by Joseph F. Davies, and Dana M. Davies

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Presentation transcript:

by Joseph F. Davies, and Dana M. Davies Surgical Technique for the Repair of Tears to the Gluteus Medius and Minimus Tendons of the Hip by Joseph F. Davies, and Dana M. Davies JBJS Essent Surg Tech Volume 4(2):e11 June 11, 2014 ©2014 by The Journal of Bone and Joint Surgery, Inc.

A cadaveric dissection demonstrating the anatomy of the gluteus medius. Joseph F. Davies, and Dana M. Davies JBJS Essent Surg Tech 2014;4:e11 ©2014 by The Journal of Bone and Joint Surgery, Inc.

A cadaveric dissection demonstrating the anatomy of the gluteus minimus, as viewed looking caudally from a cephalad position. A cadaveric dissection demonstrating the anatomy of the gluteus minimus, as viewed looking caudally from a cephalad position. The gluteus minimus originates from the ilium between the inferior and anterior gluteal lines. It inserts onto both the anterior part of the capsule and via the long head onto its discrete facet (*) onto the anterior surface of the greater trochanter. Joseph F. Davies, and Dana M. Davies JBJS Essent Surg Tech 2014;4:e11 ©2014 by The Journal of Bone and Joint Surgery, Inc.

The classification system for tears of the hip abductors for the right and left hips. The classification system for tears of the hip abductors for the right and left hips. It is based on the hours of the clock. In a right hip, the gluteus medius inserts between the 11 o’clock and 3 o’clock positions; in a left hip, it inserts between 9 o’clock and 1 o’clock. Each grade of the tear is equal to one hour of the clock. A Grade-I tear involves one hour; Grade II, two hours, and so on. Joseph F. Davies, and Dana M. Davies JBJS Essent Surg Tech 2014;4:e11 ©2014 by The Journal of Bone and Joint Surgery, Inc.

A drawing demonstrating the appearances of the various grades of tears in a right hip, showing their progression. A drawing demonstrating the appearances of the various grades of tears in a right hip, showing their progression. Tears typically begin in the central fibers of the gluteus medius at about 1 o’clock (right hip) and then extend inferiorly and posteriorly, increasing the grade as the tear progresses (blue arrows). Joseph F. Davies, and Dana M. Davies JBJS Essent Surg Tech 2014;4:e11 ©2014 by The Journal of Bone and Joint Surgery, Inc.

A cadaveric dissection demonstrating the anatomy of the superior gluteal neurovascular (NV) bundle. Joseph F. Davies, and Dana M. Davies JBJS Essent Surg Tech 2014;4:e11 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Two illustrations of the insertion sites of the gluteus medius. Two illustrations of the insertion sites of the gluteus medius. (Reproduced, with permission from Elsevier, from: Robertson WJ, Gardner MJ, Barker JU, Boraiah S, Lorich DG, Kelly BT. Anatomy and dimensions of the gluteus medius tendon insertion. Arthroscopy. 2008 Feb;24[2]:130-6.)‏ Joseph F. Davies, and Dana M. Davies JBJS Essent Surg Tech 2014;4:e11 ©2014 by The Journal of Bone and Joint Surgery, Inc.

Repair of a Grade-IV tear in a right hip. Repair of a Grade-IV tear in a right hip. Fig. 7-A Two rows of transosseous holes placed parallel to the anterior and posterior margins of the lateral and superior-posterior facets as described by Robertson et al.21 create tunnels. Krackow stitches with number-5 FiberWire are woven into the tendon to create pull sutures that exit 7 to 10 mm from the underside of the tendon edge. These pull sutures are routed through tunnels, drawing the tendon over the footprint site. Additional simple stitches are placed through each tunnel to secure the tendon margin to the abductor footprint. The sutures from a 6.5-mm suture anchor are placed in the tendon of the long head of the gluteus minimus (G Minimus). Fig. 7-B The sutures from the suture anchor secure the gluteus minimus down to its anterior facet, and then pull sutures are tied down under maximum tension, drawing the gluteus medius (G Medius) tendon back down to its footprint on the greater trochanter. Fig. 7-C The tendon, having been reduced into its position, is further secured with the simple sutures. Joseph F. Davies, and Dana M. Davies JBJS Essent Surg Tech 2014;4:e11 ©2014 by The Journal of Bone and Joint Surgery, Inc.