Dermal Allograft Augmentation for Open Gluteus Medius Repair: A Case Series at 2-Year Follow-up.

Abstract

Gluteus medius (GM) tears are a common cause of peritrochanteric regional pain and disability among middle-aged and older populations. While largely successful, when primary repair fails, it is often attributed to poor tendon quality. Dermal allograft augmentation offers a solution for this patient population by enhancing the biological and mechanical properties of the repair construct. To evaluate the outcomes of open isolated GM repair with dermal allograft augmentation at 2-year follow-up, with a sex-based subanalysis comparing clinical outcomes in male versus female patients. Case series; Level of evidence, 4. Prospectively collected data were retrospectively analyzed for all patients who underwent open GM repair with dermal allograft augmentation between June 2016 and April 2022. Included patients had complete preoperative and 2-year follow-up data for the following patient-reported outcome measures (PROMs): modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), International Hip Outcome Tool-12 (iHOT-12), visual analog scale for pain, and patient satisfaction; if complete 2-year follow-up data were not available, patients had a documented endpoint such as further surgery. Clinically relevant thresholds, complications, and secondary surgery were reported. A total of 23 hips (18 female, 5 male) were included in this study. There were 17 primary procedures with dermal allograft augmentation (73.9%) and 6 revisions after prior GM repair without previous dermal allograft augmentation (26.1%). A significant improvement was observed on all evaluated PROMs, with 1 reoperation (4.4%) for a recurrent tear. A high percentage of patients achieved the minimal clinically important difference for the mHHS (86.4%), NAHS (81.8%), and iHOT-12 (72.7%). Moreover, 16 (72.7%) answered the patient acceptable symptom state anchor question positively. A sex-based subanalysis showed that female patients demonstrated a greater postoperative improvement on PROMs and a higher rate of achieving clinically relevant thresholds compared with male patients. Patients with extensive degenerative GM tears who underwent repair with dermal allograft augmentation had favorable outcomes with significant improvements on PROMs and low reoperation rates at short-term follow-up.