Concise Review With Video Illustration| Volume 26, ISSUE 12, P1697-1705, December 2010

Partial-Thickness Tears of the Gluteus Medius: Rationale and Technique for Trans-Tendinous Endoscopic Repair

Published:October 18, 2010DOI:


      Tears in the gluteus medius and minimus tendons, often misdiagnosed as trochanteric bursitis, have recently emerged as an important cause of recalcitrant greater trochanter pain syndrome. Advances in endoscopic surgery of the hip have created opportunities to better evaluate and treat pathology in the peritrochanteric compartment. We reviewed the literature on trochanteric pain syndrome and gluteus medius tendon injuries. Existing techniques for endoscopic and open gluteus tendon repair and potential challenges in restoration of abductor function were analyzed. Partial-thickness undersurface tears of the gluteus medius were identified as a common pathologic entity. Although these tears are otherwise analogous to partial-thickness tears of the rotator cuff, the lack of arthroscopic access to the deep side of the gluteus medius tendon represents a unique technical challenge. To address the difficulty in visualizing and thus repairing undersurface tears of the gluteus medius, a novel endoscopic trans-tendinous repair technique was developed. The purposes of this article are to review the anatomy, pathology, and existing repair techniques of gluteus medius tendon tears and to describe the rationale and surgical steps for endoscopic trans-tendinous repair.
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        • Williams B.S.
        • Cohen S.P.
        Greater trochanteric pain syndrome: A review of anatomy, diagnosis and treatment.
        Anesth Analg. 2009; 108: 1662-1670
        • Silva F.
        • Adams T.
        • Feinstein J.
        • Arroyo R.A.
        Trochanteric bursitis: Refuting the myth of inflammation.
        J Clin Rheumatol. 2008; 14: 82-86
        • LaBan M.M.
        • Weir S.K.
        • Taylor R.S.
        ‘Bald trochanter’ spontaneous rupture of the conjoined tendons of the gluteus medius and minimus presenting as a trochanteric bursitis.
        Am J Phys Med Rehabil. 2004; 83: 806-809
        • Bird P.A.
        • Oakley S.P.
        • Shnier R.
        • Kirkham B.W.
        Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome.
        Arthritis Rheum. 2001; 44: 2138-2145
        • Bewyer D.
        • Chen J.
        Gluteus medius tendon rupture as a source for back, buttock and leg pain: Case report.
        Iowa Orthop J. 2005; 25: 187-189
        • Ozcakar L.
        • Erol O.
        • Kaymak B.
        • Aydemir N.
        An underdiagnosed hip pathology: Apropos of two cases with gluteus medius tendon tears.
        Clin Rheumatol. 2004; 23: 464-466
        • Kong A.
        • Van der Vliet A.
        • Zadow S.
        MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome.
        Eur Radiol. 2007; 17: 1772-1783
        • Kingzett-Taylor A.
        • Tirman P.F.
        • Feller J.
        • et al.
        Tendinosis and tears of gluteus medius and minimus muscles as a cause of hip pain: MR imaging findings.
        AJR Am J Roentgenol. 1999; 173: 1123-1126
        • Connell D.A.
        • Bass C.
        • Sykes C.A.
        • Young D.
        • Edwards E.
        Sonographic evaluation of gluteus medius and minimus tendinopathy.
        Eur Radiol. 2003; 13: 1339-1347
        • Chung C.B.
        • Robertson J.E.
        • Cho G.J.
        • Vaughan L.M.
        • Copp S.N.
        • Resnick D.
        Gluteus medius tendon tears and avulsive injuries in elderly women: Imaging findings in six patients.
        AJR Am J Roentgenol. 1999; 173: 351-353
        • Dwek J.
        • Pfirrmann C.
        • Stanley A.
        • Pathria M.
        • Chung C.B.
        MR imaging of the hip abductors: Normal anatomy and commonly encountered pathology at the greater trochanter.
        Magn Reson Imaging Clin N Am. 2005; 13 (vii): 691-704
        • Pfirrmann C.W.
        • Chung C.B.
        • Theumann N.H.
        • Trudell D.J.
        • Resnick D.
        Greater trochanter of the hip: Attachment of the abductor mechanism and a complex of three bursae—MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers.
        Radiology. 2001; 221: 469-477
        • Robertson W.J.
        • Gardner M.J.
        • Barker J.U.
        • Boraiah S.
        • Lorich D.G.
        • Kelly B.T.
        Anatomy and dimensions of the gluteus medius tendon insertion.
        Arthroscopy. 2008; 24: 130-136
        • Gottschalk F.
        • Kourosh S.
        • Leveau B.
        The functional anatomy of tensor fasciae latae and gluteus medius and minimus.
        J Anat. 1989; 166: 179-189
        • Lequesne M.
        • Mathieu P.
        • Vuillemin-Bodaghi V.
        • Bard H.
        • Djian P.
        Gluteal tendinopathy in refractory greater trochanter pain syndrome: Diagnostic value of two clinical tests.
        Arthritis Rheum. 2008; 59: 241-246
        • Naito M.
        • Ogata K.
        • Emoto G.
        The blood supply to the greater trochanter.
        Clin Orthop Relat Res. 1996; : 294-297
        • Najima H.
        • Gagey O.
        • Cottias P.
        • Huten D.
        Blood supply of the greater trochanter after trochanterotomy.
        Clin Orthop Relat Res. 1998; : 235-241
        • Bunker T.D.
        • Esler C.N.
        • Leach W.J.
        Rotator-cuff tear of the hip.
        J Bone Joint Surg Br. 1997; 79: 618-620
        • Kagan II, A.
        Rotator cuff tears of the hip.
        Clin Orthop Relat Res. 1999; : 135-140
        • Lonner J.H.
        • Van Kleunen J.P.
        Spontaneous rupture of the gluteus medius and minimus tendons.
        Am J Orthop (Belle Mead NJ). 2002; 31: 579-581
        • Gabrion A.
        • Vernois J.
        • Havet E.
        • Mertl P.
        • de Lestang M.
        Gluteus medius tendon tear and degenerative hip disease.
        Rev Chir Orthop Reparatrice Appar Mot. 2003; 89 (in French): 640-642
        • Schuh A.
        • Zeiler G.
        Rupture of the gluteus medius tendon.
        Zentralbl Chir. 2003; 128 (discussion 143 (in German)): 139-142
        • Chebil M.
        • Ben Maitigue M.
        • Haddad N.
        • et al.
        Arthroscopy of the shoulder.
        Tunis Med. 2007; 85 (in French): 519-523
        • Karpinski M.R.
        • Piggott H.
        Greater trochanteric pain syndrome.
        J Bone Joint Surg Br. 1985; 67: 762-763
        • Weber S.C.
        Arthroscopic debridement and acromioplasty versus mini-open repair in the management of significant partial-thickness tears of the rotator cuff.
        Orthop Clin North Am. 1997; 28: 79-82
        • Budoff J.E.
        • Nirschl R.P.
        • Guidi E.J.
        Debridement of partial-thickness tears of the rotator cuff without acromioplasty.
        J Bone Joint Surg Am. 1998; 80: 733-748
        • Rudzki J.R.
        • Shaffer B.
        New approaches to diagnosis and arthroscopic management of partial-thickness cuff tears.
        Clin Sports Med. 2008; 27: 691-717
        • Ellman H.
        Diagnosis and treatment of incomplete rotator cuff tears.
        Clin Orthop Relat Res. 1990; : 64-74
        • Weber S.C.
        Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears.
        Arthroscopy. 1999; 15: 126-131
        • Waibl B.
        • Buess E.
        Partial-thickness articular surface supraspinatus tears: A new transtendon suture technique.
        Arthroscopy. 2005; 21 (376-281)
        • Lo I.K.
        • Burkhart S.S.
        Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff.
        Arthroscopy. 2004; 20: 214-220
        • Spencer Jr, E.E.
        Partial-thickness articular surface rotator cuff tears: An all-inside repair technique.
        Clin Orthop Relat Res. 2010; 468: 1514-1520
        • Calfee R.P.
        • Patel A.
        • DaSilva M.F.
        • Akelman E.
        Management of lateral epicondylitis: Current concepts.
        J Am Acad Orthop Surg. 2008; 16: 19-29
        • Thornton S.J.
        • Rogers J.R.
        • Prickett W.D.
        • Dunn W.R.
        • Allen A.A.
        • Hannafin J.A.
        Treatment of recalcitrant lateral epicondylitis with suture anchor repair.
        Am J Sports Med. 2005; 33: 1558-1564
        • Chirputkar K.
        • Weir P.
        • Gray A.
        Z-lengthening of the iliotibial band to treat recalcitrant cases of trochanteric bursitis.
        Hip Int. 2007; 17: 31-35
        • Provencher M.T.
        • Hofmeister E.P.
        • Muldoon M.P.
        The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band.
        Am J Sports Med. 2004; 32: 470-476
        • Govaert L.H.
        • van der Vis H.M.
        • Marti R.K.
        • Albers G.H.
        Trochanteric reduction osteotomy as a treatment for refractory trochanteric bursitis.
        J Bone Joint Surg Br. 2003; 85: 199-203
        • Davies H.
        • Zhaeentan S.
        • Tavakkolizadeh A.
        • Janes G.
        Surgical repair of chronic tears of the hip abductor mechanism.
        Hip Int. 2009; 19: 372-376
        • Baker Jr, C.L.
        • Massie R.V.
        • Hurt W.G.
        • Savory C.G.
        Arthroscopic bursectomy for recalcitrant trochanteric bursitis.
        Arthroscopy. 2007; 23 (8278-32)
        • Ilizaliturri Jr, V.M.
        • Martinez-Escalante F.A.
        • Chaidez P.A.
        • Camacho-Galindo J.
        Endoscopic iliotibial band release for external snapping hip syndrome.
        Arthroscopy. 2006; 22: 505-510
        • Farr D.
        • Selesnick H.
        • Janecki C.
        • Cordas D.
        Arthroscopic bursectomy with concomitant iliotibial band release for the treatment of recalcitrant trochanteric bursitis.
        Arthroscopy. 2007; 23: 905.e1-905.e5
        • Kandemir U.
        • Bharam S.
        • Philippon M.J.
        • Fu F.H.
        Endoscopic treatment of calcific tendinitis of gluteus medius and minimus.
        Arthroscopy. 2003; 19: E4
        • Voos J.E.
        • Rudzki J.R.
        • Shindle M.K.
        • Martin H.
        • Kelly B.T.
        Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip.
        Arthroscopy. 2007; 23: 1246.e1-1246.e5
        • Bard H.
        Tendinopathy of the gluteus medius tendon.
        Rev Prat. 2009; 59 (in French): 463-468
        • Cormier G.
        • Berthelot J.M.
        • Maugars Y.
        Gluteus tendon rupture is underrecognized by French orthopedic surgeons: Results of a mail survey.
        Joint Bone Spine. 2006; 73: 411-413
        • Lequesne M.
        • Djian P.
        • Vuillemin V.
        • Mathieu P.
        Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair.
        Joint Bone Spine. 2008; 75: 458-464
        • Blankenbaker D.G.
        • Ullrick S.R.
        • Davis K.W.
        • De Smet A.A.
        • Haaland B.
        • Fine J.P.
        Correlation of MRI findings with clinical findings of trochanteric pain syndrome.
        Skeletal Radiol. 2008; 37: 903-909