Results of Endoscopic Labral Repair With Concomitant Gluteus Medius and/or Minimus Repair Compared With Outcomes of Labral Repair Alone: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-up

Abstract

Background: There is a paucity of information available to clinicians on outcomes of patients undergoing endoscopic surgery for labral repairs and femoroacetabular impingement syndrome with simultaneous repair of the gluteus medius and/or minimus muscles. Purpose: To determine whether patients with labral tears and concomitant gluteal pathology who undergo simultaneous endoscopic labral and gluteus medius and/or minimus repair experience similar outcomes to patients with isolated labral tears who undergo endoscopic labral repair alone. Study Design: Cohort study; Level of evidence, 3. Methods: A matched retrospective comparative cohort study was performed. Patients who underwent gluteus medius and/or minimus repair with concomitant labral repair between January 2012 and November 2019 were identified. These patients were matched in a 1:3 ratio by sex, age, and body mass index (BMI) to patients who underwent labral repair alone. Preoperative radiographs were assessed. Patient-reported outcomes (PROs) were assessed preoperatively and 2 years postoperatively. PRO measures included the Hip Outcome Score Activities of Daily Living and Sports subscales, modified Harris Hip Score, 12-Item International Hip Outcome Tool, and visual analog scales for pain and satisfaction. Published labral repair minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were utilized for these measures. Results: A total of 31 patients who underwent gluteus medius and/or minimus repair with concomitant labral repair (27 female, 4 male; age, 50.8 ± 7.3 years; BMI, 27.9 ± 5.2) were matched with 93 patients who underwent labral repair alone (81 female, 12 male; age, 50.9 ± 8.1 years; BMI, 28.5 ± 6.2). There were no significant differences in sex ( P > .99), age ( P = .869), or BMI ( P = .592); preoperative radiographic measurements; or preoperative or 2-year postoperative PRO scores ( P≥ .081). Changes between preoperative and 2-year postoperative PRO scores were significantly different for both groups for all PROs assessed ( P < .001 for all). There were no significant differences in MCID or PASS achievement rates ( P≥ .123), with low PASS achievement rates of 40% to 60% found in both groups. Conclusion: Patients who were treated with endoscopic gluteus medius and/or minimus repair with concomitant labral repair demonstrated comparable outcomes with those who were treated with endoscopic labral repair alone.

Outcomes of Isolated Endoscopic Gluteal Tendon Repair Compared With Concomitant Endoscopic Gluteal Tendon Repair and Arthroscopic Hip Labral Repair: A Propensity-Matched Analysis With Minimum 2-Year Follow-up

“…After matching, there were no differences in these demographic characteristics or postoperative outcomes between the 2 groups. Similar to the findings of Horner et al, 13 who found successful results for patients with simultaneous labral and gluteal repairs compared with those undergoing isolated labral repairs, the present study highlights similarly successful outcomes of patients with gluteal pathology who undergo concomitant intra-articular intervention for FAIS and labral tear along with gluteal tendon repair when compared with a well-matched cohort undergoing isolated gluteal repair.…”

“…With a focus on gluteal tendon repair rather than labral treatment, the present study is the first to compare outcomes between patients who underwent concomitant endoscopic gluteus medius/minimus repair and arthroscopic hip labral repair and correction of FAIS versus those who underwent isolated endoscopic gluteus medius/minimus repair. The combined findings of the present study and the studies by Meghpara et al 19,20,21 and Horner et al 13 provide strong evidence that patients achieve excellent short-term outcomes even in overlapping gluteal, labral, and FAIS pathology. Based on these data, one can conclude that, in appropriately indicated patients, performing combined endoscopic gluteus medius/minimus and arthroscopic hip labral repair and correction of FAIS should not be expected to affect outcomes relative to either procedure alone.…”

“…Meghpara et al 19 previously compared patients who underwent endoscopic gluteus medius repair with labral treatment (76% debridement, 24% repair) to those who underwent isolated labral treatment (55% debridement, 8% reconstruction, and 37% repair) and found that the 2 groups achieved CSOs at a similar rate for the mHHS, HOS-SS, iHOT-12, and Nonarthritic Hip Score at 5 years postoperatively. Similarly, Horner et al 13 found that a cohort of patients who underwent combined labral and gluteal tendon repair achieved similar PROs and CSOs achievement rates compared with a propensity-matched cohort of patients who underwent isolated labral repair. With a focus on gluteal tendon repair rather than labral treatment, the present study is the first to compare outcomes between patients who underwent concomitant endoscopic gluteus medius/minimus repair and arthroscopic hip labral repair and correction of FAIS versus those who underwent isolated endoscopic gluteus medius/minimus repair.…”

“…Postoperative rehabilitation followed a standardized 3phase protocol for patients in both study groups. 13,28,31,33 In phase 1-the initial postoperative period (0-6 weeks)rehabilitation consists of full-time hip bracing to limit active hip abduction, toe-touch weightbearing using a walker or crutches, and light passive range of motion. For the combined procedure, patients' physical therapy is initiated by week 4.…”

“…3,6,[19][20][21]28,31,35 Many clinical outcomes studies examining gluteal repair have included patients who underwent concomitant labral treatment; however, they uniformly have pooled results from patients who underwent a variety of labral procedures, including debridement, repair, and reconstruction, as well as those who had no labral treatment at all. 3,6,[18][19][20]28,31,35 While Horner et al 13 recently investigated the relationship between patients undergoing combined labral and gluteal repair (G 1 L) versus those undergoing labral repair and demonstrated comparable outcomes between the groups, there are limited data on the corollary comparing patients undergoing combined G 1 L versus those undergoing endoscopic gluteus medius/minimus repair without labral repair (G).…”