Anatomic considerations for open and endoscopic gluteal tendon surgery

Abstract

The tendons of the gluteus medius and minimus serve as the main abductors of the hip joint. Structural compromise of these tendons can be a source of lateral hip pain, weakness, and gait abnormalities. Surgical repair of gluteus medius or minimus tears is associated with reliable improvement in pain and function, but the anatomy of the lateral hip is often poorly understood despite being of paramount importance to the hip surgeon. The osteology of the greater trochanter is complex. The lateral trochanter comprises 4 facets: anterior, lateral, posterior, and superoposterior. The gluteus minimus mainly inserts on the anterior facet with additional fibers attaching to the hip capsule itself. The gluteus medius has 2 parts. The thicker posterior part inserts on the superoposterior facet and functions to stabilize the femoral head in the acetabulum during gait. The thinner anterolateral part inserts on the lateral facet. The anterolateral part of the gluteus medius is the most frequently torn portion of the hip abductor complex. Gluteal tendon avulsions should be repaired to their anatomic insertion sites, and therefore, a detailed understanding of both the osteology and soft tissue surrounding the lateral hip is important for the surgeon performing repairs of the hip abductor mechanism.