Endoscopic Gluteus Medius Repair Augmented With Bioinductive Implant

Abstract

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.

A Prospective 2-Year Clinical Evaluation of Augmented Hip Abductor Tendon Repair

“…2,8,28 Despite first being reported in 1997 by Bunker et al, 4 a review 13 published in 2015 highlighted encouraging outcomes in patients embarking on HAT surgical repair via a range of surgical techniques, with numerous open, endoscopic, and augmented techniques reported since that time. 5,14,22,[24][25][26]31,33 Interestingly, only a few of these studies 14,22,37,47 actually documented outcomes in more than 30 patients, with a recent review summarizing the surgical outcomes of patients undergoing HAT repair reporting that many studies lack detail on the patient cohort, postoperative care, and clinical follow-up. 13 Furthermore, despite the encouraging published outcomes, satisfaction rates vary across studies, ranging from 66% to 90%, 3,10,36,[38][39][40]42 and surgical failure rates as high as 31% and 33% have been cited.…”

Editorial Commentary: Pioneering the Gluteal Interval: Understanding and Treating Undersurface and Full-Thickness Gluteus Medius Tears of the Hip

“…As platelet rich plasma, stem cell, and biologic membranes advance, the RCT would provide a valuable insight for making this next leap in treatment options including cost effectiveness and efficacy. 4,5 The techniques described in this article and the original publication are significant advancements in the understanding of partial gluteus medius tears. The article describes a "longitudinal incision made in line with the tendon fibers over the lateral facet" allowing the undersurface inspection of the tendinous pathology.…”

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

“…Recently, the use of highly purified type I collagen bovine Achilles tendon scaffolds on partial- and full-thickness rotator cuff tears has shown improved outcomes; the formation of mature, well-integrated tendon-like tissue; and increasing thickness of the supraspinatus tendon 12, 13. Purified collagen lacks undesired impurities (elastin and hair follicles) commonly found in dermal implants and absorbs in 6 months without causing an inflammatory reaction 14 . Despite its widespread use in rotator cuff tears, this implant has not been heavily adopted in the hip; to date, only 1 article has described its use in an endoscopic repair of the gluteal tendons 14 .…”

“…Purified collagen lacks undesired impurities (elastin and hair follicles) commonly found in dermal implants and absorbs in 6 months without causing an inflammatory reaction 14 . Despite its widespread use in rotator cuff tears, this implant has not been heavily adopted in the hip; to date, only 1 article has described its use in an endoscopic repair of the gluteal tendons 14 . We describe a double-row open repair technique for a full-thickness gluteus medius and minimus tendon tear augmented with a bovine collagen patch.…”