What is the treatment for a gluteus minimus tear?

Treatment of Gluteus Minimus Tear

For acute full-thickness gluteus minimus tears, surgical repair is the preferred treatment and should be performed within 3 weeks of injury to achieve superior outcomes, while conservative management may be attempted only in select cases with minimal functional deficit. 1

Diagnostic Workup

• Obtain standard hip radiographs first to exclude bony pathology, fractures, or structural abnormalities 1
• 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 1
• MRI assesses tear size, retraction, and fatty degeneration—critical factors that determine surgical candidacy 1
• Avoid ultrasound as the primary diagnostic tool, as it has inferior sensitivity (79%) and frequently misses gluteus minimus tears 2

Treatment Algorithm Based on Tear Characteristics

Acute Full-Thickness Tears (< 3 months from injury)

Surgical repair is the preferred option and should be performed within 3 weeks of injury, as this timing produces superior outcomes compared to delayed repair. 1

• Early surgical repair (within 3 weeks to 3 months) prevents worse outcomes due to tendon retraction and fatty degeneration 1
• Both endoscopic and open techniques have shown good clinical results, with more severe tears requiring more rigid and complex fixation 3, 4
• Surgery is indicated when four conditions are met: (1) failure of conservative treatment >6 months, (2) MRI showing tendon tear, (3) positive ultrasound-guided infiltration test, and (4) absence of evolved fatty degeneration or atrophy 4
• Surgical outcomes show steady complete remission of pain in 87.5% of patients (7 of 8) with mean follow-up of 22.4 months 5

Conservative Management (Only for Select Cases)

Conservative treatment may be attempted initially for less than 6 months in patients meeting ALL of the following criteria: minimal functional deficit, no Trendelenburg gait, and patient preference for non-operative care. 1

Conservative management includes:

• Activity modification to reduce repetitive loading of the damaged tendon 1, 6
• Physical therapy with eccentric strengthening of hip abductors—supervised exercise programs focusing on eccentric strengthening are more effective than passive interventions 6, 3
• Land-based physical therapy is preferred over aquatic therapy 6
• NSAIDs for pain management 1, 6
• Cryotherapy (ice application for 10-minute periods through a wet towel) for acute pain relief 6
• A single ultrasound-guided corticosteroid injection into the peritrochanteric space (NOT directly into the tendon) 1

Critical Pitfalls to Avoid

• Never inject corticosteroids directly into the tendon substance, as this has deleterious effects on tendon integrity 1, 6
• Avoid repeated corticosteroid injections—limit to a single injection 1
• Do not delay surgery beyond 3 months for full-thickness tears, as tendon retraction and fatty degeneration compromise surgical outcomes 1, 4
• Differentiation between trochanteric bursitis and gluteus minimus tendinosis can be difficult, as these conditions frequently coexist 2, 6
• MRI may miss associated gluteus minimus tears in up to 60% of cases (3 of 5 tears missed in one surgical series), so clinical suspicion should remain high 5

Postoperative Rehabilitation

• Exercise intervention improves symptoms after 4 months to 1 year of therapy, requiring close supervision of the rehabilitation protocol 3
• Postoperative protocols are similar to conservative management, protecting hip abductor tendons from excessive tensile and compression stresses while applying progressive load 3
• Systematic resection of bony structures implicated in impingement and complete bursectomy should accompany endoscopic repair 4

When Conservative Management Fails

If symptoms persist after 3-6 months of comprehensive conservative treatment, surgical repair becomes indicated. 6, 4

• Extracorporeal shock wave therapy is a safe, noninvasive option before proceeding to surgery 6
• Surgical management has been performed both open and endoscopically with good reported clinical results 3
• The clearest indication for surgical management is failure of conservative management combined with loss of abductor muscle power 3