2018 AWARD WINNER

Introduction: Tears in the gluteus medius and minimus tendons are a common cause of greater trochanteric pain syndrome. Related causes of greater trochanteric pain syndrome include excessive iliotibial band tension, limb-length discrepancy, structural abnormalities in the lumbar spine or hip that result in chronic stress in the trochanteric insertion of the gluteus medius and minimus tendons, sports activities that overload the gluteus medius and minimus muscles, direct or abduction trauma, microcrystal deposits, and reduced vasculature of the gluteus medius tendon in older patients with decreased healing potential. Endoscopic surgical repair is effective for the treatment of patients with a gluteus tendons tear.

Purpose: This video shows the gross anatomy of the peritrochanteric space, the gluteus medius and minimus muscles, the bony attachment sites of the gluteus medius and minimus muscles on the greater trochanter, and endoscopic gluteal tendon repair. In addition, the video discusses the clinical presentation of patients with a gluteal tendon tear and reviews the outcomes of endoscopic tendon repair.

Methods: The video shows the gross anatomy of the peritrochanteric space and the gluteal tendons as well as gluteus medius repair in a cadaver model and in patients with a gluteus medius tear. Twenty-eight patients with a gluteus medius tendon tear who underwent endoscopic surgical repair are retrospectively reviewed. Outcomes were assessed at a mean follow-up of 16 months (range, 12 to 32 months) using the modified Harris hip score, patient satisfaction scores, the visual analog scale for pain, and abduction strength. Physical examination revealed trochanteric pain, abduction strength weakness, limp, and a positive Trendelenburg test. Diagnosis was confirmed using MRI.

Results: Twenty-eight women were included in the study. The mean age of the patients was 63.4 years (range, 50 to 67 years; standard deviation [SD] ± 4.24). A gluteus medius tendon tear was confirmed in all the patients using MRI. The mean modified Harris hip score increased from 45 preoperatively (range, 24 to 62; SD ± 4.94) to 85 at final follow-up (range, 75 to 95; SD ± 10.6). The mean visual analog pain score decreased from 7.67 preoperatively (range, 5 to 10; SD ± 0.7) to 2 at final follow-up (range, 0 to 5; SD ± 1.41). The mean patient satisfaction score was 8.5 at final follow-up (range, 5 to 10; SD ± 1.41). The procedure was considered a failure in one patient, who had persistent pain and a visual analog pain score of 5 at final follow-up.

Conclusion: Endoscopic gluteus medius repair is effective for the treatment of patients with a gluteus medius tear.