Gluteus medius is one of 3 muscles in the buttocks and is situated on the outer surface of the hip. The function of the gluteus medius is to assist with pelvis stability, hip abduction, along with internal and external rotation of the hip. Tears of the gluteus medius usually occur where the tendon inserts at the greater trochanter, causing lateral hip pain.
Tears of the gluteus medius can occur due to traumatic injury or degenerative conditions such as tendinopathy (chronic inflammation of the gluteus medius tendon). Gluteus medius tears cause pain and weakness on the affected side of the hip.
Initial treatment involves ice, non-steroidal anti-inflammatory drugs (NSAIDs) and activity modification to decrease pain and inflammation. If a severe, full-thickness gluteus medius tear is present, surgical repair may be required.
Gluteus medius repair surgery involves the following steps:
- You will be placed either under general anaesthesia or spinal anaesthesia
- The surgeon makes two or three small incisions, about 1/4 of an inch each, around the hip joint area. Each incision is called a portal. Mid anterior, anterolateral, posterolateral, and distal peritrochanteric portals are made.
- A blunt tube, called a trocar, is inserted into each portal prior to the insertion of the arthroscope and surgical instruments.
- The arthroscope is inserted through the mid- anterior portal, to view the hip joint. The images from the arthroscope guide the surgeon and assist in detection of any anomaly. It also enables the surgeon to see the attachment of the gluteus medius muscle.
- The surgeon conducts a diagnostic endoscopic examination of the peritrochanteric space.
- The other portals are used for the insertion of surgical instruments.
- Debridement of the tears on the under surface of the gluteus tendon and pathologic tendon tissue is performed using a shaver.
- The tear at the lateral facet of the greater trochanter is identified and removed using a bur to stimulate active bleeding which would aid in healing of the repaired tendon
- The tendons are visualised and anchor(s) is/are placed onto the greater trochanter of the femur and a suture is passed through the ruptured tendon. The tendon is then pulled down to its normal anatomic position and tied over the bone.
- After the surgical procedure is complete, the incisions will be closed with sutures or surgical tapes