Comparative Efficacy of Biologic Augmentations in Gluteus Medius Tendon Repair is Lacking: A Systematic Review.

Abstract

Introduction: Gluteus medius tendon (GMT) tears are a widely recognized source of lateral hip pain and weakness. While surgical repair often leads to symptom relief, outcomes are less favorable in cases involving chronic or high-grade tears. To improve healing, a variety of biologic augmentation strategies have been explored, including platelet-rich plasma (PRP), platelet-rich fibrin matrix (PRFM), collagen patches, dermal allografts, synthetic scaffolds, and bone marrow aspirate concentrate (BMAC). However, their effectiveness remains uncertain.

Objective: To systematically review published clinical outcomes associated with different biologic augmentation techniques used in GMT repair.

Methods: A systematic literature search was conducted through PubMed, Cochrane Library, and Embase for studies published between 2000 and 2025 reporting on the surgical repair of GMT tears with biologic augmentation. Data extracted included study design, type of biologic intervention, and postoperative clinical and imaging outcomes.

Results: A total of four studies comprising 123 hips were included, and all studies reported improvements in patient reported outcomes following surgical repair. However, the two available comparative studies found no significant differences in pain or function between augmented and unaugmented repairs. Case series of collagen patch augmentation demonstrated favorable structural healing in early clinical outcomes, while synthetic mesh combined with muscle transfer showed improvement in patients with irreparable tears.

Conclusion: While biologic augmentation in GMT repair appears safe and technically feasible, more data needs to be published relative to the results obtained with commonly used orthobiologic augmentation to determine if and under what circumstances such treatment provides consistent clinical advantage over standard repair.