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

Browning, Robert B.; Clapp, Ian M.; Alter, Thomas D.; Nwachukwu, Benedict U.; Wolfson, Theodore; Suppauksorn, Sunikom; Nho, Shane J.

doi:10.1016/j.asmr.2021.05.013

Cited by 7 publications

(7 citation statements)

References 38 publications

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“…There is currently no gold standard for repair of hip abductor tears. Techniques that have been described to date include repair augmentation with acellular dermal matrix, reconstruction with Achilles allograft and various isolated or combined tendon transfer techniques involving the gluteus maximus, TFL or vastus lateralis [ 9 , 10 , 17–20 ]. Tendon transfer and augmentation have multiple benefits.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcomes following open gluteus maximus transfer for the management of hip abductor tears

Lemme

Dworkin

Morrissey

et al. 2023

Journal of Hip Preservation Surgery

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Tears of the gluteus medius and minimus are an important cause of recalcitrant greater trochanteric pain syndrome. Although endoscopic and open abductor repairs have demonstrated promising outcomes, the success of these techniques is dependent on the size of the tear and the quality of the tissue. In patients presenting with abductor insufficiency and evidence of previous repair failure, large retracted tears, muscle atrophy and/or fatty infiltration, reconstruction/augmentation techniques should be considered. In the present study, we present a retrospective cohort study assessing patient outcomes following open gluteus maximus transfer for irreparable or severely retracted gluteus medius tears. Patients were included in the present study if they underwent open gluteus maximus transfer to address hip abductor tears that a senior surgeon deemed irreparable or at high risk for failure following isolated repair secondary to the following tear characteristics: large tears with >2 cm of retraction, the presence of extensive fatty infiltration (Goutallier Grade 3 or greater) and/or patients requiring revision abductor repair due to primary repair failure with associated pain and a Trendelenburg gait. Patients undergoing a concomitant, or those with a previous history of hip arthroplasty, were excluded from the study. All participants were prospectively enrolled in the study, and both pre- and post-operative patient-reported outcomes were collected at 6 months and 1 year including the modified Hip Harris Score, Visual Analog Score, Hip Outcomes Score of Activities Daily Living, Hip Outcomes Score for Sports-Related Activities and Overall Satisfaction with Hip. Pre-operative scores were compared with post-operative assessments using Student’s t-test with a significance level of P < 0.05. Twenty-one patients and 22 hips were included. The average age was 69 (SD ±9.2) and 17 (81%) were females. The average body mass index was 30.0 (±6.2). The outcome scores at both 6 months and 1 year demonstrated significant improvements compared with pre-operative functional assessment. This article reports the utility of gluteus medius/minimus repair augmentation or reconstruction via gluteus maximus transfer demonstrating improvement in patient-reported outcomes at short-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Short-term outcomes following open gluteus maximus transfer for the management of hip abductor tears

Lemme

Dworkin

Morrissey

et al. 2023

Journal of Hip Preservation Surgery

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“…Accordingly, indications for allograft use are related to tendon quality, where there is concern for ability to achieve a robust repair in the operating room (OR). 2,7 In this case, given the complete tear with large amount of tendon retraction on preoperative MRI, it was decided allograft augmentation would be utilized.…”

Section: Video Transcriptmentioning

confidence: 99%

“…Outcome studies are currently limited, but a 2021 study of 8 patients who underwent abductor reconstruction with a dermal allograft found no re-tears at 1-year follow-up, with 75% of patients above Patient Acceptable Symptomatic State based on the modified Harris Hip score (mHHS). 2…”

Section: Video Transcriptmentioning

confidence: 99%

“…At 12 weeks, patients should be ambulating without assistance. 2 Outcome studies are currently limited, but a 2021 study of 8 patients who underwent abductor reconstruction with a dermal allograft found no re-tears at 1-year follow-up, with 75% of patients above Patient Acceptable Symptomatic State based on the modified Harris Hip score (mHHS). 2 Another recent study using a mini-open double-row technique found patients had significantly improved abductor strength, decreased Trendelenburg sign, and improved mHHS scores, providing clinical evidence of technique efficacy.…”

Section: Video Transcriptmentioning

confidence: 99%

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Open Gluteus Medius Double-Row Repair With Acellular Allograft Augmentation

Capurro,

Kaplan,

Fenn

et al. 2023

Video Journal of Sports Medicine

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Background: Gluteus medius tears are a common pathology affecting the lower extremity, predominantly in older female patients, and most often caused by chronic degenerative changes. Due to the associated morbidity with gluteus medius insufficiency, various surgical repair techniques are utilized, including open and endoscopic approaches, with equivalent biomechanical outcomes. Indications: Open gluteus medius double-row repair with acellular allograft augmentation is indicated for patients with massive, full thickness tears, full thickness tears with extensive retraction, degenerative tears, poor tissue quality, revision cases where tendon reduction to the footprint is challenging, and impaired hip abduction strength. The primary benefit of acellular allograft use is the provision of immediate structural strength to the repair construct. Technique Description: The patient is placed in the lateral decubitus position, and a direct lateral incision is made over the greater trochanter. The gluteus medius and/or minimus tendons are identified, mobilized, and provisionally reduced to the footprint. The tendon footprint is then debrided, and proximal anchors are placed. The graft is provisionally fixed to the tendon with sutures anteriorly and posteriorly to ensure correct placement. Sutures are passed from the proximal row through the tendon and prepared allograft, where 1 suture limb from each mattress is placed into a double-row anchor in the distal row. Once secured, the repair is checked through a range of dynamic positions. Results: Although outcomes studies are limited, case series of patients undergoing open gluteus medius repair with allograft have demonstrated favorable patient-reported outcomes, improved pain, improved hip abduction strength, and improved gait. Discussion: Open gluteus medius repair with acellular allograft provides immediate structural strength to the repair construct and should be considered in patients with massive, full thickness tears with extensive retraction, degenerative tears with poor tissue quality, revision cases, and impaired hip abduction strength. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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“…Reconstruction provides an option when the tendon is too degenerated or retracted for primary repair and would result in high tension with risk of surgical failure. In 2021, Browning et al evaluated the 1-year outcomes in a small series of patients who underwent superior gluteal reconstruction (SGR) for irreparable abductor tendon tears 66 . They described using human dermal allograft secured by a DR technique, and at the 1-year follow-up, SGR had favorable patient-reported outcomes with no evidence of retears.…”

Section: Augmentation and Reconstruction Techniquesmentioning

confidence: 99%