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

ABSTRACT: 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.

SUBMITTER: Laskovski J

PROVIDER: S-EPMC5989483 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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

Laskovski Jovan J Urchek Ryan R

Arthroscopy techniques 20180212 3

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 ...[more]

PMID: 29876243

Similar Datasets

Open Gluteus Medius and Minimus Repair With Double-Row Technique and Bioinductive Implant Augmentation.

Project description:Lateral hip pain in patients without significant osteoarthritis may be due to a number of different etiologies. Recent attention has been placed on the role of abductor tendon (gluteus medius and minimus) deficiency in these patients. These tears, analogous to rotator cuff tears in the shoulder, may cause pain, weakness, limp, and dysfunction. Mainstays of treatment include nonoperative treatment and, in select patients, operative fixation. This article presents an overview of management of patients with symptomatic, large, retracted, chronic tears of the abductor tendons. The highlighted repair is a "double-row" repair with biological patch augmentation.

| S-EPMC6620622 | biostudies-literature

Surgical Treatment of Gluteus Medius Tears Augmented With Allograft Human Dermis.

Project description:Greater trochanteric pain syndrome can be caused by gluteus medius and minimus tendinopathy/tears and chronic trochanteric bursitis. Specifically, moderate-to-severe abductor tendon tears can cause severe lateral hip pain, limp, and abnormal gait. A variety of open and endoscopic techniques to treat glut abductors hip tears have been described. The use of scaffolds, such as acellular human dermal allograft, to augment tendon repair, already has been successfully reported in rotator cuff repairs of the shoulder. Still, the use of acellular human dermal allograft in the hip has been limited. However, there are some clinical scenarios in which augmentation of abductors hip tendon repair with scaffold is indicated. Chronic or massive gluteus tears or revision cases may benefit from augmentation with a scaffold. The purpose of this technical note and accompanying video is to describe our indications, pearls, and pitfalls of repair of moderate to severe gluteus tears via a minimally invasive technique augmented with acellular human dermal allograft.

| S-EPMC6926308 | biostudies-literature

Rehabilitation After Gluteus Medius and Minimus Treatment

Project description:We reviewed the current literature regarding rehabilitation after gluteus medius and minimus tears as part of a conservative management or postoperative protocol. The greater trochanteric pain syndrome includes a constellation of pathologies that generate pain in the greater trochanteric region and may be accompanied by varying degrees of hip abductor disfunction. It may be related to tendinitis of the gluteus medius and minimus, greater trochanteric bursitis, or even formal tears of the hip abductor tendons. The initial management strategy of the hip abductor tears is conservative, including different anti-inflammatory therapies such as physical therapy and cortisone and platelet-rich plasma injections. The clearest indication for surgical management is failure of conservative management and loss of abductor muscle power. Surgical management has been performed both open and endoscopic with good reported clinical results. More severe tears typically require a more rigid and complex type of fixation. Exorcise intervention seem to improve symptoms after 4 months to a year of therapy therefore a very close supervision of the rehabilitation protocol is mandatory. Gluteus medius and minimus tears are frequent and may be not diagnosed timely. Treatment of these of lesions is based on the knowledge of pathomechanics involved and the extent of injury to the tendon and muscle tissue. Conservative management is based on protecting the hip abductor tendons from excessive tensile and compression stresses while applying progressive load in conjunction with physical and medical anti-inflammatory measures. Surgical treatment is indicated when conservative management fails or an abductor power deficit is associated with pain. Similar physical therapy protocols to those used in conservative management are used postoperatively. Level of Evidence Level V, expert opinion.

| S-EPMC8811496 | 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.

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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

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

Project description: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.

| S-EPMC3716196 | 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

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

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

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