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

Abstract

The purpose of this study was to perform an initial, prospective evaluation of imaging findings and outcomes after open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation. A prospective study was performed of patients with clinical and magnetic resonance imaging (MRI) evidence of symptomatic gluteus medius tears who underwent open, double-row suture anchor repair with bioinductive bovine collagen patch augmentation. Preoperative and 6-month postoperative MRIs were reviewed by a fellowship-trained musculoskeletal radiologist, and outcome scores were recorded preoperatively and 6 months postoperatively [Hip Outcome Score (HOS) Sport; HOS Activities of Daily Living (HOS ADL); Modified Harris Hip Score (mHHS) and International Hip Outcomes Tool (iHOT-33)]. Nine patients, four high-grade tears (≥50% tendon thickness) and five low-grade tears (<50% thickness) underwent surgical repair. At 6 months, 7/9 (77.8%) of tendons were qualitatively classified as completely healed on MRI, with no complications. Mean tendon thickness increased significantly: mediolateral dimension by 5.8 mm (P < 0.001), anteroposterior dimension by 4.1 mm (P = 0.02) and cross-sectional area (CSA) by 48.4 mm2 (P = 0.001). Gluteus medius and minimus CSA did not change significantly (P > 0.05). Patients demonstrated improvements in mean scores for HOS ADL, mHHS and iHOT that met defined minimum clinically important differences (P < 0.05). Open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation is safe and associated with increased tendon thickness on postoperative MRI. Early outcome scores are encouraging and should be evaluated after patients have completed postoperative rehabilitation to measure the whole effect of treatment.

Endoscopic gluteus medius partial tear repair with collagen patch augmentation. Clinical and imaging results

“…We believe that the lateral inflammatory pathology is caused by a frictional problem between the iliotibial band and the greater trochanter. Day et al, 17 reported using the Regeneten® patch in nine partial lesions of the GM tendon through an open approach. They identified the lesion on the medial side of the GM tendon, made a longitudinal incision over the defect, debrided the area, and made a repair with double row sutures.…”

“…Both techniques have reported good clinical outcomes with comparable results in terms of functionality and pain. 17,18 However, complications related to open techniques have been reported. 19 Although these techniques have shown promising clinical results, 5-25% of the repairs fail to heal.…”

“…To enhance the healing process of tendon repairs, bioinductive collagen patches have been utilized, firstly applied in repairing the rotator cuff in the shoulder. 22,23 This bioinductive collagen patch has been used in open repairs of the hip abductor apparatus, 17 describing its safety and favorable clinical results.…”

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

“…Greater trochanteric pain syndrome (GTPS) affects up to 25% of the general population [ 25 , 37 ]. While the exact incidence of hip abductor tendon tears in those presenting with symptomatic GTPS has not been reported to the best of our knowledge, their contribution is now acknowledged more widely and highlighted by the array of open, endoscopic and augmented surgical techniques now reported [ 2 , 7 , 11 , 13 , 15 , 16 , 18 , 22 , 23 ]. Published reviews have reported encouraging outcomes overall [ 1 , 4 , 8 , 19 – 21 , 26 , 39 ], with patient satisfaction rates ranging from 66 to 90%, [ 3 , 31 , 32 , 36 ] and similar clinical and functional outcomes in patients undergoing open and endoscopic hip abductor tendon repair methods [ 1 , 4 ].…”