. 2019 Sep 26;8(10):e1255–e1261. doi: 10.1016/j.eats.2019.06.016

Table 2.

Pearls and Pitfalls of Superior Gluteal Reconstruction

Pearls	Pitfalls
Identifying both tear timing (acute vs. chronic) and morphology (i.e. partial vs. complete) is important. A trial of conservative treatment is warranted for partial tears prior to surgery. Chronic cases with extensive retraction and scarring will likely require a superior gluteal reconstruction via an open approach. Identify the greater trochanter and make an incision over it approximately 6-8 cm in length. A burr should be used to remove cortical bone and create a healthy surface to facilitate healing. A double row fixation should be used when bridging the graft over the tendon and tendon footprint in order to suture failure, with the hip placed in 20 degrees of abduction, neutral to slightly internal rotation using a Mayo stand. Weight bearing is kept to 20-lb flat-foot for the first 8 weeks after surgery, with prevention of active abduction or passive adduction. Weight bearing as tolerated is allowed by 9 weeks and full weight bearing without assistive devises by week 12.	Familiarity with the anatomic insertion of the gluteus medius and minimus is crucial to avoid important neurovascular structures. While not viewable from this position, it is important to be aware of the sciatic nerve medially to prevent devastating neurological injury.

Pearls

Pitfalls

Identifying both tear timing (acute vs. chronic) and morphology (i.e. partial vs. complete) is important. A trial of conservative treatment is warranted for partial tears prior to surgery. Chronic cases with extensive retraction and scarring will likely require a superior gluteal reconstruction via an open approach.
Identify the greater trochanter and make an incision over it approximately 6-8 cm in length.
A burr should be used to remove cortical bone and create a healthy surface to facilitate healing.
A double row fixation should be used when bridging the graft over the tendon and tendon footprint in order to suture failure, with the hip placed in 20 degrees of abduction, neutral to slightly internal rotation using a Mayo stand.
Weight bearing is kept to 20-lb flat-foot for the first 8 weeks after surgery, with prevention of active abduction or passive adduction. Weight bearing as tolerated is allowed by 9 weeks and full weight bearing without assistive devises by week 12.

Familiarity with the anatomic insertion of the gluteus medius and minimus is crucial to avoid important neurovascular structures.
While not viewable from this position, it is important to be aware of the sciatic nerve medially to prevent devastating neurological injury.