Name: Arthroscopic vs. Open Treatment of Gluteus Medius Tears
Uploaded: 2016-07-19T00:00:00Z
Channel: Arthrex

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VPT1-00671-EN | A | Arthroscopic vs. Open Treatment of Gluteus Medius Tears

Misty Suri

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Arthroscopic vs. Open Treatment of Gluteus Medius Tears

There's a little bit about the gluteus medius scope versus open repairs. A little just quick about the anatomy. We don't need to go over this too much, but basically the lateral facet and the and the superior posterior facet, two insertion points are just useful to remember anatomically when we're doing this arthroscopically or open if we're going to do it a bunch of verses here. I don't really waste too much time trying to find this, trying to find these. They just they tend to be dissected out in the, in the in the manner that which you're addressing, anyway, with the trochanteric bursitis that you're often addressing with in this problem. The very common problem in the, in the middle aged women and middle aged men, mostly in the women, of course, it was a good study by Robertson. So the lateral hip pain, you know, the the abductor lurch. Of course this is this is a common finding this single leg stance pain. Pain in pain in the hip abductor area. At the 32nd, around the 32nd mark with a single leg stance. I think that's a useful test. This bottom right picture I think is useful. I've been having many discussions with the therapist in the hip abductor position of about 30 degrees or so. 20 or 30 degrees or so. In ten degrees of extension in their in their, their data, their literature shows that that's that isolates the the hip abductors the best, the gluteus medius the best. So I think that's a useful test to to measure the strengths. If they're weak, if they're weak, then, you know, then we can obviously look for look for the tear on imaging. So as we said you know, ultrasound if you like if you guys like to use that or MRI obviously the surgery after the non-operative treatment. Just a couple of articles quickly. You know, this article was pretty good. Basically, the long as we've all seen, the long time to diagnosis. Don't need to belabor that. Under-recognized. Often missed. We'll see these over and over again in our clinic that have seen multiple doctors and patients are patients are are told they're crazy and they show up in their clinic. They've got a tear and you fix them. They do great, which is gratifying for us. So open versus scope. This paper showed the higher much higher complication rate in the open open group versus the scope group. Ten out of 127 versus versus zero out of 40. So their conclusion was that in this systematic review was that the scope works better than open. I don't really like systematic reviews. I think they're not the best. I don't learn too much from them. But this one actually was was pretty good. Same thing on that, on that second systematic review with the same conclusion there. They work pretty well in terms of the Vas scores and the functional outcomes. Again, another paper, they do well. I'm just going to go over a case here in a second. So this is a case. 61 year old lady. She had pain for for years. Several years. She couldn't remember. On the outside of her hip. Multiple injections. Typical, you know, significantly affected activities of daily living in our life and our sleep. Very nice lady and had a legitimate, legitimate problem. She had the pain. You know, all the physical exam findings. We talked about normal looking X-rays in terms of, you know, a little bit of a little bit arthritis, nothing terrible. But it was it was outside of her hip. The diagnostic injections that she got helped her, but the pain kept coming back. So imaging unfortunately, I don't have her MRI, but she had to take my word for it. So we did a double row SutureBridge here. This is kind of standard stuff here. That's what the tear looked like. And these are anchors getting put in. That's what it looked like after we're done. Corkscrew anchors medially and then tied those down. And then in the laterally with the SwiveLock two of those laterally. And that's what it looks like. The repair looks like on the bottom. On the bottom right. This is the lady Dramatically dramatic improvement in her pain. Six weeks after surgery, she's walking around. She's got a little bit of weakness still on that side, but she's walking around pretty good. Her pain is dramatically better. It's amazing how much how quickly these patients get better. And the tissue to me is not the most substantive of tissue. It's not it's not the most thick tissue. But somehow, amazingly, it works and it holds and their strength comes back. And I've been I've been quite surprised over the years how well they do rehab. Bracing are bracing for six weeks. And this was the lady she'd, she'd about 2 or 3 days before coming into the clinic. In that video she got rid of her, got rid of her crutches and was walking around, you know pretty well standard stuff here with the motion and the strength and all that. But just the that that strength. Evaluation in the abducted position, ten degrees of hip extension, I think is useful. And obviously, I think the scope does better than the open.

Arthroscopic vs. Open Treatment of Gluteus Medius Tears

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