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Open Gluteus Medius Reconstruction via Double-Row Technique and Acellular Dermal Allograft

March 01, 2020

Contributors: Eddie Beck, MD, MPH; Jorge Chahla Jr, MD; Kyleen Jan; Shane Jay Nho, MD, FAAOS; Sunikom Suppauksorn, MD; Jonathan Rasio, BS

Lateral hip pain, also known as greater trochanteric pain syndrome, is a common cause of disability in women aged 40 to 60 years. With the increased use of advanced imaging modalities, gluteal tears frequently are identified as a cause of lateral hip pain refractory to nonsurgical management. Gluteal tears have been described as rotator cuff tears of the hip because of hip abduction weakness against resistance and a Trendelenburg gait secondary to degenerative or traumatic tendon injury. Although partial-thickness and full-thickness tears with minimal retraction can be repaired endoscopically, an open approach often is necessary for the management of full-thickness tears with considerable retraction. This video demonstrates open gluteus medius reconstruction via a double-row technique with acellular dermal allograft. The procedure is performed via a 6- to 8-cm incision centered over the greater trochanter followed by longitudinal splitting of the iliotibial band and the deep fascia. Tendon mobilization is performed to increase tendon excursion. Decortication at the footprint helps create a bleeding cancellous surface. We used two suture anchors in the lateral facet and the superoposterior facet near the medial border of the footprint. The sutures were passed through the tendon and graft and secured to the bone distal and lateral to the medial row anchors. This double-row repair allows for a broad area of graft compression to the osseous bed, which increases structural strength of the repair and healing.