Labral Repair With Concomitant Endoscopic Gluteus Medius and/or Minimus Repair: Outcomes at a Minimum 5-Year Follow-up Relative to a Propensity Score-Matched Control Group.

BACKGROUND

Gluteal tendon and labral tears commonly co-occur and can be addressed in a single surgical procedure. The concomitant management of gluteal tendon and labral tears has shown favorable outcomes at short-term, mid-term, and long-term follow-up, with comparable outcomes to isolated labral repair at 2 years. Yet, there remains a limited understanding of the outcomes of concomitant gluteal tendon and labral repair compared to isolated labral repair at mid-term follow-up.

PURPOSE: To compare patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation-free survival between concomitant gluteal tendon and labral repair compared to isolated labral repair.

STUDY

DESIGN

Retrospective cohort study; Level of evidence, 3.

METHODS

Patients who underwent concomitant endoscopic gluteal repair and arthroscopic labral repair between January 2012 and November 2019 with ≥5-year follow-up were included. Patients who underwent concomitant gluteal and labral repair were propensity score matched to patients who underwent isolated labral repair by age, sex, and body mass index. PROs were assessed preoperatively and at ≥5 years postoperatively, including those for the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) as well as reoperation rates were compared.

RESULTS

A total of 27 patients who underwent concomitant gluteal and labral repair were matched to 78 patients who underwent isolated labral repair. Both groups had significant improvements in all PROs from baseline (P < .001). There were no significant differences in PROs between groups preoperatively (P≥ .184) or at 5 years (P≥ .052). There were no significant differences between groups in MCID achievement for individual PRO measures (P≥ .513) or in PASS achievement for individual PRO measures (P≥ .063). There were no significant differences between groups in MCID or PASS achievement for any single PRO measure at ≥5 years (P = .673 and P = .408, respectively). Time-dependent reoperation-free survivorship was comparable between the groups (P = .979).

CONCLUSION

At mid-term follow-up, patients who underwent endoscopic gluteus medius/minimus repair with concomitant arthroscopic labral repair demonstrated favorable outcomes. Despite a greater burden in abductor abnormalities, outcomes were comparable to those of a propensity score-matched group of patients who underwent isolated labral repair, suggesting that the appropriate surgical management of abductor abnormalities can effectively restore PROs without compromise.