2019 HONORABLE MENTION

Gluteus medius and minimus tendinopathy that results in lateral hip pain and abductor weakness is more common than once thought, generally affecting adults in their fifties and sixties. As primary abductor insufficiency of the native hip joint has gained clinical recognition, tears of the gluteus medius and minimus tendons have been compared with rotator cuff tears in the shoulder. Similar to rotator cuff tears, open or endoscopic primary abductor repair has proven successful but requires durable, healthy musculotendinous tissue. Gluteus maximus tendon transfer has emerged as a viable treatment option that restores abductor function in patients with a chronic retracted tear or severe gluteus medius and minimus fatty atrophy.

This video demonstrates gluteus maximus tendon transfer for the management of primary abductor insufficiency caused by irreparable gluteus minimus and medius tendinopathy and fatty atrophy. This video provides an overview of the pathogenesis, diagnosis, and management of primary abductor insufficiency. The video discusses the case presentation of a 65-year-old man with lateral hip pain and a Trendelenburg gait in whom nonsurgical management failed. Radiographs revealed evidence of gluteus medius tendon stripping as well as gluteus medius and minimus atrophy and fatty infiltration. An isolated gluteus maximus tendon transfer was performed. The patient was admitted to the hospital postoperatively and was discharged from the hospital 1 day postoperatively. The patient was instructed to wear a hip abduction brace and remain partial weight-bearing with the use of a walker. The patient was advanced through an individualized rehabilitation protocol. Formal physical therapy was initiated at 6 weeks postoperatively, with gradual progression of abductor strengthening. At 8 months postoperatively, the patient reported almost complete resolution of hip pain and objective improvements in abductor strength. The patient continued to ambulate with a limp; however, an improved Trendelenburg sign was reported. The patient’s rehabilitation is ongoing, and continued improvements are expected for 12 to 24 months postoperatively.

Gluteus maximus tendon transfer is a novel yet reliable treatment option for the management of primary abductor insufficiency caused by irreparable gluteal tendinopathy and chronic retracted tears. Although the literature is limited, case series suggest good to excellent results and patient-reported outcomes; however, outcomes are contingent on careful and consistent technique in appropriately indicated patients.