Short-term outcomes following mini-open repair of chronic gluteus medius tendon tears using a double-row technique

Abstract

Gluteal tendon tears represent a common but underreported cause of lateral hip pain and dysfunction. In case of conservative management failure, a surgical procedure must be performed to relieve patient symptoms. Current operative treatments, either open or endoscopic, have been however associated with different drawbacks which led to the introduction of the mini-open technique. The aim of this study was to evaluate and report the short-term outcomes of patients operated through the aforementioned surgical technique for gluteus medius (GM) chronic tears. We retrospectively analysed the records of 14 consecutive patients operated at the La Tour hospital by mini-open repair using a double-row technique for full-thickness GM chronic tears. Intra- and post-operative complications were recorded. The pre- and post-operative pain on visual analogue scale (pVAS), modified Harris Hip score (mHHS), abduction strength and gait dysfunction were assessed for all patients. Pre- and post-operative values were compared to evaluate whether improvements were statistically significant and clinically relevant. The study cohort comprised 13 women (93%) and 1 man (3%) aged 62.4 ± 18.0 at index surgery. No intra- or post-operative complications were noted. Compared to pre-operative values, patients reported a significant improvement in mHHS (59.1 ± 7.1 vs 92.7 ± 4.6) and pVAS (7.4 ± 1.0 vs 1.3 ± 1.3) at last follow-up. Patients exhibited a perfect improvement in muscle strength (3.6 ± 0.5 vs 5.0 ± 0.0), and the proportion of patients with a positive Trendelenburg sign decreased from 71% to 0%. Mini-open repair of chronic GM tendon tears using a double-row technique demonstrated excellent clinical and functional outcomes at short follow-up. Level of Evidence: IV.

Open Gluteus Medius Double-Row Repair With Acellular Allograft Augmentation

“…Each have various indications and are optimal in different clinical situations. 1,[3][4][5][6][8][9][10] Considerations for augmentation with acellular allograft are based on the size of the tear, tissue quality, and tendon excursion. While the gluteus Medius is a big muscle, it has a short tendon, so in cases with questionable tendon quality or likely tension on the repair, a patch can provide structural integrity to pass sutures through.…”

“…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. 1…”

A Review of Abductor Tendon Tears

“…Since 1998, when Kagan et al first described gluteal tendon repair, several techniques have been published and reviewed in the literature [47][48][49][50][51][52][53][54] . Primary open and endoscopic techniques have shown good clinical outcomes for patients suffering from abductor tendon tears [47][48][49] (Fig.…”

“…With suture anchor fixation, the construct may be either single-row (SR) or double-row (DR) 53,54 . In a cadaveric biomechanical study from 2019, Kahlenberg et al found that DR repairs for gluteal tendon tears improved the footprint coverage compared with SR repairs, and there was a higher mean yield load in DR repairs, although not significant (p = 0.15) 56 .…”

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 ].…”