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Endoscopic Repair of Partial Thickness Undersurface Tears of the Abductor Tendon (PUSTA): Clinical Outcomes with Minimum Two-Year Follow-Up

      Introduction

      The undersurface of the abductor tendon is a common location for tears. Endoscopic trans-tendinous repair has been previously described as a technique to both identify and treat these tears. There are currently no two-year outcome studies of this technique. The purpose of this study was to report the minimum two-year outcomes of trans-tendinous repairs of Partial thickness UnderSurface Tears of the Abductor (PUSTA) tendon using patient reported outcomes (PROs), visual analog scale (VAS), and patient satisfaction scores.

      Methods

      All patients who underwent endoscopic trans-tendinous gluteus medius repair between October 2009 and May 20, 201713 at one institution were prospectively evaluated. Exclusion criteria consisted of less than two-year follow-up, previous hip surgery, inflammatory arthritis, open surgery, full thickness abductor tear, and worker's compensation patients. All patients had a documented pre-operative physical exam with strength testing (0-5) and observation of their gait. Patient satisfaction and PRO scores were recorded preoperatively, at 3 months postoperatively, and annually thereafter. The PRO scores collected were mHHS, HOS-ADL, HOS-SSS, NAHS, and VAS. Preoperative strength and gait were compared to latest follow-up.

      Results

      There were 25 patients that fit our criteria. Significant improvement in PRO scores were demonstrated for mHHS, HOS-ADL, HOS-SSS, NAHS, and VAS from 54.9-76.2, 50.2-80.6, 30.1-67.3, 51.9-82.4, and 7.1-2.7 respectively (p<0.001). There were 11 patients with appreciable weakness prior to surgery; seven of these patients moved up at least one strength grade by final follow-up. There were 14 patients who had a Trendelenburg gait pre-operatively, 12 of them had a normal gait at latest follow-up (p-<0.001). Average patient satisfaction was 7.5. There were no revision surgeries, and no complications noted.

      Conclusion

      PUSTA lesions can be treated successfully with endoscopic trans-tendinous repair preserving the intact attachment of superficial fibers of the gluteus medius. We recommend this treatment for partial undersurface tears recalcitrant to non-operative treatment.