[Gluteal insufficiency: Pathogenesis, Diagnosis and Therapy].

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Imaging
• Sports Medicine

Background:

• Gluteal insufficiency, often linked to gluteus medius (GMed) tears, is a significant cause of chronic hip pain and trochanteric pain syndrome (GTPS).
• These tears are frequently misdiagnosed as bursitis, leading to persistent peritrochanteric pain and functional deficits.
• Clinical presentation includes lateral hip pain, weakened hip abduction, and positive Trendelenburg sign.

Purpose of the Study:

• To highlight the role of gluteus medius tears in gluteal insufficiency and chronic hip pain.
• To outline diagnostic imaging modalities and treatment strategies for GMed tears.
• To evaluate the efficacy of surgical reconstruction for gluteal tendon tears.

Main Methods:

• Diagnosis confirmed with MRI, often preceded by radiography and ultrasound.
• Conservative treatment focuses on hip joint centering and abductor muscle strengthening.
• Surgical options include endoscopic repair with suture anchors for partial tears and minimally invasive open reduction for larger tears or failed conservative treatment.

Main Results:

• MRI can reveal compensatory hypertrophy of the tensor fascia latae (TFL) and fatty involution of the GMed.
• Surgical techniques like double-row suture anchors ensure anatomical tendon footprint reconstruction.
• Postoperative rehabilitation is lengthy due to high forces in the peritrochanteric region.

Conclusions:

• Surgical reconstruction of gluteal tendon tears is often necessary for chronic hip pain stemming from gluteal insufficiency.
• Available data indicate successful pain reduction and restoration of abduction strength in mid-term follow-up after reconstruction.