Anatomical study of the positioning of anchors following arthroscopic repair of the gluteus medius and minimus
Author(s):
Pansard E. (France)
Pansard E. (France)
Affiliations:
ESSKA Academy. Pansard E. 05/09/18; 209829; P19-1225 Topic: A10 - Hamstring repair/reinsertion (endoscopic)
Dr. Erwan Pansard
Dr. Erwan Pansard
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Abstract
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Objectives: According to the literature, on MRI the presence of gluteal injury in patients with gluteal, trochanteric or inguinal pain is 15%, including tears in 10%. Diagnosis of injury to the gluteus medius is delayed and occurs after a mean 45 months. To our knowledge there is no consensus on how to evaluate the position of these injuries. The main goal of this study was to propose a protocol to measure and analyze the positioning of suture anchors for the arthroscopic repair of partial and full thickness tears of the gluteus medius.

Methods: This cadaveric study was performed by the same junior orthopedic surgeon on anatomic and unembalmed cadavers. The suture anchors were positioned arthroscopically with the subject in the lateral decubitus position by 3-4 approaches : a portal under the medial lip of the linea aspera where the vastus medialis originates, a transversal subtrochanteric working portal to prepare the footprint and the placement of 2 anchors and an anterolateral and/or posterolateral portal to improve preparation of the footprint. Three postoperative measurements were obtained following each arthroscopic placement of suture anchors (1) the angle in relation to the diaphyseal axis on anteroposterior view (Â), (2) the relationship of the distances greater trochanter-suture anchor and greater trochanter-medial lip of the linea aspera on anteroposterior view (R1) and (3) the relationship of the distance suture anchor- posterior femoral cortex and the width of the greater trochanter on profil view (R2). Two evaluators performed the measurements separately. The main criteria was the correct position of the anchors (yes/no), Â=45+/-10° (better resistance to suture anchor failure), R1 between 1/3 and 1/2 (to prevent greater trochanter fractures and high tension on a first row) and R2 equal to 1/3 for the first suture anchor and 2/3 for the second. Secondary criteria were the occurrence of a trochanter fracture and suture anchor failures during cyclic loading. Intra and inter-observateur reproducibility was evaluated by the Kappa (k) coefficient.

Results: 17 hips (10 cadaveric subjects) were included, 34 anchors were placed. Intraobserver reproducibility was marked and significant. According to the evaluators, on anterioposterior view the angular position of the suture anchors was correct in 67.7% vs 64.7% of cases, k=0.54 (moderate), p=0.0008, the relationship distance between the greater trochanter-anchor/greater trochanter-linea aspera was correct in 55.9% vs 44.1%, k=0.53 (moderate), p=0.0007 and on profil in 73.5% vs 52.9%, k=0.33 (acceptable), p=0.01. A fracture of the tip of the trochanter was observed during preparation of the suture anchor pathway (1/34, 3%), no anchor pullout was observed.

Conclusions: This protocol to measure and analyze the position of suture anchors during the arthroscopic repair of the gluteus medius is reliable and reproducible.

Keywords:
gluteus medius, arthroscopic repair, suture anchor, anchor positioning
Objectives: According to the literature, on MRI the presence of gluteal injury in patients with gluteal, trochanteric or inguinal pain is 15%, including tears in 10%. Diagnosis of injury to the gluteus medius is delayed and occurs after a mean 45 months. To our knowledge there is no consensus on how to evaluate the position of these injuries. The main goal of this study was to propose a protocol to measure and analyze the positioning of suture anchors for the arthroscopic repair of partial and full thickness tears of the gluteus medius.

Methods: This cadaveric study was performed by the same junior orthopedic surgeon on anatomic and unembalmed cadavers. The suture anchors were positioned arthroscopically with the subject in the lateral decubitus position by 3-4 approaches : a portal under the medial lip of the linea aspera where the vastus medialis originates, a transversal subtrochanteric working portal to prepare the footprint and the placement of 2 anchors and an anterolateral and/or posterolateral portal to improve preparation of the footprint. Three postoperative measurements were obtained following each arthroscopic placement of suture anchors (1) the angle in relation to the diaphyseal axis on anteroposterior view (Â), (2) the relationship of the distances greater trochanter-suture anchor and greater trochanter-medial lip of the linea aspera on anteroposterior view (R1) and (3) the relationship of the distance suture anchor- posterior femoral cortex and the width of the greater trochanter on profil view (R2). Two evaluators performed the measurements separately. The main criteria was the correct position of the anchors (yes/no), Â=45+/-10° (better resistance to suture anchor failure), R1 between 1/3 and 1/2 (to prevent greater trochanter fractures and high tension on a first row) and R2 equal to 1/3 for the first suture anchor and 2/3 for the second. Secondary criteria were the occurrence of a trochanter fracture and suture anchor failures during cyclic loading. Intra and inter-observateur reproducibility was evaluated by the Kappa (k) coefficient.

Results: 17 hips (10 cadaveric subjects) were included, 34 anchors were placed. Intraobserver reproducibility was marked and significant. According to the evaluators, on anterioposterior view the angular position of the suture anchors was correct in 67.7% vs 64.7% of cases, k=0.54 (moderate), p=0.0008, the relationship distance between the greater trochanter-anchor/greater trochanter-linea aspera was correct in 55.9% vs 44.1%, k=0.53 (moderate), p=0.0007 and on profil in 73.5% vs 52.9%, k=0.33 (acceptable), p=0.01. A fracture of the tip of the trochanter was observed during preparation of the suture anchor pathway (1/34, 3%), no anchor pullout was observed.

Conclusions: This protocol to measure and analyze the position of suture anchors during the arthroscopic repair of the gluteus medius is reliable and reproducible.

Keywords:
gluteus medius, arthroscopic repair, suture anchor, anchor positioning
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