Augmentation of hip abductor repair with fascia of vastus lateralis.

BACKGROUND

Hip abductor tears are common and can cause severe limp and pain. Repair of gluteal tears often requires augmentation. Although current methods of gluteal augmentation have good reported outcomes, they can be costly and add an additional layer of complexity if they become infected because they rely on non-autologous materials. Based on the case series below, we report an alternative technique to augment gluteal tendon repair that uses vastus lateralis fascia.

METHODS

Between 2022 and 2025, 23 hip abductor repairs augmented with a vastus lateralis fascia flap, following a primary or revision hip replacement, were performed. A functioning gluteus medius was confirmed intraoperatively using a superior gluteal nerve stimulator prior to repair. The patients were allowed to weight-bear as tolerated postoperatively and commenced abductor strengthening exercises at six weeks.

RESULTS

Preoperatively, all patients had complaints of severe pain and weakness (excluding neck of femur fracture patients, who were not assessed preoperatively). At their last post-operative follow-up, 21 (91%) reported no pain and 20 (87%) had an abductor power ≥3/5. Six patients underwent subsequent operations on the same hip, during which good healing of the repair was observed. Of the 3 patients whose abductor power remained <3/5 postoperatively, 1 has since undergone a gluteal reconstruction with a deep muscle-sparing vastus lateralis to gluteus medius translational transfer/transposition, with the other patients awaiting the same.

CONCLUSION

Augmentation of hip abductor repair with a vastus lateralis fascia flap is a cost-effective autologous technique with encouraging early outcomes. To avoid performing gluteal repairs in patients who should undergo gluteal reconstruction, gluteal muscle function is tested with a nerve stimulator intraoperatively prior to every repair.