What is the treatment for an acute full thickness tear of the gluteus minimus?

Treatment of Acute Full-Thickness Gluteus Minimus Tear

For an acute full-thickness gluteus minimus tear, early surgical repair (within 3 weeks to 3 months) should be strongly considered, as delayed repair leads to worse outcomes due to tendon retraction and fatty degeneration. 1, 2

Initial Diagnostic Workup

• Obtain standard hip radiographs first to exclude bony pathology, fractures, or other structural abnormalities 3, 4
• Proceed with non-contrast MRI of the hip as the definitive imaging study, which has 33-100% sensitivity and 92-100% specificity for detecting gluteus minimus tears and can assess tear size, retraction, and fatty degeneration 3
• Ultrasound has inferior sensitivity (79%) and should not be used as the primary diagnostic tool for surgical planning 3

Treatment Algorithm

Acute Tears (< 3 months from injury)

Surgical repair is the preferred option for acute full-thickness tears, particularly when performed within 3 weeks of injury, as this timing produces superior outcomes compared to delayed repair 1. The evidence from rotator cuff literature (analogous pathology) demonstrates that patients repaired within 3 weeks had better results than those repaired after 3 weeks 1.

Key surgical considerations:

• Endoscopic double-row repair technique is the modern standard, offering lower complication rates than open approaches while achieving significant pain reduction and functional improvement 2, 5
• The goal is tendon-to-bone healing using suture anchors to recreate the normal footprint 5, 6
• A 5-stage classification guides technique selection based on intraoperative findings and MRI: from isolated bursectomy to single/double-row repair 2

Critical Timing Considerations

Do not delay surgical intervention if the following are present:

• Full-thickness tear visible on MRI 2
• Acute traumatic onset with functional deficit 1
• Development of Trendelenburg gait (abductor weakness) 2

Waiting for tendon retraction and fatty degeneration significantly worsens prognosis for both functional results and tendon healing 2. These degenerative changes are factors of poor prognosis that should be avoided 2.

Conservative Management (Only for Select Cases)

Conservative treatment may be attempted initially for less than 6 months in patients with:

• Minimal functional deficit
• No Trendelenburg gait
• Patient preference for non-operative care

Conservative protocol includes:

• Activity modification to reduce repetitive loading 4, 7
• Physical therapy with eccentric strengthening of hip abductors (supervised programs preferred over passive interventions) 4, 7
• NSAIDs for pain management 4
• Cryotherapy (ice for 10-minute periods through wet towel) 4
• Single ultrasound-guided corticosteroid injection into peritrochanteric space (NOT intratendinous) may provide short-term relief 4, 7

Important Caveats

Avoid these common pitfalls:

• Do not perform repeated corticosteroid injections, as they have deleterious effects on tendon substance 8, 4
• Do not inject corticosteroids directly into the tendon; peritendinous injections only 4
• Do not wait beyond 6 months of failed conservative treatment before considering surgery, as this allows progression to irreparable tear with fatty infiltration 2, 7
• Do not confuse with isolated trochanteric bursitis, which frequently coexists but requires different management 4

Surgical Indications (Strong)

Proceed to endoscopic repair when:

• Acute full-thickness tear with functional deficit 2, 7
• Failure of 6 months conservative management 2, 7
• Progressive abductor weakness or Trendelenburg gait 2
• MRI-confirmed full-thickness tear with pain 2

The evidence strongly favors early repair over delayed intervention to prevent the poor prognostic factors of retraction and fatty degeneration that make late repairs less successful 2.