Endoscopic Repair of Full-Thickness Gluteus Medius and Minimus Tears-Prospective Study with a Minimum 2-Year Follow-up

PURPOSE:

The purpose of this study is to evaluate the short-term outcomes of endoscopic repair of full-thickness gluteus medius and minimus tendon tears with a minimum of 2-year follow-up and add to the paucity of literature on abductor tendon tears.

METHODS:

All patients who underwent endoscopic abductor tendon repair between December 2013 and August 2017 were prospectively evaluated. The inclusion criteria for this study were primary full-thickness gluteal tendon tears and at least 2-years follow-up. Clinical outcome data consisted of VAS pain score, hip abduction strength, Trendelenburg sign, complications, and patient reported outcome measures (PROMs): modified Harris Hip Score, Hip Outcome Score, Non-arthritic Hip Scale, International Hip Outcome Tool, and Lower Extremity Functional Scale.

RESULTS:

A total of 15 hips, all full-thickness tears, met inclusion criteria with an average follow-up of 31.2 months, with no patients being excluded. On physical exam, there was a significant improvement in VAS pain score from 5.36 to 2.43 (p-value = .0243), hip abduction strength with 8 (53.3%) hips improving by at least 1 point (p-value = .02056), and resolution of Trendelenburg sign in all 15 hips at 2-years (p-value = .0019). The mean difference for all 6 PROMs was statistically significant, even after Bonferroni adjustment, with the majority of patient improvement exceeding the minimal clinically important difference (MCID) thresholds: mHHS: 86.67%, HOS-ADL: 86.67%, HOS-SSS: 66.67%, NAHS: 93.33%, and iHOT-33: 80%. Higher Goutallier grade was associated with a higher VAS pain score. There were no complications, including no re-tears.

CONCLUSIONS:

In this study of 15 hips with full-thickness gluteal tendon tears managed endoscopically, we found excellent outcomes that exceeded the MCID thresholds in the majority of patients at an average of 31.2 months follow-up, while offering the potential advantages of less tissue violation, ambulatory day surgery, and fewer complications compared to open repair.