Gluteus Medius / Minimus Repair

Why this approach — at MOS

Gluteus medius tears are one of the most commonly missed diagnoses in orthopedic hip care. A patient who has received multiple cortisone injections for "bursitis" without lasting improvement, or who continues to limp despite adequate conservative treatment, deserves an MRI to evaluate the gluteal tendons directly. The diagnosis often explains years of inadequately treated lateral hip pain.

Dr. Christoforetti's approach involves a thorough clinical assessment — including a Trendelenburg gait analysis, manual muscle testing of hip abduction, palpation of the trochanteric footprint, and provocative testing — followed by MRI review. When a tear is confirmed and surgery is warranted, the repair technique — arthroscopic vs. mini-open — is selected based on tear size, pattern, and the need for simultaneous intra-articular work.

Both arthroscopic and mini-open gluteal repairs produce equivalent functional outcomes based on published systematic review data. The arthroscopic approach allows simultaneous treatment of any intra-articular problem (labral tear, FAI) in the same setting and avoids the larger incision of open surgery. The mini-open approach provides direct visualization that may be preferable for large or complex tear patterns.

Patients in Montgomery County with chronic lateral hip pain that has not responded to treatment are encouraged to call (301) 515-0900 for an evaluation.

Who is a candidate?

Indications

• Partial or complete gluteus medius or minimus tendon tear confirmed on MRI
• Persistent lateral hip pain, tenderness over the greater trochanter, and/or a positive Trendelenburg gait (pelvis drops to opposite side during stance)
• Failure of conservative management (physical therapy, NSAIDs, cortisone injections) for 3–6 months
• Functional limitation — difficulty walking, climbing stairs, or sleeping on the affected side
• Age: most commonly affects women in their 50s–70s, though can occur in active individuals of any age or gender

Contraindications

• Mild partial tears with minimal functional impact — conservative management appropriate first
• Advanced hip osteoarthritis as the primary source of lateral hip pain
• Significant medical comorbidities that increase surgical risk
• Patient unable to comply with post-operative weight-bearing restrictions and rehabilitation

Conservative Treatment First

Gluteus medius tears are treated conservatively first. Physical therapy targeting hip abductor strengthening, iliotibial band stretching, and gait retraining can reduce pain and improve function in partial tears with less functional impairment. Cortisone injection into the trochanteric bursa reduces inflammation and pain but does not heal a torn tendon. Platelet-rich plasma (PRP) injection is sometimes tried for partial-thickness tears, though evidence is limited. Activity modification — reducing or eliminating activities that aggravate symptoms — is always part of the initial plan.

Surgery is considered when a tear is confirmed on MRI, functional limitation is significant, and 3–6 months of consistent non-operative care has not provided adequate relief. Complete tears, in particular, are unlikely to heal without surgical repair and often warrant earlier surgical consideration.

The procedure

What Is Gluteus Medius / Minimus Repair?

Gluteus medius and minimus repair is a surgical procedure — performed arthroscopically or through a small (mini-open) incision — that reattaches torn hip abductor tendons back to the greater trochanter. These tears cause persistent lateral hip pain and limping, and are frequently misdiagnosed as trochanteric bursitis, particularly in women over 50.

The gluteus medius and gluteus minimus are the primary hip abductor muscles — they lift the leg out to the side and, more importantly, stabilize the pelvis during walking, preventing the pelvis from dropping toward the non-stance leg with each step. These muscles are often called the "rotator cuff of the hip" because their anatomy, function, and tear patterns closely parallel the rotator cuff of the shoulder.

Both muscles originate from the outer surface of the ilium (the large blade of the pelvis) and converge into tendons that attach to the greater trochanter — the bony prominence on the outer thigh. The gluteus medius has an anterior and posterior insertion band on the superolateral and posterior facets of the greater trochanter. The smaller gluteus minimus attaches to the anterior facet.

Tears of these tendons — particularly at the posterior footprint of the gluteus medius — cause a characteristic lateral hip pain that is worse with walking, climbing stairs, lying on the affected side, and activity. Because the greater trochanteric bursa sits directly over the insertion and also becomes inflamed in response to the tendon problem, these patients are often labeled as having "trochanteric bursitis" and treated with cortisone injections — which may help temporarily but do not repair the torn tendon. The correct diagnosis requires an MRI.

What Happens During Gluteus Medius / Minimus Repair?

The procedure is performed at an ambulatory surgery center under general anesthesia with a nerve block for post-operative pain control. The patient is positioned in the lateral decubitus (side-lying) position with the affected hip facing up.

Peritrochanteric Access For an arthroscopic repair, portals are placed around the greater trochanter (peritrochanteric portals) — separate from the intra-articular portals used for hip arthroscopy. The trochanteric bursa is visualized and debrided. The gluteus medius and minimus tendons are inspected, and the tear is characterized — partial or complete, anterior or posterior insertion involvement.

For a mini-open repair, a small incision (4–6 cm) is made directly over the greater trochanter. The iliotibial band is split longitudinally and the bursa is entered, exposing the tendon insertion directly.

Tendon Repair The trochanteric footprint is prepared with a burr to create a bleeding bony surface for healing. Suture anchors are placed into the greater trochanter at the normal tendon insertion site. Sutures are passed through the full thickness of the torn tendon using a passer. The sutures are tied, pulling the tendon back to the trochanteric footprint. For large or retracted tears, multiple anchors and suture configurations may be needed.

If trochanteric bursitis is present, the bursa is debrided or excised as part of the same procedure. If an intra-articular hip problem (labral tear, FAI) coexists, the surgeon may address both the intra-articular pathology and the peritrochanteric problem at the same setting through separate portals.

Closure is performed in layers. The procedure typically takes 60–90 minutes.

Recovery timeline

Frequently Asked Questions