Treatment of Gluteus Medius Tear
For acute full-thickness gluteus medius tears, surgical repair should be performed within 3 weeks to 3 months of injury to optimize outcomes and prevent tendon retraction and fatty degeneration. 1
Diagnostic Confirmation
Initial imaging should begin with standard hip radiographs to exclude bony pathology, followed by non-contrast MRI of the hip as the definitive diagnostic study. 2, 1
- MRI without contrast is the mainstay for evaluating gluteus medius tendinopathy, with sensitivity ranging from 33-100% and specificity of 92-100% for detecting tears 2, 1
- MRI can assess critical prognostic factors including tear size, degree of retraction, and fatty degeneration 1
- Ultrasound has inferior sensitivity (79%) and insufficient evidence supports its use for acute gluteus tendon tears 2
Treatment Algorithm Based on Tear Characteristics
Acute Full-Thickness Tears (< 3 months from injury)
Surgical repair is the preferred treatment option, with optimal timing within 3 weeks of injury producing superior outcomes compared to delayed repair. 1
- Early surgical intervention (within 3 weeks to 3 months) prevents worse outcomes from tendon retraction and fatty degeneration 1
- Endoscopic repair with correction of intra-articular pathology is effective, showing significant improvement in functional scores and pain with lower complication rates than open techniques 3, 4
- Double-row repair maximizes tendon-to-bone contact area and is superior to single-row repair when using endoscopic technique 5
- Both suture bridge technique (after completion of partial tears) and transtendinous technique show equivalent patient-reported outcomes at 2-year follow-up 4
Partial-Thickness Tears
Surgical repair using endoscopic trans-tendinous technique is indicated after failure of 6 months of conservative management, particularly if Trendelenburg gait develops. 3, 6
- Partial-thickness undersurface tears are analogous to rotator cuff tears and require specialized trans-tendinous repair techniques to access the deep tendon surface 6
- Endoscopic repair of partial tears shows significant improvement in modified Harris hip scores, with mean VAS pain scores decreasing from 6.6 preoperatively to 2.4 at 2 years 4
Conservative Management (Limited Role)
Conservative treatment may be attempted for less than 6 months only in highly select cases: patients with minimal functional deficit, no Trendelenburg gait, and strong preference for non-operative care. 1, 3
Conservative management includes:
- Activity modification to reduce repetitive loading of the damaged tendon 1, 7
- Physical therapy with eccentric strengthening of hip abductor muscles 1, 7
- NSAIDs for pain management and anti-inflammatory effects 1
- Cryotherapy (ice application for 10-minute periods through wet towel) for acute pain relief 1
- A single ultrasound-guided corticosteroid injection into the peritrochanteric space (NOT directly into tendon substance) 1
Critical Pitfalls to Avoid
Do not delay surgical repair beyond 6 months or wait for Trendelenburg gait to develop, as tendon retraction and fatty degeneration are poor prognostic factors for functional outcomes and tendon healing. 3, 5
- Avoid repeated corticosteroid injections, which have deleterious effects on tendon substance 1
- Never inject corticosteroids directly into the tendon—only into the peritendinous space 1
- Patients with more severe fatty infiltration may experience greater improvement with open repair, while those with less severe fatty infiltration benefit more from endoscopic treatment 5
- Approximately 58% of patients with preoperative gait deviation regain completely normal gait after endoscopic repair 4
Postoperative Rehabilitation
Postoperative protocols must protect hip abductor tendons from excessive tensile and compression stresses while applying progressive load in conjunction with physical therapy. 7