Clinical and MRI results in 67 patients operated for gluteus medius and minimus tendon tears with a median follow-up of 4.6 years.

INTRODUCTION: Although various techniques can be used to repair gluteal tendon tears, the long-term outcome is unclear and published studies typically involve only a small number of patients. The goals of this study were to determine (1) if functional improvement can be obtained, (2) if the repairs are continuous based on MRI, and (3) which factors determine success. HYPOTHESIS: Gluteus medius and minimus tears can be repaired effectively with an open double-row technique. MATERIAL AND METHODS: Seventy-three patients were operated on between 2003 and 2010. Of these patients, 67 (62 women, 5 men) were available for review consisting of functional clinical tests and MRI of the hip and pelvis. A double-row repair was performed on all tendon tears, no matter the type of injury. Age, body mass index (BMI), fatty degeneration and muscle atrophy were also evaluated to determine if these variables affected the outcome. RESULTS: The average follow-up was 4.6 years (range 1-8). The pre-operative scores had improved at the last follow-up: (1) pain (VAS): 8.7 ± 1.1 versus 1.7 ± 2.7 at the follow-up, (P<0.001), (2) Lequesne index: 12.3 ± 2.6 versus 4.0 ± 4.0 at the follow-up, (P<0.001), (3) Harris Hip Score: 50.5 ± 8 versus 87.9 ± 15.5 at the follow-up, (P<0.001). There were 11 failures (16%) including two repeat tears that were reoperated successfully. In the other 56 patients, the MRI showed no signs of the initial tear or bursitis. Of the four factors (age, BMI, fatty degeneration, muscle atrophy) that were potential predictors of the outcome, only muscle atrophy had a negative impact on functional outcome (P<0.05). CONCLUSION: Using an open double-row technique to repair gluteal tendon tears led to 85% of patients having good clinical results with significant improvement in symptoms and disappearance of abnormal findings on MRI. This technique can be used with all types of tendon tears, but should be performed before muscle atrophy sets in. LEVEL OF PROOF: Level IV-retrospective study.

A new arthroscopic technique for lateral meniscal allograft transplantation: cadaver feasibility study.

INTRODUCTION: The three prerequisites for a successful meniscal allograft are fixation, graft sizing and precise positioning. The goal of this study was to demonstrate that lateral meniscal allografts can be reliably positioned using a fully arthroscopic technique. HYPOTHESIS: This surgical technique is feasible and results in good positioning of the meniscal graft. MATERIAL AND METHODS: Twelve fresh cadavers were used in the study. The meniscal graft implantation procedure was performed entirely by arthroscopy. The meniscal horns were fixed with screw-in suture anchors and the meniscal border was fixed to the capsule by arthroscopic meniscus-capsule sutures. The main outcome measure of good implant positioning was based on the distance between the implanted location of the posterior horn of the lateral meniscus (PHLM) and its original location. To accomplish this, aerial photographs of the tibial plateau were used to compare the insertion zones and to calculate the distance between them. These measurements were performed by two surgeons and then compared. RESULTS: Eleven of the 12 procedures (92%) were performed successfully. The posterior horn of the lateral meniscus was positioned an average of 4.3mm in the medial-lateral axis and 1.7 mm in the anterior-posterior axis away from its original location. Thus the position of the implanted PHLM was on average 4.6mm away from its original location. DISCUSSION: This fully arthroscopic technique is feasible. It offers the advantages associated with minimally-invasive surgery and results in good positioning of the posterior horn of the allograft. Two limitations of this study are that the size of the implant was not matched and the chosen fixation method was not subjected to biomechanical evaluation. The lack of a tibial tunnel will make it easier to combine this procedure with ACL reconstruction. In these conditions, the clinical application of this technique seems to be timely. LEVEL OF PROOF: IV - Controlled experimental study.