Two-year follow-up shows efficacy of endoscopic repair for gluteus medius tears

Issue: October 2012

BALTIMORE — Patients who underwent endoscopic repair of partial and full thickness gluteus medius tears showed significant improvements on four hip-specific questionnaires and 87% rated their hips as good or excellent at short-term follow-up.

Perspective from Kenneth E. DeHaven, MD

“Endoscopic repair of the gluteus medius has shown to be effective in the 2-year term with good patient satisfaction, dramatic improvement in outcome scores and improvement in strength,” study author Benjamin G. Domb, MD, said during his presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting 2012.

Domb and colleagues prospectively studied 15 patients (14 women and one man) with an average age of 58 years who underwent endoscopic gluteus medius repair and had a minimum 2-years follow-up. The study included patients with MRI-confirmed tears with preoperative lateral hip pain and gluteus medius weakness who failed steroid injection treatment and at least 3 months of physical therapy. The investigators excluded patients from the study who had revision procedures or previous hip conditions, such as Legg-Calvé-Perthes disease or hip fracture.

Preoperatively and postoperatively, the patients completed the Visual Analog Scale (VAS) and four hip-specific questionnaires that included the modified Harris Hip Score (mHHS), Non-arthritic Hip Score, and the sports-specific and activities of daily living subscales of the Hip Outcome Score. Patients also rated their satisfaction on a 0 to 10 scale postoperatively.

Full thickness tear of the gluteus medius from the lateral facet insertion is shown.

Images: Domb BG

Six patients underwent repair using a transtendinous technique for partial thickness tears; nine had a full thickness repair using double-row suture-bridge technique. Of the latter nine patients, Domb said five patients had full thickness tears, and four patients had high-grade partial thickness tears that were completed for the repair. The patients were braced postoperatively and were on crutches for 6 weeks followed by an extended program of progressive gluteus medius strengthening.

At 2-year follow-up, the investigators found significant improvements for all of the hip-specific questionnaires. Domb noted that the mHHS improved 38 points, “Which, in comparison with other hip arthroscopy series at our center and elsewhere, is a fairly dramatic change. In terms of their pain, they had an average improvement in their VAS score of 5.2.”

A suture is passed through the tendon of a full thickness tear of the gluteus medius.

The investigators found that 13 patients (87%) rated their outcomes as good or excellent, with consistent return to full strength, normal gait and resolution of peritrochanteric pain. Two patients had fair results: one patient had a good outcome related to the gluteus medius, but rated the outcome as fair due to continued intra-articular pain from early arthritis; the second failed to comply with postoperative restrictions and physical therapy. – by Gina Brockenbrough, MA

The double-row suture-bridge repair construct is completed.

Reference:

Domb BG, Finley ZJ, Baise RA, et al. Outcomes of endoscopic gluteus medius repair. Paper #25. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting 2012. July 12-15. Baltimore.

Benjamin G. Domb, MD, can be reached at Hinsdale Orthopaedics and the American Hip Institute in Chicago, 1010 Executive Ct., Suite 250, Westmont, IL; email: drdomb@americanhipinstitute.org.

Disclosure: Domb received financial support for this research from Arthrex Inc.

Perspective

Kenneth E. DeHaven, MD

This is an interesting prospective, clinical study of endoscopic repair of partial and complete gluteus medius tendon tears using multiple hip-specific and general outcome measures preoperatively and postoperatively. Their impressive outcomes at 2 years are consistent with reports from other hip centers using endoscopic techniques to treat symptomatic peritrochanteric pathology.

Recognition of the morphologic and functional similarities of the abductor mechanisms of the shoulder and hip (gluteus medius and minimus tendons) has lead to the terminology of rotator cuff of the hip. Rotator cuff repairs of both require protective and lengthy aftercare that transitions to activity-specific rehabilitation for up to 6 months or more to return successfully to strenuous activities. One major difference is that you do not have to walk on your shoulder.

While this study addresses chronic conditions that have failed nonoperative treatment for at least 3 months, I would emphasize that acute traumatic complete gluteus medius tears may be uncommon, but I know from personal experience that they do occur. Acute cases with clinical signs of abductor mechanism disruption should have prompt confirmation by MRI. Unless there are contraindications, acute repair of complete tears (open or endoscopic) should be considered, especially when there is retraction of the torn tendons.

Kenneth E. DeHaven, MD

Emeritus Professor of Orthopaedics, University of Rochester Medical Center, Rochester, N.Y.

Disclosures: DeHaven has no relevant financial disclosures.