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Gluteal tendon tear and repair

71 citationsUpdated Sep 2026

Overview

Surgical repair of torn gluteal tendons is a viable option 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 patients with severe symptoms, surgical repair has been effective at relieving symptoms in 95% of reviewed cases [1]. Both open and endoscopic techniques are effective for treating gluteus medius tears at short- and long-term follow-up, producing good to excellent functional results and reducing pain [3, 19, 59]. 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 [11].

Endoscopic repair appears to result in fewer postoperative complications, including tendon retear, compared to open repair [19, 59]. 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 [36]. Endoscopic repair of gluteus medius tears is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up [13]. 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 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]. 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 [16]. 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]. Endoscopic repair of full-thickness gluteus medius tears offers the potential advantages of less tissue violation, ambulatory day surgery, and fewer complications compared with open repair [22].

Gluteal fatty infiltration grade 1 tears showed a significantly higher clinical success rate than grade 4 tears [11]. 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]. 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]. Autologous tenocyte injection for gluteal tendinopathy is safe, with improved and sustained clinical outcomes to 24 months [4]. Gluteus maximus tendon transfer for abductor insufficiency has demonstrated reliable outcomes at 3 years, with improvement in hip function and pain [6]. 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]. 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% [18]. 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 [14]. 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 [17].

Anatomy & Pathophysiology

Bony Anatomy

The hemipelvis comprises the ilium, ischium, and pubis, which unite at the triradiate cartilage within the concave acetabulum [70]. 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 [70]. The posterosuperior articular surface of the acetabulum is thickened to accommodate weight bearing [76, 77]. The inferior surface contains the acetabular (cotyloid) notch, which is bound by the transverse acetabular ligament [76, 77]. The acetabulum is normally anteverted 15 degrees and obliquely oriented in the coronal plane 45 degrees caudally [76, 77].

The femoral neck-shaft angle averages 125° [70], with other reports citing an average of 127 degrees [76, 77]. The greater and lesser trochanters are connected by the intertrochanteric line anteriorly and the intertrochanteric crest posteriorly [70]. The basicervical and intertrochanteric crest regions of the femur are extracapsular [67, 68].

Ligamentous Anatomy

The iliofemoral ligament, also known as the Y ligament of Bigelow, is the strongest ligament in the body and attaches the AIIS to the intertrochanteric line in an inverted Y manner [67, 68]. The ischiofemoral and pubofemoral ligaments are weaker than the iliofemoral ligament but provide additional stability to the hip [67, 68]. The hip joint capsule extends anteriorly to the intertrochanteric crest but posteriorly only partially across the femoral neck [67, 68]. The ligamentum teres arises from the apex of the cotyloid notch and attaches to the fovea of the femoral head [67, 68].

Muscular Anatomy

The abductors of the hip are predominantly the gluteus medius and minimus muscles [78]. The gluteus medius has three different components: anterior, middle, and posterior [78]. The gluteus medius and minimus muscles function together to maintain and abduct the femur during the stance phase of gait [78]. 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 [78]. The most consistent internal rotators of the hip joint are the gluteus medius and tensor fascia latae muscles [78].

The gluteus maximus originates from the sacrum, the coccyx, and the sacrotuberous ligaments [78]. The tensor fasciae latae muscle originates laterally on the anterolateral edge of the iliac crest [78]. The action of the tensor fasciae latae is to flex, abduct, and rotate the hip [78].

Neurovascular Anatomy

In adulthood, the major blood supply to the femoral head is from the medial femoral circumflex and lateral epiphyseal arteries [84]. The ligamentum teres transmits an arterial branch of the posterior division of the obturator artery to the femoral head [67, 68]. The superior gluteal vessels are branches of the posterior division of the internal iliac artery [84]. The inferior gluteal vessels are branches of the anterior division of the internal iliac artery [84]. The inferior gluteal vessels exit the pelvis between the piriformis and coccygeus muscles [84]. The superior gluteal nerve and artery exit the pelvis above the piriformis muscle [78]. The inferior gluteal nerve, inferior gluteal artery, and nerve to the quadratus femoris exit the pelvis below the piriformis muscle [78].

Pathophysiology

Lateral hip pain is a common condition that has been reported to be as debilitating as end-stage degenerative joint disease [82]. Lateral 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) [82]. In patients between 50 and 79 years of age, GTPS was found in 15% of women and 6.6% of men in one hip [82]. 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 [82]. Trochanteric bursitis is often related to the other conditions of GTPS and not true inflammation of the local bursa [82]. Lateral hip pain used to be a poorly defined entity, but advances in imaging and interest in sports medicine have led to a better understanding of the pathology, presentation and management of this cohort of patients [37].

Degeneration is the primary pathology underlying hip abductor tendon tears [53]. Tears of the gluteus medius and minimus tendons are often misdiagnosed as trochanteric bursitis [42]. Partial-thickness undersurface tears of the gluteus medius are a common pathologic entity [42]. The lack of arthroscopic access to the deep side of the gluteus medius tendon represents a unique technical challenge for repairing undersurface tears [42].

Hip abductor tendon tears occur through several typical presentations: * Chronic degenerative tear: results in progressive worsening of symptoms and function [26]. * Acute traumatic tear: occurs 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/hip fracture [26].

The Goutallier/Fuchs rotator cuff classification is purposed for hip abductor tears, describing tears from Stage 0 to Stage 4 based on fatty infiltration of the muscle belly [26]. * Stage 0: represents normal muscle [26]. * Stage 1: represents some fatty streaks [26]. * Stage 2: represents fatty infiltrate with more muscle than fat [26]. * Stage 3: represents an equal amount of fat and muscle [26]. * Stage 4: represents more fat than muscle [26].

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/higher lateral center-edge angle and gluteus medius pathology [41]. Patients with hip abductor tendon disorders were 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 [61]. 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 [57]. Patients with lateral hip pain who are not palpably tender over the greater trochanter are unlikely to have MRI-detected gluteal tendinopathy [62]. Generic health status in female patients suffering from lateral hip pain due to hip abductor tendon pathology is severely affected compared to a national population norm [58].

Classification

Fatty Infiltration Grading

Goutallier/Fuchs: This rotator cuff classification is applied to hip abductor tears, describing stages 0 through 4 based on fatty infiltration of the muscle belly [26]. The system can be reliably and reproducibly applied to the evaluation of abductor tendon tears of the hip [52, 97]. While the classification appears to correlate with patient-rated outcomes after repair [52, 97], it does not dictate surgical management types or differentiate between tear types [26].

Incavo and Harper: A newer classification system proposed by Incavo and Harper is based on factors other than the Goutallier/Fuchs scale [26].

Tear Morphology and Mechanism

Hip abductor tendon tears occur through three distinct mechanisms: a chronic, degenerative tear type resulting in progressive worsening of symptoms and function; an acute traumatic tear from a fall or resisted hip abduction with immediate pain and dysfunction; and iatrogenic injury at the time of surgical intervention for total hip arthroplasty or hip fracture [26].

Treatment strategies are determined by tear morphology. Partial-thickness undersurface tears of the abductor tendon are treated with endoscopic transtendinous repair preserving the intact attachment of the superficial fibers of the gluteus medius [21, 33, 34]. Full-thickness gluteus medius tears are treated with endoscopic repair using transtendinous or full-thickness techniques [10]. Massive, irreparable abductor tendon tears are characterized by severe tendon loss and atrophy [9].

MRI Assessment

The Melbourne Hip MRI Score allows gluteal tendon pathology to be graded prior to treatment [35]. It is used for standardized comparisons between results in future research undertaking radiological review of gluteal tendinopathy [35].

Proximally and distally directed enthesophytes are strong predictors for the presence of a hip abductor tendon tear [29]. Specifically, these enthesophytes are strong predictors for the presence of a full-thickness hip abductor tendon tear [29]. Increasing size of enthesophyte findings is associated with more severe tendon injuries [29].

Outcome Correlation by Grade

GF grade 1 tears show a significantly higher clinical success rate than GF grade 4 tears after primary repair [11]. However, primary repair of gluteus medius and/or minimus tears results in clinical success in most patients irrespective of MRI grade [11]. This clinical success is also observed irrespective of the surgical approach used at each MRI grade [11].

The presence of high-grade fatty infiltration results in less improvement in outcomes after surgical intervention for symptomatic hip abductor tendon tears [23]. Functional outcomes after open repair of extensive gluteal tears are dependent on the degree of fatty degeneration of muscles [30].

Clinical Presentation

Symptoms and Physical Findings

Gluteal tendon tears present with dull pain on the lateral aspect of the hip, sometimes with radiation posteriorly and into the thigh [42]. This pain is aggravated by pressure on the area, weight bearing, and resisted hip abduction [42]. Patients with hip abductor tendon disorders are associated with a high prevalence of underlying lumbar and lumbosacral pathologies [39]. Surgical repair of torn abductor tendons is a viable option when MRI and clinical findings are consistent with tendon disruption and weakness [8].

Mechanisms and Tear Types

Hip abductor tendon tears occur through two distinct mechanisms. The first is a chronic, degenerative tear type that results in progressive worsening of symptoms and function [26]. The second is an acute traumatic tear from a fall or resisted hip abduction, characterized by immediate pain and dysfunction after the mechanism [26]. Partial-thickness undersurface tears of the gluteus medius are identified as a common pathologic entity [42].

Imaging and Diagnostic Associations

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 enthesophytes is associated with more severe tendon injuries [29]. Trochanteric bursitis occurs almost exclusively in the presence of gluteus medius or minimus tendinopathies, suggesting it should not be assumed as a primary diagnosis [55]. 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 [55]. There is a correlation between lower femoral neck-shaft angle and higher lateral center-edge angle and gluteus medius pathology [41]. The Melbourne Hip MRI Score allows gluteal tendon pathology to be graded prior to treatment for standardized comparisons in research [35].

Comorbidities

Patients who underwent endoscopic management of greater trochanteric pain syndrome commonly 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]. Findings from imaging studies should complement clinical examination findings to provide the most accurate diagnosis [48].

Plain radiography: Conventional radiographs remain critical in the initial imaging evaluation of the hip [49]. Plain radiographs are the first imaging studies obtained for patients presenting with hip pain and can determine the presence of fractures, degenerative changes, and abnormal joint morphology [88].

MRI: MRI is the modality of choice for patients suspected of soft tissue or intra-articular pathology, given its superior sensitivity and specificity [88]. Conventional MRI is effective at identifying musculotendinous pathologies [88]. Magnetic resonance arthrography (MRA) is more appropriate than conventional MRI to determine injuries to labrochondral structures and the ligamentum teres [88].

Ultrasonography: Ultrasonography can be an effective modality to identify musculotendinous disruptions and inflammatory conditions such as bursitis [88]. Ultrasonography provides real-time dynamic assessment of the hip and is useful in diagnosing soft-tissue abnormalities about the hip joint [72].

CT: CT scans are effective for examining cortical and cancellous bone and can be used to create three-dimensional reconstructions of the hip for use in surgical planning [88].

Bone scan: Scintigraphy can provide sensitive and specific diagnoses of gluteus medius tendinitis and trochanteric bursitis [113].

Other Considerations: Trochanteric bursitis occurs almost exclusively in the presence of gluteus medius/minimus tendinopathies, suggesting it should not be assumed as a primary diagnosis [55]. 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 [35]. Advances in imaging and interest in sports medicine have led to a better understanding of the pathology, presentation, and management of lateral hip pain [37].

Treatment

Non-Operative

Nonoperative management remains a valid long-term option for degenerative hip abductor lesions, particularly partial tears, which demonstrate a low risk of clinically relevant progression or muscle fatty infiltration [24]. Clinical outcomes for partial tears are similar to those reported for operatively treated lesions [24]. While contemporary nonoperative modalities show variable results [12], autologous tenocyte injection is safe and provides improved, sustained clinical outcomes to 24 months [4].

Operative

Indications: Surgical repair is indicated for patients with severe symptoms, where it has been effective at relieving symptoms in 95% of reviewed cases [1]. Intervention is also appropriate after failed conservative management, where endoscopic repair has proven effective at short-term follow-up [60].

Surgical Approach / Technique: Endoscopic repair is a primary approach for gluteus medius tears, critical for restoring functional outcomes and maximizing tendon compression over the lateral facet [17]. This technique lowers tendon retear rates compared with open surgical approaches [17]. Endoscopic management results in improved modified Harris Hip Score (mHHS) and North American Hip Score (NAHS) at two years [16], with significant improvements in patient-reported outcomes and pain scores [28]. Both partial- and full-thickness tears managed endoscopically demonstrate good-to-excellent patient-reported outcomes with low complication, retear, and revision rates [27]. In a cohort of 15 hips with full-thickness tears, excellent outcomes exceeding minimal clinically important difference thresholds were observed at an average of 31.2 months [22]. Endoscopic trans-tendinous repair successfully treats proximal upper superficial tendon (PUSTA) lesions by preserving the intact attachment of superficial gluteus medius fibers [33]. This approach also resolves pain and improves hip function in traumatic musculotendinous junction tears [20] and serves as an effective short-term treatment [15].

Open repair via contemporary tendon techniques, with or without concomitant hip arthroscopy, achieves favorable patient-reported outcomes at minimum two-year follow-up for full-thickness gluteus medius tears [5]. Repair to a bleeding trochanteric bed using transosseous sutures typically provides good pain relief and improved strength and function [64]. For extensive tears where torn ends can be mobilized and fatty degeneration is less than 75%, transosseous fixation with a nonresorbable collagen patch appears promising [18]. A reproducible open reconstruction technique for chronic tears utilizes gluteus maximus–tensor fascia lata transfer, double-row abductor tendon repair, and scaffold augmentation [32]. For high-grade partial gluteus medius and minimus tears, a knotless transtendon proximal-pulley repair combined with distal-row suture-bridge fixation and bioinductive collagen patch augmentation is described [40].

Implant Selection: Abductor repair augmented with acellular human dermal allograft offers a simple technique that provides immediate structural strength and a biologic environment for improved tendon-to-bone healing [44].

Other Considerations: Surgical outcomes are influenced by preoperative pathology. High-grade fatty infiltration results in less improvement after surgical intervention [23], and grade 1 fatty infiltration tears show significantly higher clinical success rates than grade 4 tears following primary repair [11]. However, preoperative fatty infiltration was not associated with pertinent outcome parameters, including pain, symptoms, functional capacity, perceived improvement, and satisfaction, when repair was augmented with LARS [45]. Overall, surgical intervention for symptomatic tears improves outcomes as reflected by changes in Harris Hip Score or modified Harris Hip Score [23].

Concomitant pathology is common; patients undergoing endoscopic management of greater trochanteric pain syndrome frequently have gluteal tendon repairs alongside identified labral tears and chondral lesions [7]. In patients with gluteal pathology undergoing total hip arthroplasty, gluteal muscle tears and tendinopathies are associated with greater pain, decreased satisfaction, and inferior functional outcomes [38].

Complications

Tendon retear: Endoscopic repair of gluteal tendon tears appears to result in fewer postoperative complications, including tendon retear, compared with open repair [19]. This advantage is consistent across gluteus medius tears, where endoscopic techniques offer the potential for fewer complications [22] and result in fewer postoperative complications such as retear compared with open methods [59]. Overall, endoscopic repairs of hip abductor tendon tears demonstrate low complication, retear, and revision rates [27]. Specific case reports document retear leading to revision surgery in both augmented and non-augmented cohorts; one patient without augmentation required revision at 56 months postoperatively due to re-tear and pain recurrence [99], while one patient with dermal allograft augmentation required revision at 9 months postoperatively for the same reasons [99].

Other Considerations: Patients with 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 patients undergoing total hip arthroplasty with a posterior approach, 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]. Similarly, postoperative 1-year HOOS-JR scores were statistically lower in patients with grades 2 to 3 gluteal tendon tears compared with patients who had 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 [114].

Recovery

Operative Outcomes: 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]. Patients who underwent open repairs in the setting of 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]. GF grade 1 tears showed a significantly higher clinical success rate than GF grade 4 tears [11]. 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]. 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]. 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 [102].

Reconstruction and Transfer Outcomes: 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].

Non-Operative Outcomes: 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].

Prognostic Factors: 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 [45].

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)
  • [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. [14] (10.1016/j.eats.2020.10.043)
  • [L4] Endoscopic surgical repair can be an effective treatment of gluteus medius tears in the short term. [15] (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. [16] (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. [17] (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%. [18] (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. [19] (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. [20] (10.1016/j.eats.2012.11.004)
  • [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)
  • [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. [32] (10.1016/j.eats.2025.103981)
  • [L4] PUSTA lesions can be treated successfully with endoscopic trans-tendinous repair preserving the intact attachment of superficial fibers of the gluteus medius. [33] (10.1016/j.arthro.2017.04.060)
  • [L4] PUSTA lesions can be treated successfully with endoscopic trans-tendinous repair preserving the intact attachment of superficial fibers of the gluteus medius. [34] (10.1177/2325967118s00111)
  • [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. [35] (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. [36] (10.1016/j.arthro.2024.02.028)
  • [L4] Lateral hip pain used to be a poorly defined entity, but advances in imaging and interest in sports medicine have led to a better understanding of the pathology, presentation and management of this cohort of patients. [37] (10.1007/s00167-020-06354-1)
  • [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)
  • [L5] [40] (10.1002/atn2.70142)
  • [L4] There was a correlation between lower femoral neck-shaft angle/higher lateral center-edge angle and gluteus medius pathology. [41] (10.1016/j.arthro.2021.10.006)
  • [L5] [42] (10.1016/j.arthro.2010.06.002)
  • [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. [44] (10.1016/j.eats.2019.07.014)
  • [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. [45] (10.1177/0363546519873672)
  • [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 study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. [53] (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. [55] (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. [57] (10.1177/2325967115571079)
  • [L3] Generic health status in female patients suffering from lateral hip pain due to hip abductor tendon pathology is severely affected compared to a national population norm. [58] (10.1186/s12891-025-08889-1)
  • [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. [59] (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. [60] (10.1016/j.arthro.2013.08.024)
  • [L4] Patients demonstrating symptomatic hip abductor deficiency should be screened for concomitant lower lumbo-sacral spine pathology. [61] (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. [62] (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. [64] (10.5435/00124635-201107000-00001)
  • [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 outcome following repair. [97] (10.1016/j.arthro.2015.04.040)
  • [L3] [99] (10.1016/j.arthro.2024.08.024)
  • [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. [102] (10.1016/j.otsr.2021.102927)
  • [L2] Scintigraphy can provide sensitive and specific diagnoses of gluteus medius tendinitis and trochanteric bursitis. [113] (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. [114] (10.1186/s13018-021-02434-1)

See Also

References

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[6] Gluteus Maximus Transfer for Irreparable Hip Abductor Deficiency: A Systematic Review and Meta-Analysis. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.10.036

[7] Labral Tears and Chondral Lesions Are Common Comorbidities Identified During Endoscopic Repair of Gluteal Tendon Tears for Greater Trochanteric Pain Syndrome: A Systematic Review. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.06.031

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[28] Outcomes of Endoscopic Gluteus Medius Repair. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.n.01229

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[30] A roadmap to develop clinical guidelines for open surgery of acute and chronic tears of hip abductor tendons. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06320-x

[32] Gluteus Maximus‐Tensor Fascia Lata Transfer With Double‐Row Repair and Bioinductive Scaffold Augmentation for Chronic Abductor Tendon Tears. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103981

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[36] Editorial Commentary: Endoscopic Repair of Abductor Tendon Tears Results in Variable Patient Reported Outcomes and Generally Good to Excellent Results. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.02.028

[37] Pathogenesis and contemporary diagnoses for lateral hip pain: a scoping review. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06354-1

[38] Outcomes of Direct Anterior Total Hip Arthroplasty in Patients Who Have Preoperative Gluteal Tendinopathy and Muscle Tears: A Propensity-Matched Analysis. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.01.006

[39] High Prevalence of Lumbosacral Pathology in Patients with Greater Trochanteric Pain Syndrome. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.09.026

[40] Trans‐Tendon Suture‐Bridge Knotless Proximal Pulley Repair With Bioinductive Patch Augmentation for High‐Grade Partial Hip Abductor Tendon Tears. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70142

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