Open Gluteus Reconstruction with Inlay Enthesis Allograft and Onlay Acellular Dermal Allograft

Gluteus medius/minimus tears are common, especially in older women. These can occur acutely due to trauma or chronically from degeneration. Treatment options vary depending on the extent of the tear. In cases with poor tendon quality or retracted tears, allograft augmentation is a promising surgical option that may enhance repair strength and healing potential.

Open gluteus medius/minimus repair with allograft augmentation is indicated for patients with large, chronic tears that are unlikely to heal due to factors such as age, tissue degeneration, or prior failed repairs. Specifically, allograft augmentation is used in chronic tears, massive tears with fatty atrophy, and revision surgeries.

The patient is secured in the lateral decubitus position. An incision is made directly over the greater trochanter to expose the gluteus medius and minimus tendons. The tendons are mobilized and reduced to their footprint, allowing identification and decortication. The enthesis biphasic inlay allograft is added to a slightly excavated area on the trochanteric footprint. The glute tendon is then sewn superficially, above the inlay enthesis graft, in a secure manner. Proximal anchors are placed, and the onlay human dermal allograft is cut to appropriate dimensions for fixation to the torn tendon, with sutures placed both anteriorly and posteriorly. Anchor sutures are then passed through the graft-tendon-graft construct and in mattress fashion, forming the proximal row. One suture limb from each mattress is then loaded into a double-row anchor to form the distal row.

There are case series in the literature describing outcomes after gluteal reconstruction; however, this is the first demonstration of the use of biphasic enthesis allograft for gluteal reconstruction. Open gluteal reconstructions have shown improvements in patient-reported outcomes, pain, and hip functionality.

Open gluteus medius/minimus reconstruction with inlay biphasic enthesis allograft and onlay acellular dermal allograft provides an immediate scaffold for strength and support. The allograft augmentation should be considered particularly for cases of retracted tears and fatty infiltrated musculature. The enthesis graft has been used successfully in rotator cuff repairs, and its benefits are applicable to the hip for significant tears with poor repair quality.

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