Good afternoon, everyone. First I'd like to thank Anna and the program committee for the opportunity and the honor to present today. Second, I'd like to thank my co-authors for this collaboration on this project. We have no disclosures. So a little background. Glute tears were first ignored and then often misdiagnosed as trochanteric bursitis, and then oftentimes are associated iatrogenically with steroid injections. Shown on the screen, there are two images. One is a hip and one is a shoulder. It's quite difficult to tell which is which because anatomically, both have two abductors, and operatively, they are viewed and fixed in a very similar manner. That's why when glute tears were first described in the late 90s by Bunker and Kagan, they were referred to as the rotator cuff of the hip. The differential includes primary trochanteric bursitis, which is quite rare, snapping hip, hip osteoarthritis, and lumbar etiologies. Epidemiologically, glute tears occur predominantly in females between the ages of 40 and 60 years old. They present with lateral hip pain, variable levels of weakness, and oftentimes Trendelenburg gait and or sign. This can result in a significant amount of functional impairment of ambulation and activities of daily living. MRI is really key here in terms of allowing us to accurately assess the characteristics of the tear in addition to assessing the muscle tendon unit, including the degree of fatty infiltration. Patients are typically given at least two months of conservative management focusing on physical therapy with gait training, including the use of ambulatory aids. Shown here are preoperative T2-weighted MRIs. On the left is a coronal cut in which we can appreciate the left hip as having an isolated gluteus medius tear here and a significant amount of fatty infiltration here. On the right is an axial cut in which we can also appreciate the tear quite nicely. In terms of methods, this was a prospective study focused on primary full thickness gluteus medius and minimus tears with at least one year of follow-up. Our outcomes were PROM scores or patient-reported outcome measurements, VAST pain score, hip abduction strength, and Trendelenburg gait and or sign. In terms of surgical technique, so in this image we're looking at a left hip. The patient's head is up here, feeder is downward. The patient is in the right lateral decubitus position. The surgeon is positioned posteriorly. The scope is in the distal portal, shearer is in the proximal portal, and we have two utility portals. Upon entering a deep peritracheal space, we can appreciate a full thickness crescent-shaped gluteus medius tear and a minimus tear back here, both of which have retracted superiorly off their anatomic footprint. On the right image, we can see that the tendon is being held with a tissue grasper. This is done so that when we put the hip through a full range of motion, we can assess the tear dynamically. In terms of repair, it's accomplished with a transosseous equivalent double row technique in which the proximal row of anchors is placed in the anatomic footprint while the distal row of anchors is placed in the vastus ridge. This approximates the tendon to the anatomic footprint quite nicely and provides attention-free repair. Most operatively, we are not using that abduction brace. Instead, patients are educated on the importance of maintaining a level pelvis. Patients are typically full weight-bearing as tolerated with using a walker for the first three months and then a cane or a crutch for the next three months, however, a key point being that they are kept on ambulatory aid until they are able to maintain a level pelvis as lurching stress is the repair. In terms of results, the cohort had 15 patients with a mean follow-up of 20 months. The average age was 67, 80% of the cohort was female. Almost all the tears were degenerative in nature. Tendon involvement was isolated to the gluteus medius in two-thirds of the patients while the remainder had double tendon involvement. Shown here are the mean PROM scores. We can appreciate that functionality improved over time. Comparing the mean difference from baseline to two years out, you can see that all six PROM scores were statistically significant even after Bonferroni adjustment. In addition, we can note that after the one-year mark, it appears that functionality improvements begin to plateau. Hip abduction strength improved by at least one grade in over 50% of patients. Trendelenburg sign and gait resulted in all patients by two years out. The VAS pain score decreased from 5.4 to 1.6. All three results were statistically significant. There was no complications. The strength of the study is 100% follow-up, reporting on six PROM scores, including reporting on Trendelenburg sign and gait resolution. And finally, this was a focus cohort. There was no inter-articular procedures were performed. This allows us to focus on the functional and pain improvement due to the glute tendon repair alone. In conclusion, in properly selected patients, endoscopic abductor tendon repair is safe and successful with outcomes equivalent to open repair with low post-operative pain and low complications. Thank you.

glute tears

trochanteric bursitis

steroid injections

double row technique

endoscopic abductor tendon repair