AOSSM/AANA Specialty Day 2020-Endoscopic Gluteus Medius_Minimus Repair

Endoscopic Gluteus Medius_Minimus Repair_ My Decision Making for Scope vs. Open

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Dr. Shane J. Nho discusses decision-making for treating gluteus medius (GMed) and gluteus minimus (GMin) tears, often referred to as "rotator cuff tears of the hip," which have a prevalence of 10-25%. Diagnosis involves physical examination and MRI to assess tear characteristics such as partial vs. full thickness, tendon retraction (e.g., ≥2cm), and fatty atrophy staged 0-4 by the Goutallier/Fuchs classification. These factors guide the choice between endoscopic (scope) versus open surgical repair techniques.<br /><br />Clinical outcomes indicate that both endoscopic and open repairs can yield excellent results with low complication rates. Endoscopic repair shows a particularly low retear rate (0%) compared to open repair (9%), with patients experiencing pain resolution and improved functional scores (MHHS, HOS). Open surgery remains vital for massive or retracted tears, with superior gluteal reconstruction (SGR) emerging as a promising option for complex cases.<br /><br />Gluteus maximus transfer is an option for recalcitrant or massive tears, involving harvesting a gluteus maximus flap and transosseous fixation via bone tunnels. Studies demonstrate significant improvements in pain and function post-surgery.<br /><br />Postoperative rehabilitation is key, progressing from 6-8 weeks of protected weight-bearing with hip orthosis and passive range of motion to gait training, strengthening, and proximal motor control.<br /><br />In conclusion, patients with persistent lateral hip pain should be evaluated for GMed and GMin tears. An understanding of MRI findings and tear characteristics directs surgical planning. Both endoscopic and open repairs provide good to excellent outcomes, and novel techniques like SGR offer hope for massive tears. This comprehensive approach aims to restore abductor function and alleviate pain effectively.

Keywords

Gluteus medius tear

Gluteus minimus tear

Hip rotator cuff tear

Endoscopic repair

Open surgical repair

MRI diagnosis

Tendon retraction

Fatty atrophy classification

Superior gluteal reconstruction

Gluteus maximus transfer