I'm Bobby Browning, I'm a fifth-year resident at Rush. I'm presenting our findings on defining minimal clinically important difference in patient acceptable symptom state after endoscopic gluteus medius repair at minimum five-year follow-up. The list are our disclosures. So endoscopic repair of gluteus medius tears results in improved patient-reported outcomes, pain scores, and hip abduction strength at short-term follow-up. Endoscopic repair is also shown to have similar outcomes to that of open repair at short-term follow-up, with several systematic reviews showing fewer complications, such as re-tear in the endoscopic group. Due to the significant variability in patient-reported outcome measures in hip preservation surgery, there's been a shift towards defining clinically significant outcomes in this patient population. Our group defined MCID and PASS after isolated endoscopic gluteus medius repair at two-year follow-up for HOS ADL, HOS SS, and modified Harris hip score, with excellent achievement of both MCID and PASS. Despite this, a few studies have assessed five-year outcomes in this patient population. Peretz et al. reviewed 14 patients who underwent endoscopic gluteus medius repair and demonstrated excellent results with significant improvement in patient-reported outcomes at five years following endoscopic repair, with no increase in complications from two to five years postoperatively. Meg Parr et al. then reviewed 43 patients who underwent endoscopic gluteus medius repair and showed significant improvement in all patient-reported outcomes at five years. They also defined MCID for modified Harris hip score in NASS and HOS SS. They also defined PASS for modified Harris hip score, HOS SS, and IHOP-12. They demonstrated high rates of achievement of both MCID and PASS. Despite this, no studies to date have defined MCID for commonly used hip outcome scores such as HOS ADL, IHOP-12, and VAS for pain. The purpose of our study was to define MCID and PASS at a minimum five years postoperatively for patients undergoing endoscopic hip abductor repair. This is a retrospective case series of consecutive patients who underwent primary endoscopic hip abductor repair by the senior author between 2012 and 2015. The outcome scores including HOS ADL, HOS SS, modified Harris hip score, IHOP-12, and VAS for pain were obtained preoperatively and at five years postoperatively. Significantly, we did have a compliance rate of nearly 90% for five-year PROs. We defined MCID utilizing the distribution method with one-half standard deviation for the threshold value. We defined PASS using the anchor-based method, utilizing ROC curves and Yowden's index for threshold values. Survivorship is displayed here with a Kaplan-Meier survivorship curve, and failure was defined as revision surgery or re-tear seen on MRI. Ultimately, 46 patients were included in this study, which is the largest to date. Average age, 59 years, nearly 90% female, and BMI of 28 with the other demographics listed below. The majority of our patients underwent gluteus medius repair alone, and nearly 90% were partial thickness tears. There's a significant improvement in all patient report outcomes in our study, and the majority of our patients achieved a positive clinically significant outcome. On the bottom left, we have the threshold values for the achievement of MCID and PASS. Significantly, we were unable to provide a threshold value for the achievement of PASS for VAS for pain due to an area under the curve less than 0.7. 92% of patients achieved any MCID, while 74% achieved any PASS. We had excellent survivorship rate at five years. There was one revision surgery. It was a traumatic partial re-tear with significant fat infiltration. The patient underwent a glute max transfer with excellent results. And then two patients had a re-tear that were seen on MRI. They were treated non-operatively and doing well at this point. We defined threshold values for the achievement of MCID at five years for HOS ADL, HOS SS, modified Harris HIP score, IHOP 12, and VAS for pain. We also defined the thresholds for the achievement of PASS for these PROs, but there was no PASS threshold recommended for VAS for pain due to the area under the curve less than 0.7. We had 92% of patients reach the threshold to achieve any MCID, and 74% reached the threshold to achieve any PASS. In conclusion, patients sustained a clinically significant outcome with excellent survivorship from two to five years post-operatively. Thank you.

minimal clinically important difference

patient acceptable symptom state

endoscopic gluteus medius repair

patient-reported outcomes

hip abduction strength