Three gluteus muscles cross the hip joint, and all have important and unique function to facilitate normal mobility. While the gluteus maximus is the largest muscle of the three, it is not the most important and is very infrequently injured. The gluteus medius and minimus muscles are smaller, but vital to hip function, pelvic stability, and mobility. These muscles attach to the top of the thigh bone (femur) at a location called the greater trochanter, and are the main abductor muscles that keep the pelvis level when walking or allow the leg to be lifted directly to the side of the body.
Tendonitis of the gluteus tendons is very common, and is seen frequently in runners, dancers, and as an overuse injury later in life. The vast majority of tendonitis resolves with non-surgical treatment, including anti-inflammatory medications, therapy, soft-tissue massage, dry needling, and injections (steroid or PRP). Occasionally, the gluteus tendons can tear off of the bone, resulting in pain over the outside of the hip, weakness, and often a limp. Non-surgical modalities should be attempted to treat partial tears, but if symptoms fail to improve surgery should be considered.
Partial and full-thickness tears of the gluteus medius and minimus tendons can be repaired using a minimally-invasive, endoscopic approach. Several small incisions are made around the outside of the hip to access and visualize the torn tendon and its bony attachment. The tendon is then repaired using special suture anchors that are inserted into the bone. Suture is then passed through the tendon, and the tendon is then tied back down to its native attachment site. Occasionally, if the tear is chronic, scarred down, or significantly retracted an open approach may be needed.
A gluteus tendon repair is an outpatient surgery, allowing patients to go home the same day. Most patients require a brace after surgery for up to six weeks. The brace is needed to prevent the leg from certain motions and to protect the repair. Weight-bearing (the amount of weight one is able to put on the operative leg) is modified based on the severity of the tendon tear, and crutches will be provided and required after surgery. Therapy will begin immediately to facilitate decreased swelling and pain, muscle activation and motion, and eventually improve strength to maximize function after surgery.