2017 ISAKOS Biennial Congress ePoster #504

 

Fatty Degeneration of Gluteus Minimus and Medius Affects Clinical Outcomes of Endoscopic Hip Abductor Cuff Repair

Mathieu Thaunat, MD, Lyon, Auvergne Rhône Alpes FRANCE
Bertrand Sonnery-Cottet, MD, PhD, Lyon, Rhône FRANCE
Gilles Clowez, MD, Lyon FRANCE

Centre orthopédique Santy, lyon, FRANCE

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Summary

This study suggests that endoscopic surgical repair can be an effective treatment of gluteus medius tears in the short term . Fatty degeneration of gluteus minimus and medius affects clinical outcomes of endoscopic hip abductor cuff repair. A longer-term follow up study would help in finding out if this approach is effective long-term.

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Abstract

Introduction

The purpose of this study was to report the early outcomes of endoscopic repair of partial and full thickness tears of the gluteus medius and to determine whether fatty degeneration had an influence on clinical results after surgical repair of the tendon.

Methods

Between October 2012 and June 2014, data were prospectively collected for all patients undergoing endoscopic gluteus medius repairs. Only patients with evidence of gluteus medius tear on magnetic resonance, lateral hip pain and failure of at least 6 months of conservative treatment were treated surgically. Patients were assessed pre- and post-operatively using 2 hip specific questionnaires (the modified Harris Hip Score, the Non-Arthritic Hip Score) and Visual Analogic Scale for pain. Gluteus minimus and the 3 distinct parts of the Gluteus medius (Anterior, Middle and Posterior) were assigned a grade of fatty degeneration according to the Goutallier classification on preoperative magnetic resonance imaging scans. Postoperative outcome measures were compared with preoperative fatty degeneration index, to assess for correlations.

Results

20 hips met the inclusion criteria with 31.7 months mean follow-up (range, 24 to 47 months).The mean age at the time of surgery was 66 years (range, 45 to 82 years). Of the 20 hips included in the study, 6 had no fatty degeneration of Gluteus medius, 10 were classified as grade 1 (n = 5) or grade 2 (n = 5) and 4 patients were grades 3 and 4. One patient had a repair failure and underwent an iterative open repair. Post-operative improvement was seen in mHHS (33.7 points v 80.2 points, P = .0001), NAHS (47.7 points v 76.8 points, P = .0001) and in the visual analog scale for pain (7.2 v 3.2, P < .05). Increasing preoperative fatty degeneration index of the Gluteus medius and minimus correlated with decreased postoperative functional hip score values (regression coefficient, -3.50; P = .0008). Patient age, tear characteristics (partial or full thickness), or repair type (double vs single row) did not affect postoperative outcomes.

Conclusions

This study suggests that endoscopic surgical repair can be an effective treatment of gluteus medius tears in the short term . Fatty degeneration of gluteus minimus and medius affects clinical outcomes of endoscopic hip abductor cuff repair. A longer-term follow up study would help in finding out if this approach is effective long-term.