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Gluteal tendon tear and repair

67 citationsUpdated Oct 2026
Illustration: hip

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Surgical repair of torn gluteal tendons is a viable option for patients with severe symptoms when MRI and clinical findings are consistent with tendon disruption and weakness [8]. Management of hip abductor tendon injuries remains difficult and controversial, with contemporary nonoperative modalities showing variable results [12]. In reviewed cases, surgical repair has been effective at relieving symptoms in 95% of patients [1]. Both endoscopic and open gluteal tendon repairs result in improvements in outcomes and functional improvement [3]. Primary repair of gluteus medius and/or minimus tears results in clinical success in most patients irrespective of MRI grade and surgical approach [11], although GF grade 1 tears show a significantly higher clinical success rate than GF grade 4 tears [11].

Endoscopic repair is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up [13]. It results in improved mHHS and NAHS at 2 years of follow-up compared with baseline [15] and is effective for gluteus medius tears at a minimum follow-up of 2 years, whether performed through a transtendinous or full-thickness technique [10]. Endoscopic repair is critical for restoring functional outcomes, maximizing tendon compression over the lateral facet, and lowering tendon retear rates in comparison with open surgical approaches [16]. Both open and endoscopic techniques are viable surgical approaches that produce good to excellent functional results and reduce pain [18], though endoscopic repair appears to result in fewer postoperative complications including tendon retear [18, 61].

Patients who underwent open repairs for full-thickness GM tears via contemporary tendon repair techniques, with or without concomitant hip arthroscopy, achieved favorable results in several PRO scores at minimum 2-year follow-up [5]. In a study of 15 hips with full-thickness gluteal tendon tears managed endoscopically, excellent outcomes that exceeded the MCID thresholds were found in the majority of patients at an average of 31.2 months follow-up [22]. Endoscopic management offers the potential advantages of less tissue violation, ambulatory day surgery, and fewer complications compared with open repair [22]. Partial-thickness undersurface tears can be treated successfully with endoscopic transtendinous repair preserving the intact attachment of the superficial fibers [21]. With proper indications, partial gluteus medius tears can be evaluated and treated through the direct anterior approach in a reproducible manner by applying previously described arthroscopic techniques in an open setting [20]. Superior gluteal reconstruction for massive, irreparable abductor tendon tears with severe tendon loss and atrophy demonstrates promising 1-year postoperative outcomes in both primary and revision patients [9]. Gluteus maximus tendon transfer for abductor insufficiency has demonstrated reliable outcomes at 3 years, with improvement in hip function and pain [6]. The technique of transosseous fixation and a nonresorbable collagen patch appears promising for patients with extensive gluteal tears where torn ends can be mobilized and fatty degeneration is less than 75% [17]. Patients who underwent endoscopic management of GTPS commonly underwent repair of gluteal tendon tears, and in many cases had concomitant labral tears and chondral lesions identified intraoperatively [7]. Autologous tenocyte injection for gluteal tendinopathy is safe, with improved and sustained clinical outcomes to 24 months [4]. Endoscopic surgical repair of abductor tendon tears generally shows good or excellent results, though patient-reported outcome measures may not fully capture objective improvements in gait and strength [37].

Anatomy & Pathophysiology

Bony Anatomy

The hemipelvis comprises the ilium, ischium, and pubis, which unite at the triradiate cartilage within the concave acetabulum [72]. The acetabulum consists of an articular crescent-moon–shaped lunate surface and a nonarticular central fossa that serves as the attachment point for the ligamentum teres [72]. Inferiorly, the acetabulum is incomplete, forming a notch through which vital blood vessels and nerves pass to supply the joint [72]. The femoral head forms two-thirds of a sphere, featuring a small central depression from which the ligamentum teres extends to connect to the acetabular notch [72]. The neck-shaft angle of the femur averages 125° [72], while normal version, defined as the head-neck angle in the frontal plane, averages 15 to 20° [72].

The acetabulum is normally anteverted 15 degrees and obliquely oriented in the coronal plane 45 degrees caudally [78]. The femoral neck is normally anteverted approximately 14 degrees in relation to the femoral condyles, with a range of 1–40 degrees [78]. The femoral neck-shaft angle averages 127 degrees, beginning at 141 degrees in the fetus [78]. The posterosuperior articular surface of the acetabulum is thickened to accommodate weight bearing [78]. The inferior surface of the acetabulum contains the acetabular (cotyloid) notch, which is bound by the transverse acetabular ligament [78].

Muscular Anatomy

The abductors of the hip are predominantly the gluteus medius and minimus muscles [80]. The gluteus medius has three different components: anterior, middle, and posterior [80]. The gluteus medius and minimus muscles function together to maintain and abduct the femur during the stance phase of gait [80]. A Trendelenburg lurch is an attempt by the body to compensate for abductor weakness by bringing the center of gravity closer to the hip center, forcing the patient to lean toward the affected side [80]. The gluteus maximus originates from the sacrum, the coccyx, and the sacrotuberous ligaments [80]. The tensor fasciae latae muscle originates laterally on the anterolateral edge of the iliac crest [80]. The action of the tensor fasciae latae is to flex, abduct, and rotate the hip [80]. The most consistent internal rotators of the hip joint are the gluteus medius and tensor fascia latae muscles [80].

Pathophysiology

Lateral-sided hip pain is now more commonly recognized as a conglomerate of conditions (snapping hip, trochanteric bursitis, and gluteal tendinopathy) lumped together as greater trochanteric pain syndrome (GTPS) [84]. In patients between 50 and 79 years of age, GTPS was found in 15% of women and 6.6% of men in one hip [84]. The largest bursa in the lateral hip is found between the gluteus maximus muscle and the gluteus medius tendon, which is located directly lateral to the greater trochanter [84]. Trochanteric bursitis is often related to the other conditions of GTPS and not true inflammation of the local bursa [84].

Degeneration is the primary pathology underlying hip abductor tendon tears [54]. Tears in the gluteus medius and minimus tendons are often misdiagnosed as trochanteric bursitis and have emerged as an important cause of recalcitrant greater trochanter pain syndrome [43]. Partial-thickness undersurface tears of the gluteus medius are identified as a common pathologic entity [43]. The lack of arthroscopic access to the deep side of the gluteus medius tendon represents a unique technical challenge for repairing undersurface tears [43].

Hip abductor tendon tears occur through chronic degenerative tear types, acute traumatic tears from a fall or resisted hip abduction, or iatrogenic injury at the time of surgical intervention for total hip arthroplasty or hip fracture [26]. Proximally and distally directed enthesophytes are strong predictors for the presence of a hip abductor tendon tear, specifically a full-thickness tear [29]. Increasing size of peritrochanteric calcifications is associated with more severe tendon injuries [29]. There is a correlation between lower femoral neck-shaft angles and higher lateral center-edge angles and gluteus medius pathology [42].

Patients with hip abductor tendon disorders are associated with a high prevalence of underlying lumbar and lumbosacral pathologies [39]. Patients demonstrating symptomatic hip abductor deficiency should be screened for concomitant lower lumbo-sacral spine pathology [63]. Reduced power of resisted abduction and the presence of gait deviation on initial evaluation of patients with gluteus medius tears increases the likelihood of surgical intervention [58]. Patients with lateral hip pain who are not palpably tender over the greater trochanter are unlikely to have MRI-detected gluteal tendinopathy [64].

Classification

Goutallier/Fuchs: This rotator cuff classification system is reliably and reproducibly applicable to the evaluation of hip abductor tendon tears [52]. It describes tears from Stage 0 to Stage 4 based on fatty infiltration of the muscle belly [26]. Stage 0 represents normal muscle, while Stage 1 indicates some fatty streaks [26]. Stage 2 is defined by fatty infiltrate with more muscle than fat, and Stage 3 represents an equal amount of fat and muscle [26]. Stage 4 is characterized by more fat than muscle [26]. The system does not dictate surgical management types or differentiate between tear types [26]. It appears to correlate with patient-rated outcomes after repair of hip abductor tendon tears [52].

Incavo and Harper: This classification system is based on purposing the Goutallier/Fuchs rotator cuff classification to hip abductor tears [26].

Melbourne Hip MRI Score: This score allows gluteal tendon pathology to be graded prior to treatment [36]. It can be used for standardized comparisons between results in future research undertaking radiological review of gluteal tendinopathy [36].

Other Considerations: Tears of the gluteus minimus and/or medius tendons can occur in cases of hip abductor tendon tears unresponsive to non-operative management [60]. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear [29]. Specifically, these enthesophytes were strong predictors for the presence of a full-thickness hip abductor tendon tear [29]. Increasing size of proximally and distally directed enthesophytes was associated with more severe tendon injuries [29].

In a series of 1,538 THA subjects, 33% were found to have any grade of gluteal tendinopathy [51]. Within this cohort, 179 patients (12%) had a partial or full-thickness gluteal tendon tear (grades 2 to 3) at the time of surgery [51]. Gluteal tendinopathy or tear was associated with women, older age, and higher BMI [51]. No statistically significant difference was observed in baseline Oxford Hip Scores between groups with different gluteal tendon grades [51]. Similarly, no statistically significant difference was observed in baseline HOOS-JR scores between groups with different gluteal tendon grades [51].

Postoperative 1-year Oxford Hip Scores were statistically lower in patients with grades 2 to 3 tendon tears compared with patients who had grades 0 gluteal tendons [51]. Postoperative 1-year Oxford Hip Scores were also statistically lower in patients with grades 2 to 3 tendon tears compared with patients who had grade 1 gluteal tendons [51]. Postoperative 1-year HOOS-JR scores were statistically lower in patients who had grades 2 to 3 tendon tears compared with grade 0 gluteal tendons [51]. Changes between preoperative and 1-year postoperative Oxford Hip Scores were statistically lower in patients who had grades 2 to 3 tendon tears compared to those in the grade 0 group [51].

Clinical Presentation

Symptoms and Signs

Gluteal tendinopathy presents with a dull pain on the lateral aspect of the hip, sometimes with radiation posteriorly and into the thigh [43]. Pain associated with gluteal tendinopathy is aggravated by pressure on the area, weight bearing, and resisted hip abduction [43].

Diagnostic Imaging and Pathology

Trochanteric bursitis occurs almost exclusively in the presence of gluteus medius or minimus tendinopathies, suggesting it should not be assumed as a primary diagnosis [56]. 3.0-T MRI scans appear superior to 1.5-T scans for differentiating bursitis from underlying tendon pathology and detecting partial or full-thickness tendon tears [56]. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear [29]. Increasing size of enthesophyte findings was associated with more severe tendon injuries [29]. There was a correlation between lower femoral neck-shaft angle and higher lateral center-edge angle and gluteus medius pathology [42]. The Melbourne Hip MRI Score allows gluteal tendon pathology to be graded prior to treatment and to be used for standardized comparisons between results in future research [36].

Tear Classification and Etiology

Hip abductor tendon tears occur through three distinct mechanisms: * Chronic degenerative tear: Results in progressive worsening of symptoms and function [26]. * Acute traumatic tear: Results from a fall or resisted hip abduction with immediate pain and dysfunction after the mechanism [26]. * Iatrogenic injury: Occurs at the time of surgical intervention for total hip arthroplasty or hip fracture [26].

The Goutallier/Fuchs rotator cuff classification is applied to hip abductor tears, describing tears from Stage 0 to Stage 4 based on fatty infiltration of the muscle belly [26]. * Stage 0: Normal muscle [26]. * Stage 1: Some fatty streaks [26]. * Stage 2: Fatty infiltrate with more muscle than fat [26]. * Stage 3: An equal amount of fat and muscle [26]. * Stage 4: More fat than muscle [26].

While studies show a correlation of severity with final outcomes after surgical repair, the Goutallier/Fuchs classification does not help dictate surgical management types or differentiate between tear types [26].

Comorbidities

Patients who underwent endoscopic management of greater trochanteric pain syndrome commonly underwent repair of gluteal tendon tears, and in many cases had concomitant labral tears and chondral lesions identified intraoperatively [7].

Investigations

Clinical Examination

A thorough clinical examination is required to determine a differential diagnosis for hip pain, as many conditions present with similar symptoms [48]. Clinical examination tests and imaging findings should be used to confirm a suspected clinical diagnosis [48].

Imaging Modalities

Plain radiography: Conventional radiographs remain critical in the initial imaging evaluation of the hip [49].

MRI: MRI is the modality of choice for patients suspected of soft tissue or intra-articular pathology due to its superior sensitivity and specificity [90]. Conventional MRI is effective at identifying musculotendinous pathologies [90]. Magnetic resonance imaging and operative observations suggest that chronic degeneration in the abductor mechanism is the major impediment to successful repair [109].

Ultrasonography: Ultrasonography can be an effective modality to identify musculotendinous disruptions and inflammatory conditions such as bursitis [90].

Bone scan: Scintigraphy can provide sensitive and specific diagnoses of gluteus medius tendinitis and trochanteric bursitis [118].

Specific Pathology Findings

Trochanteric bursitis occurs almost exclusively in the presence of gluteus medius/minimus tendinopathies, suggesting it should not be assumed as a primary diagnosis [56]. There was a correlation between lower femoral neck-shaft angle/higher lateral center-edge angle and gluteus medius pathology [42].

Treatment

Non-Operative

Contemporary nonoperative modalities for managing hip abductor tendon injuries yield variable results [12]. For degenerative hip abductor lesions, particularly partial tears, nonoperative treatment remains a valid long-term option, demonstrating a low risk of clinically relevant progression or muscle fatty infiltration and clinical outcomes similar to those reported for operatively treated lesions [24]. Autologous tenocyte injection for gluteal tendinopathy is safe and provides improved, sustained clinical outcomes through 24 months [4].

Operative

Indications: Surgical intervention is appropriate for symptomatic hip abductor tendon tears, as it improves outcomes reflected by changes in HHS/mHHS [23]. Endoscopic abductor tendon repair is an effective surgical intervention following failed conservative management [62].

Surgical Approach / Technique: Endoscopic repair serves as an effective treatment for gluteus medius tears in the short term [14]. At two-year follow-up, endoscopic gluteus medius repair results in significant improvement in all four patient-reported outcomes and pain scores [28]. Endoscopic repairs of both partial- and full-thickness hip abductor tendon tears achieve good-to-excellent patient-reported outcomes with low complication, retear, and revision rates [27]. Specifically, 41 to 75% of patients achieve a patient acceptable symptomatic state after endoscopic repair [27]. For partial thickness undersurface tears (PUSTA), endoscopic trans-tendinous repair successfully treats the lesion while preserving the intact attachment of superficial gluteus medius fibers [32]. This surgical treatment differs from traditional approaches and may be difficult to adopt due to entrenched thinking, but the reward is stronger, happier, and more active patients [102].

Open repair of torn abductor tendons to a bleeding trochanteric bed with transosseous sutures typically provides good pain relief as well as improved strength and function [66]. Abductor repair augmented with acellular human dermal allograft offers a simple technique that provides immediate structural strength and a biologic environment for better tendon-to-bone healing [45]. A reproducible technique exists for open reconstruction of chronic hip abductor tears using gluteus maximus–TFL transfer, double-row abductor tendon repair, and scaffold augmentation [34]. Additionally, a knotless trans-tendon proximal-pulley repair with distal-row fixation and bioinductive patch augmentation is described to optimize healing and construct strength for partial-thickness gluteus medius and minimus tears [53].

Other Considerations: The presence of high-grade fatty infiltration results in less improvement in outcomes after surgical intervention for symptomatic hip abductor tendon tears [23]. Conversely, preoperative fatty infiltration was not associated with pertinent parameters of patient outcome after hip abductor tendon repair, including pain, symptoms, functional capacity, perceived improvement, and satisfaction [59]. In a propensity-matched controlled study of endoscopic gluteus medius repair with concomitant arthroscopic labral treatment, 69.8% of cases found partial-thickness GM tears and 30.2% found full-thickness tears [44]. Patients with gluteal pathology do well following DA THA; however, gluteal muscle tears and tendinopathies are associated with greater pain, decreased satisfaction, and inferior functional outcomes [38].

Complications

Tendon Retear and Revision

Endoscopic repair of gluteal tendon tears is associated with lower rates of tendon retear and fewer postoperative complications compared to open surgical approaches [16, 18, 61]. Endoscopic repairs of hip abductor tendon tears generally exhibit low complication, retear, and revision rates [27]. Patients undergoing augmented hip abductor tendon repair demonstrated a low rerupture rate over the 24-month postoperative period [47]. In one series, a patient in the gluteus medius repair group without augmentation underwent revision surgery due to re-tear of the gluteus medius tendon and recurrence of pain at 56 months postoperatively [101]. Conversely, a patient in the gluteus medius repair group with dermal allograft augmentation underwent revision surgery due to re-tear of the gluteus medius tendon and recurrence of pain at 9 months postoperatively [101].

Long-Term Durability and Outcomes

With 5- to 10-year follow-up, 92.2% of patients undergoing endoscopic abductor tendon repair achieved the minimal clinically important difference [122]. Endoscopic repair of gluteus medius tears results in improved modified Harris Hip Score and North American Hip Score at 2 years of follow-up compared with baseline [15]. Patients who underwent endoscopic repairs of full-thickness gluteal tendon tears achieved excellent outcomes that exceeded the minimal clinically important difference thresholds in the majority of patients at an average of 31.2 months follow-up [22]. Endoscopic repair of gluteus medius tears, whether performed through a transtendinous or full-thickness technique, is an effective treatment at a minimum follow-up of 2 years [10]. Patients who underwent open repairs for full-thickness gluteus medius tears achieved favorable results in several patient-reported outcome scores at minimum 2-year follow-up [5]. Primary repair of gluteus medius and/or minimus tears resulted in clinical success in most patients irrespective of MRI grade and surgical approach [11]. Surgical repair of torn gluteal tendons in patients with severe symptoms has been effective at relieving symptoms in 95% of the cases reviewed [1]. Both open and endoscopic gluteal tendon repairs resulted in improvements in outcomes and functional improvement [3]. Patients who underwent concomitant endoscopic abductor tendon repair and hip arthroscopic surgery had significant improvements on patient-reported outcome measures with low rates of secondary surgery at a minimum 2-year follow-up [46]. Endoscopic surgical repair of abductor tendon tears generally shows good or excellent results [37].

Impact of Fatty Infiltration on Outcomes

High-grade fatty infiltration portends worse outcomes after gluteal tendon repair [11]. Functional outcomes of patients with extensive gluteal tears managed with suture anchors and a non-resorbable collagen patch were dependent on the degree of the fatty degeneration of muscles [30].

Concomitant Pathology and Comorbidities

Patients who underwent endoscopic management of greater trochanteric pain syndrome commonly had concomitant labral tears and chondral lesions identified intraoperatively [7]. In a study of endoscopic gluteus medius repair with concomitant arthroscopic labral treatment, 67.4% of cases found acetabular labrum articular disruption defects of grade 2 or greater [44]. In the same study, 65.1% of cases had an acetabular Outerbridge classification of grade 2 or greater [44]. Additionally, 69.8% of cases found partial-thickness gluteus medius tears [44]. Patients with hip abductor tendon disorders were associated with a high prevalence of underlying lumbar and lumbosacral pathologies [39].

Gluteal muscle tears and tendinopathies are associated with greater pain, decreased satisfaction, and inferior functional outcomes following direct anterior total hip arthroplasty [38]. In a cohort of 1,538 total hip arthroplasty patients, postoperative 1-year Oxford Hip Scores were statistically lower in patients with grades 2 to 3 gluteal tendon tears compared with patients who had grade 0 gluteal tendons [51]. In the same cohort, postoperative 1-year HOOS-JR scores were statistically lower in patients who had grades 2 to 3 gluteal tendon tears compared with grade 0 gluteal tendons [51]. The gluteus medius tendon shows more ultrastructural degeneration in patients who undergo hip revision arthroplasty than in patients with primary osteoarthritis of the hip and control patients [119]. Iatrogenic injury to the hip abductor tendons can occur at the time of surgical intervention for total hip arthroplasty or hip fracture [26].

Surgical Technique and Augmentation Outcomes

Superior gluteal reconstruction for massive, irreparable abductor tendon tears demonstrates promising 1-year postoperative outcomes in both primary and revision patients [9]. The technique of transosseous fixation with a nonresorbable collagen patch appears promising for patients with extensive gluteal tears where torn ends can be mobilized and fatty degeneration is less than 75% [17].

Recovery

Light activity (weeks): The provided evidence does not specify a typical week range for light activities such as desk work, driving, or light activities of daily living.

Full activity (months): The provided evidence does not specify a month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The provided evidence does not specify a month range for when pain, strength, and final functional outcomes stabilise.

Rehabilitation protocol: The provided evidence does not detail specific physical therapy phasing, immobilisation duration, weight-bearing or range-of-motion progression, or sling/brace removal timing.

Functional milestones: Patients who underwent open repairs for full-thickness gluteus medius tears via contemporary tendon repair techniques, with or without concomitant hip arthroscopy, achieved favorable results in several patient-reported outcome scores at minimum 2-year follow-up [5]. Endoscopic repair for gluteus medius tears results in improved modified Harris Hip Score and North American Hip Score at 2 years of follow-up compared with baseline [15]. In a study of 15 hips with full-thickness gluteal tendon tears managed endoscopically, outcomes exceeded the minimal clinically important difference thresholds in the majority of patients at an average of 31.2 months follow-up [22]. Patients undergoing augmented hip abductor tendon repair demonstrated significant clinical and functional improvement over the 24-month postoperative period with a low rerupture rate [47].

Other Considerations: Endoscopic repair of gluteus medius tears is critical for restoring functional outcomes of the hip, maximizing tendon compression over the lateral facet, and lowering tendon retear rates in comparison with open surgical approaches [16]. Endoscopic repair of a traumatic gluteus medius musculotendinous junction tear resulted in resolution of pain and improved hip function [19]. Endoscopic Whiteside transfer associated to gluteus medius tendon repair provided only moderate results in terms of recovery of abduction power and resolution of Trendelenburg gait [104]. Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle fatty infiltration and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions [24].

Key Evidence

  • [L4] Surgical repair of torn gluteal tendons in patients with severe symptoms has been effective at relieving symptoms in 95% of the cases that were reviewed. [1] (10.1016/j.arth.2011.03.004)
  • [L4] Both endoscopic and open gluteal tendon repairs resulted in improvements in outcomes and functional improvement. [3] (10.1136/jisakos-2020-000474)
  • [L4] ATI for gluteal tendinopathy is safe, with improved and sustained clinical outcomes to 24 months. [4] (10.1177/2325967116688866)
  • [L4] Patients who underwent open repairs in the setting of full-thickness GM tears via contemporary tendon repair techniques, with or without concomitant hip arthroscopy, achieved favorable results in several PRO scores at minimum 2-year follow-up. [5] (10.1177/2325967120929330)
  • [L4] Gluteus maximus tendon transfer for abductor insufficiency has demonstrated reliable outcomes at 3 years, with improvement in hip function and pain. [6] (10.1016/j.arth.2023.10.036)
  • [L1] Patients who underwent endoscopic management of GTPS commonly underwent repair of gluteal tendon tears, and in many cases had concomitant labral tears and chondral lesions identified intraoperatively. [7] (10.1016/j.arthro.2022.06.031)
  • [L4] Surgical repair of torn abductor tendons of the hip is a viable option when MRI and clinical findings are consistent with tendon disruption and weakness. [8] (10.2106/jbjs.l.00709)
  • [L4] Superior gluteal reconstruction for massive, irreparable abductor tendon tears with severe tendon loss and atrophy is a technique that demonstrates promising 1-year postoperative outcomes in both primary and revision patients. [9] (10.1016/j.asmr.2021.05.013)
  • [L4] This study demonstrates that endoscopic surgical repair, whether performed through a transtendinous or full-thickness technique, can be an effective treatment of gluteus medius tears at a minimum follow-up of 2 years. [10] (10.1177/0363546513481575)
  • [L4] Primary repair of gluteus medius and/or minimus tears resulted in clinical success in most patients irrespective of MRI grade and irrespective of the surgical approach used at each MRI grade, yet GF grade 1 tears showed a significantly higher clinical success rate than GF grade 4 tears. [11] (10.1016/j.arthro.2024.05.021)
  • [L4] Management of hip abductor tendon injuries remains difficult and controversial, with contemporary nonoperative modalities showing variable results. [12] (10.2106/jbjs.rvw.25.00031)
  • [L4] Endoscopic repair of gluteus medius tears is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up. [13] (10.1016/j.arthro.2023.10.049)
  • [L4] Endoscopic surgical repair can be an effective treatment of gluteus medius tears in the short term. [14] (10.1016/j.arthro.2018.01.005)
  • [L4] Endoscopic repair for gluteus medius tears results in improved mHHS and NAHS at 2 years of follow-up compared with baseline. [15] (10.1016/j.arthro.2020.07.022)
  • [L5] Endoscopic repair of gluteus medius tears is critical for not only restoring functional outcomes of the hip but also maximizing tendon compression over the lateral facet and lowering tendon retear rates in comparison with open surgical approaches. [16] (10.1016/j.eats.2024.102929)
  • [L4] The technique appears promising for patients with extensive gluteal tears where torn ends can be mobilized and fatty degeneration is less than 75%. [17] (10.1016/j.arth.2017.08.045)
  • [L1] Both open and endoscopic techniques are viable surgical approaches to repairing abductor tendon tears in the hip that produce good to excellent functional results and reduce pain; however, endoscopic repair appears to result in fewer postoperative complications including tendon retear. [18] (10.1016/j.arthro.2014.09.001)
  • [Paper] This is the first report to describe a traumatic gluteus medius musculotendinous junction tear and its endoscopic treatment, resulting in resolution of pain and improved hip function. [19] (10.1016/j.eats.2012.11.004)
  • [Paper] With proper indications, partial gluteus medius tears can be evaluated and treated through the direct anterior approach in a reproducible manner by applying previously described arthroscopic techniques in an open setting. [20] (10.1016/j.eats.2020.10.043)
  • [L4] Partial-thickness undersurface tears of the abductor can be treated successfully with endoscopic transtendinous repair preserving the intact attachment of the superficial fibers of the gluteus medius. [21] (10.1016/j.arthro.2017.10.022)
  • [L4] In this study of 15 hips with full-thickness gluteal tendon tears managed endoscopically, we found excellent outcomes that exceeded the MCID thresholds in the majority of patients at an average of 31.2 months follow-up, while offering the potential advantages of less tissue violation, ambulatory day surgery, and fewer complications compared with open repair. [22] (10.1016/j.arthro.2020.04.025)
  • [L1] Surgical intervention for symptomatic hip abductor tendon tears improved outcomes as reflected by change in HHS/mHHS; however, the presence of high-grade fatty infiltration resulted in less improvement. [23] (10.1177/03635465211027911)
  • [L4] Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle fatty infiltration and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions. [24] (10.1177/03635465221135759)
  • [L5] [26] (10.5435/jaaos-d-23-00224)
  • [L4] Endoscopic repairs of both partial- and full-thickness hip abductor tendon tears have good-to-excellent PROs and low complication, retear, and revision rates. [27] (10.1016/j.arthro.2024.01.001)
  • [L4] Endoscopic gluteus medius repair resulted in significant improvement in all four patient-reported outcomes and pain scores at two-year follow-up. [28] (10.2106/jbjs.n.01229)
  • [L3] Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear, and increasing size of the findings was associated with more severe tendon injuries. [29] (10.1177/03635465211008104)
  • [L4] [30] (10.1007/s00167-020-06320-x)
  • [L4] PUSTA lesions can be treated successfully with endoscopic trans-tendinous repair preserving the intact attachment of superficial fibers of the gluteus medius. [32] (10.1016/j.arthro.2017.04.060)
  • [L5] This Technical Note outlines a reproducible technique for open reconstruction of chronic hip abductor tears using gluteus maximus—TFL transfer, double-row abductor tendon repair, and scaffold augmentation. [34] (10.1016/j.eats.2025.103981)
  • [L3] This score allows gluteal tendon pathology to be graded prior to treatment and to be used for standardized comparisons between results in future research undertaking radiological review of gluteal tendinopathy. [36] (10.1177/2325967121998389)
  • [L5] Endoscopic surgical repair of abductor tendon tears generally shows good or excellent results, though patient-reported outcome measures may not fully capture objective improvements in gait and strength. [37] (10.1016/j.arthro.2024.02.028)
  • [L3] Patients who had gluteal pathology do well following DA THA; however, gluteal muscle tears and tendinopathies are associated with greater pain, decreased satisfaction, and inferior functional outcomes. [38] (10.1016/j.arth.2025.01.006)
  • [L4] Patients with hip abductor tendon disorders were associated with a high prevalence of underlying lumbar and lumbosacral pathologies. [39] (10.1016/j.arthro.2021.09.026)
  • [L4] There was a correlation between lower femoral neck-shaft angle/higher lateral center-edge angle and gluteus medius pathology. [42] (10.1016/j.arthro.2021.10.006)
  • [L5] [43] (10.1016/j.arthro.2010.06.002)
  • [L3] [44] (10.1016/j.arthro.2020.07.020)
  • [Paper] Abductor repair of the hip augmented with acellular human dermal allograft provides a simple technique that offers immediate structural strength and a biologic environment for better tendon to bone healing. [45] (10.1016/j.eats.2019.07.014)
  • [L4] Patients who underwent concomitant endoscopic abductor tendon repair and hip arthroscopic surgery had significant improvements on PROMs with low rates of secondary surgery at a minimum 2-year follow-up. [46] (10.1177/23259671251341479)
  • [L4] Patients undergoing augmented hip abductor tendon repair demonstrated significant clinical and functional improvement over the 24-month postoperative period with a low rerupture rate. [47] (10.1177/2325967119897881)
  • [L2] [51] (10.1016/j.arth.2024.01.060)
  • [L4] The Goutallier/Fuchs classification system can be reliably and reproducibly applied to the evaluation of abductor tendon tears of the hip and appears to correlate with patient-rated outcomes after repair. [52] (10.1016/j.arthro.2015.04.101)
  • [L5] This technical note describes a knotless trans-tendon proximal-pulley repair with distal-row fixation and bioinductive patch augmentation to optimize healing and construct strength for partial-thickness gluteus medius and minimus tears. [53] (10.1002/atn2.70142)
  • [L5] This study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. [54] (10.1186/s12891-020-03784-3)
  • [L3] Trochanteric bursitis occurs almost exclusively in the presence of gluteus medius/minimus tendinopathies, suggesting it should not be assumed as a primary diagnosis. 3.0-T MRI scans appear superior to 1.5-T scans for differentiating bursitis from underlying tendon pathology and detecting partial or full-thickness tendon tears. [56] (10.1007/s00402-019-03228-1)
  • [L3] Reduced power of resisted abduction and the presence of gait deviation on initial evaluation of patients with gluteus medius tears increases the likelihood of surgical intervention. [58] (10.1177/2325967115571079)
  • [L4] Preoperative fatty infiltration was not associated with pertinent parameters of patient outcome after hip abductor tendon repair, including pain, symptoms, functional capacity, perceived improvement, and satisfaction. [59] (10.1177/0363546519873672)
  • [L4] [60] (10.1007/s00402-026-06449-3)
  • [L5] Both open and endoscopic techniques are effective for treating gluteus medius tears at short- and long-term follow-up, though endoscopic techniques result in fewer postoperative complications such as retear. [61] (10.1016/j.arthro.2022.05.002)
  • [L4] In this small series, endoscopic abductor tendon repair was an effective surgical intervention after failed conservative management at short-term follow-up. [62] (10.1016/j.arthro.2013.08.024)
  • [L4] Patients demonstrating symptomatic hip abductor deficiency should be screened for concomitant lower lumbo-sacral spine pathology. [63] (10.1016/j.arth.2024.06.003)
  • [L4] Patients with lateral hip pain who are not palpably tender over the greater trochanter are unlikely to have MRI-detected GT. [64] (10.1136/bjsports-2016-096175)
  • [L5] Repair of torn abductor tendons to a bleeding trochanteric bed with transosseous sutures typically provides good pain relief as well as improved strength and function. [66] (10.5435/00124635-201107000-00001)
  • [L3] [101] (10.1016/j.arthro.2024.08.024)
  • [L5] Surgical treatment of partial thickness undersurface tears of the abductor tendon is different than traditional approaches and may be difficult to adopt due to entrenched thinking, but the reward is stronger, happier, and more active patients. [102] (10.1016/j.arthro.2017.11.024)
  • [L4] Endoscopic Whiteside transfer associated to gluteus medius tendon repair provided only moderate results in terms of recovery of abduction power and resolution of Trendelenburg gait. [104] (10.1016/j.otsr.2021.102927)
  • [L4] Magnetic resonance imaging and operative observations suggest that chronic degeneration in the abductor mechanism is the major impediment to successful repair. [109] (10.1016/j.arth.2008.12.010)
  • [L2] Scintigraphy can provide sensitive and specific diagnoses of gluteus medius tendinitis and trochanteric bursitis. [118] (10.1097/blo.0b013e31802f9f9a)
  • [L3] The GMED tendon shows more ultrastructural degeneration in patients who undergo hip revision arthroplasty than in patients with primary OA of the hip and control patients. [119] (10.1186/s13018-021-02434-1)
  • [L4] Collectively, with 5- to 10-year follow-up, patients undergoing endoscopic abductor tendon repair can respond exceptionally well, with 92.2% achieving the MCID, even among a heterogeneous group of partial- and full-thickness tears with single- and 2-tendon involvement undergoing single- and double-row repair. [122] (10.1016/j.arthro.2023.11.031)

See Also

References

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