Superior Gluteal Reconstruction for Severe Hip Abductor Deficiency

Abstract

Abductor tendon tears are one of the common causes of recalcitrant laterally based hip pain and dysfunction. In most cases, abductor tendon tears are associated with chronic nontraumatic tearing of the gluteus medius tendon. Restoring abductor function of the hip by primary repair of the gluteus medius tendon has been reported to have good and excellent outcomes. However, primary repair might not be as effective for chronic detachment of the gluteus medius tendon with a wide separation from the femoral footprint or severe tendon loss. The lack of tendinous foot for repair and the intrinsically degenerative condition of the tendon may create high tension at the repair site thereby predisposing to surgical failure. We believe that the use of soft-tissue allograft from the Achilles tendon or human dermal allograft may help strengthen the surgical site. We describe a superior gluteal reconstruction technique that is suitable for cases with abductor tendon tear with severe tendon loss.

Impact of fatty degeneration on the functional outcomes of 38 patients undergoing surgical repair of gluteal tendon tears

“…EGR also requires specialized equipment and a considerable learning-curve with the risk of poor anchor placement [ 64 ]. Open approaches offer a greater exposure and access to the retracted edge of chronic GTT and therefore provide greater treatment flexibility with more options for fixation including, if required, the use of augmentation or reconstruction techniques in cases with more extended soft tissue damage [ 24 – 33 , 65 , 66 ] or palsy of the superior gluteal nerve [ 16 , 67 , 68 ].…”

Superior Gluteal Reconstruction Results in Promising Outcomes for Massive Abductor Tendon Tears

“…The indications for SGR include failure of primary gluteal repair, massive tears with fatty atrophy, or muscular delamination from gluteal tendons ( Fig 1 ). 29 The procedure was performed using a direct lateral approach with the patient in the lateral decubitus position. The iliotibial band was incised in line with their fibers to allow entry into the peritrochanteric space, and a trochanteric bursectomy was performed.…”

“…21,22 A few case series reporting the use of synthetic, allograft, and autograft tissue for augmentation or reconstruction have provided positive early results. [23][24][25][26][27][28] Suppauksorn et al 29 proposed a superior gluteal reconstruction (SGR), which uses an acellular dermal allograft matrix for reconstruction of the massive, irreparable hip abductor tendon tear and is the senior author's technique of choice for large, irreparable gluteus medius tears.…”

“… 23 , 24 , 25 , 26 , 27 , 28 Suppauksorn et al. 29 proposed a superior gluteal reconstruction (SGR), which uses an acellular dermal allograft matrix for reconstruction of the massive, irreparable hip abductor tendon tear and is the senior author’s technique of choice for large, irreparable gluteus medius tears.…”

Influence of Fatty Infiltration on Hip Abductor Repair Outcomes: A Systematic Review and Meta-analysis

“…13,14,28,35,41,45 Treatment of hip abductor pathology is dictated by severity, chronicity, and tissue quality. 28,29,33,45,47,48,57 A trial of nonoperative management is initially offered, with surgery for refractory cases. 8,12,17,18,62,63 Both open and endoscopic repair techniques have demonstrated excellent results at midterm follow-up, 1,11,12,15,45,47,49 although some patients do not achieve clinically meaningful improvements in patientreported outcomes (PROs) postoperatively.…”