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Gluteus Medius Tears

  • Abductor tears are “rotator cuff of the hip”

  • Clinical presentation

    • rarely a history of a pop or injury, usually it is refractory lateral sided hip pain
    • age > 50
    • females > males (10:1)
    • failed corticosteroid injections
    • abductor weakness
    • trendelenburg gait/sign
    • refractory troch bursitis vs. glut med or minimus tear – this is what you must figure out
  • Literature shows equal results between open and endoscopic repair, but greater complications in open group
  • Gluteus Medius

    • tendon extends much further on the undersurface, so although it looks small on the top, there is tendon underneath
    • double row repair
    • you want to pull it down to meet the vastus lateralis, on the vastus ridge
  • Partial thickness gluteus medius

    • approach a little differently
    • more commonly present as pain and less often as weakness (opposite of full thickness tears)
    • remember to keep shaver pointing away from the glut medius (point toward IT band)
    • longitudinal split
    • place two anchors through the longitudinal split window
      • check on fluoro to make sure you are not going though the piriformis fossa
  • Gluteus Maximus Transfer

    • sometimes needed to supplement
    • open procedure
    • salvage procedure
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