Peritrochanteric access and gluteus medius repair.

Abstract

Access to the peritrochanteric space is simple and reproducible with the technique described in this report. Two anteriorly based portals are placed between the iliotibial band and the greater trochanter. Bursal tissue and debris can be cleared, optimizing visualization of the peritrochanteric space and the anatomic structures. Lesions of the gluteus medius are a common cause of lateral hip pain unresponsive to conservative treatment and have frequently been mischaracterized as recalcitrant trochanteric bursitis. These lesions are often amenable to endoscopic repair with techniques comparable to those used for rotator cuff problems in the shoulder. Portal placement and organization and execution of a gluteus medius repair are highlighted in a video example. Repair is carried out with laterally based portals in the peritrochanteric space. A viewing portal is placed posterior to the vastus lateralis ridge, with a working portal distal to the ridge. Anchors are placed from a proximal position, entering perpendicular to the cortical surface of the trochanter.