS at 6 months (5.4 ± 1.5), 1 year (4.4 ± 1.8) and the latest follow-up control visit (3.6 ± 2.2). No patient-reported major complications (re-rupture, deep infection or neurovascular injury). Eleven (50%) patients indicated the results as excellent, 7 (32%) as good, 2 (9%) as fair, and 2 (9%) as poor.ConclusionThe use of abductor tendon repair in combination with a systematic release of the reflected tendon of the gluteus maximus according to the Polesello technique seems to be a safe and effective endoscopic way of treating a full-thickness tear of the gluteus medius.Level of evidenceLevel IV.

| S-EPMC10090025 | biostudies-literature

Endoscopic Gluteus Medius Repair Augmented With Bioinductive Implant.

Project description:Patients with gluteus minimus and medius tears that fail nonoperative management may be indicated for surgical repair; however, structural failure after gluteal tendon repair remains unacceptably high. This is likely related to the limited healing potential of tendinous tissue, which is poorly vascular and heals by formation of fibrocartilaginous scar tissue rather than histologically normal tendon. An emerging option to augment tendon healing is the use of a bioinductive implant that is designed to amplify the host healing response and induce the formation of healthy tendon tissue. Though it is rapidly being adopted for partial- and full-thickness rotator cuff tears, this implant has not yet been used in the hip. A detailed technical description and a discussion of the advantages and disadvantages of the technique are provided.

| S-EPMC5040219 | biostudies-literature

Endoscopic repair of full-thickness gluteus medius tears.

Project description:Tears in the gluteus medius and minimus tendons recently have emerged as an important cause of chronic greater trochanteric pain syndrome. Increasing recognition of the gluteal insertion as a cause of chronic pain and weakness, as well as technologic advances in endoscopic hip surgery, has made gluteal insertional repair a rapidly emerging technique in minimally invasive surgery of the hip. We present an endoscopic double-row technique for gluteal insertional repair that allows for visualization, debridement, and repair, re-creating the normal footprint.

| S-EPMC3716195 | biostudies-literature

All-Endoscopic Single-Row Repair of Full-Thickness Gluteus Medius Tears.

Project description:Abductor tendon tears typically develop insidiously in middle-aged women and can lead to debilitating lateral hip pain and a Trendelenburg limp. The gluteus medius tendon is most commonly torn and may show fatty degeneration over time, similar to the rotator cuff muscles of the shoulder. Endoscopic repair offers a therapeutic alternative to traditional open techniques. This article describes the workup, examination, and endoscopic repair of a full-thickness gluteus medius tear presenting as lateral hip pain and weakness. The surgical repair for this case used a single-row suture anchor technique. In addition, the indications and technique for a double-row repair will be discussed.

| S-EPMC4809738 | biostudies-literature

Endoscopic Gluteus Medius and Minimus Repair With Allograft Augmentation Using Acellular Human Dermis.

Project description:Recently, attention has been given to recalcitrant lateral hip pain, also known as greater trochanteric pain syndrome. Although, historically, this has been attributed to greater trochanteric bursitis, the literature has shown that many patients will have a lesion of the gluteus medius and minimus tendons. Endoscopic hip abductor tendon repair has been shown to provide good outcomes with decreasing overall morbidity and is becoming more popular. However, failure rates have been reported to be as high as 35%, likely due to the poor tissue quality in this older population. Acellular human dermal allograft has been used to augment rotator cuff repairs in an attempt to improve tendon healing. The technique described in this Technical Note shows endoscopic gluteus medius and minimus repair with acellular human dermal allograft augmentation focusing on graft preparation, implantation, and fixation in a safe and reproducible manner.

| S-EPMC5989483 | biostudies-literature

Peritrochanteric access and gluteus medius repair.

Project description:Access to the peritrochanteric space is simple and reproducible with the technique described in this report. Two anteriorly based portals are placed between the iliotibial band and the greater trochanter. Bursal tissue and debris can be cleared, optimizing visualization of the peritrochanteric space and the anatomic structures. Lesions of the gluteus medius are a common cause of lateral hip pain unresponsive to conservative treatment and have frequently been mischaracterized as recalcitrant trochanteric bursitis. These lesions are often amenable to endoscopic repair with techniques comparable to those used for rotator cuff problems in the shoulder. Portal placement and organization and execution of a gluteus medius repair are highlighted in a video example. Repair is carried out with laterally based portals in the peritrochanteric space. A viewing portal is placed posterior to the vastus lateralis ridge, with a working portal distal to the ridge. Anchors are placed from a proximal position, entering perpendicular to the cortical surface of the trochanter.

| S-EPMC3834630 | biostudies-literature

Endoscopic Gluteus Medius Repair Replicates Open, Knotless Repair With Similar Cyclic Loading Properties: A Cadaveric Study.

Project description:PurposeTo compare the repair strength, gap formation, and mode of failure between endoscopic and open double-row gluteus medius repairs in a cadaveric model.MethodsSix pairs of fresh-frozen human cadavers were used in this study. Gluteus medius tears were created in an open fashion and then repaired with either open or endoscopic techniques. Specimens were manually preloaded to 5 N, then cycled between 20-50 N for 150 cycles s. Then, a ramp to/s. Specimens were then returned to 10 N and ramped to failure at 1 mm/s. Gap formation and strengths of the construct were compared for the 2 techniques.ResultsBiomechanical testing resulted in no significant differences in ultimate load (P = .86) or gap formation (P > .10) between groups. Ninety-two percent of specimens failed near the muscle origin on the ilium.ConclusionsThis study shows that both open and endoscopic gluteus medius repairs are stronger than the muscle-bone interface in a cadaveric model and loaded biomechanically in tension between the ilium origin and femoral insertion. Further, endoscopic technique is able to replicate open, knotless gluteus medius repair technique in terms of gap formation in physiologic (i.e., subfailure) cyclic loading.Clinical relevanceGluteus medius tendinopathy is an increasingly common recognized etiology of lateral hip pain. When tears occur, debate exists over whether open or endoscopic repair procedures are optimal. Double-row endoscopic gluteus medius repair with knotless suture anchors may be an alternative to open repair.

| S-EPMC9042893 | biostudies-literature

Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach.

Project description:Gluteus medius (GM) tears are a well-established source of pain and disability. Considering previous studies, which have reported rates of incidental GM tears in 20% of patients undergoing primary total hip arthroplasty (THA) and a 3-fold greater rate in elderly female patients, additional focus should be placed on identifying treatment options. The direct anterior approach (DAA) for primary THA has gained popularity within the past few years. However, there has been a paucity in the literature on how to address symptomatic and partial GM tears through this approach. The purpose of this Technical Note is to describe a method to repair partial GM tears during primary THA using the DAA.

| S-EPMC7917340 | biostudies-literature

Gluteus medius repair with double-row fixation.

Project description:The merits of double-row tendon fixation have been well defined in the shoulder and may have greater applicability for gluteus medius tears in the hip, in which protection of the repair site can be even more of a challenge because the hip is a weight-bearing extremity. A detailed technique for double-row fixation with a reliable method and implants is highlighted in the accompanying stepwise-approach video. Standard laterally based peritrochanteric portals are used, including a viewing portal posterior to the vastus lateralis ridge and a working portal distal to the ridge, with anchors placed proximally, perpendicular to the cortex of the trochanter. Proximal fixation is accomplished with double-loaded Healicoil anchors (Smith & Nephew, Andover, MA) by use of sutures placed in a mattress fashion. Distal fixation is accomplished with a Footprint anchor (Smith & Nephew) paired to each Healicoil.

| S-EPMC3834649 | biostudies-other

Isolated Endoscopic Gluteus Medius Repair Can Achieve Successful Clinical Outcomes at Minimum 2-Year Follow-up.

Project description:PurposeTo report on clinical presentations and outcomes in patients who underwent an isolated endoscopic gluteus medius (GM) repair.MethodsWe retrospectively reviewed and prospectively collected data on patients who underwent a primary isolated endoscopic GM repair. Patients were included if the following patient-reported outcome scores were obtained preoperatively and at minimum 2-year follow-up: modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog scale (VAS) score. The minimal clinically important difference (MCID) for the mHHS, NAHS, and Hip Outcome Score-Sports Specific Scale was uniquely calculated for this study. Patients who underwent concomitant procedures including hip arthroplasty and hip arthroscopy were excluded.ResultsA total of 26 hips met all inclusion and exclusion criteria, of which 23 hips (88.5%) (22 patients) had a minimum 2-year follow-up. Nineteen hips had a partial-thickness GM tear; 17 (89.5%) were high-grade partial-thickness tears treated with a side-to-side repair through a transtendinous window. Four full-thickness tears with no retraction or fatty infiltration were able to be repaired endoscopically. The mHHS, NAHS, and VAS score all significantly improved (P < .05) from baseline: The mHHS improved from 55.9 to 75.4 (P = .005); the NAHS, from 58.8 to 79.2 (P = .003); and the VAS score, from 5.9 to 3.6 (P = .009). The MCID was calculated for the mHHS, NAHS, and Hip Outcome Score-Sports Specific Scale as 5.8, 7.1, and 11.0, respectively. Most patients achieved the MCID for all 3 patient-reported outcome scores.ConclusionsAppropriately selected patients without concomitant intra-articular hip pathology may achieve successful outcomes at a minimum 2-year follow-up after an isolated endoscopic GM repair. Most isolated endoscopic GM repairs were performed for partial-thickness GM tears.Level of evidenceLevel IV, case-series study.

| S-EPMC8689210 | biostudies-literature

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