Surgical Treatment of Gluteus Medius Tears

The gluteus medius originates on the posterior face of the ilium between the posterior and anterior gluteal lines and inserts into the lateral and superoposterior facets of the greater trochanter. Because of the asymmetric nature of the muscle, tears are more likely to occur on the thinner anterolateral portion of the tendon footprint. Gluteus medius tears range from interstitial, partial thickness tears to retracted, full-thickness tears and may result from trauma, but they are more commonly the result of chronic degeneration. Patients commonly present with lateral hip pain aggravated by weight bearing and sleeping on the affected side, weakness in abduction, and the Trendelenburg sign observable on physical examination. Indications for surgery include failed conservative treatment and an ultrasound or magnetic resonance imaging study demonstrating a torn tendon. Surgical intervention aims to reapproximate and secure the torn tendon to the tendon footprint on the greater trochanter via suture anchors. Both open and endoscopic techniques have shown to be effective methods for treating gluteus medius tears at short- and long-term follow-up; however, endoscopic techniques have been shown to result in fewer postoperative complications, such as retear. A recent systematic review and meta-analysis found patients with more severe fatty infiltration (FI) may experience greater improvement after open repair, whereas patients with less severe FI may benefit more from endoscopic treatment. A double-row repair maximizes contact area between tendon and bone and has shown to be superior to single-row repair with an endoscopic technique.