Surgical repair of hip abductors. A new technique using Graft Jacket® allograft acellular human dermal matrix

Abstract

Purpose Avulsion of the abductors from the hip can be an infrequent but debilitating complication after total hip arthroplasty performed through a trans-gluteal approach. This can result in intractable pain, limp, Trendelenberg lurch and instability of the hip. There have been various methods described for repairing or reconstruction of this abductor muscle complex including direct trans-osseous repair, muscle transfers, muscle and tendon sling, bone tendon allograft reconstruction and endoscopic repair techniques. Methods In a prospective study at our institution we evaluated the results of a surgical technique in 12 patients using a transosseous repair of gluteus medius and minimus insertions augmented by a Graft Jacket® allograft acellular human dermal matrix (Graft Jacket®; Wright Medical Technology, Arlington, TN) over the anterior and anterolateral aspects of the greater trochanter. Diagnosis of hip abductor avulsions was made by evaluation of the history of presenting complaint, clinical examination and confirmed by ultrasound or MRI scans.

All-Endoscopic Single-Row Repair of Full-Thickness Gluteus Medius Tears

“…Open techniques have evolved to suture anchors and even more complex models, such as the Ligament Augment and Reconstruction System (LARS, Arc sur Tille, France) 19,20 and biologic patch augmentation. [21][22][23] Voos et al 7,24 described the first endoscopic technique using suture anchors in 2007 and reported no pain or complications in all 10 patients at a mean follow-up of 25 months. More recent reports have confirmed excellent patient-reported outcomes at similar time points after endoscopic repair.…”

Site-dependent acellularisation effects explain altered tissue mechanics: ultrastructural insights

“…These findings have a strong clinical implication. Acellular matrices have evolved becoming suitable scaffolds for soft tissue reconstruction [1,2,[5][6][7] due to their reduced antigenicity caused by the partial or complete absence of cellular proteins [9]. We could show previously that acellularisation-related effects are tissuedependent [8].…”

“…Being freed of cells and cellular components, these scaffolds produce minute antigenicity [2,6,9] and provide a biologic environment for cellular ingrowth and subsequent remodelling. However, there is a lack of morphologic and functional data on how exactly the commonly used methods of acellularisation impact extracellular matrix integrity, including commonly used chemical and physical protocols [3,10].…”

Greater Trochanteric Pain Syndrome: An Update on Diagnosis and Management

“…The anterolateral THA approach is associated with potential complications including superior gluteal nerve injury or failure of the abductor muscle repair [30]. GTPS can present as an early or late finding.…”

“…Active and passive abduction of the post-operative hip is avoided for the initial 6 weeks. Subsequently, patients are allowed to perform passive hip abduction for activities of daily and progress to active hip abduction strengthening exercises under physical therapy instruction [30].…”