Hip Tendon Injuries in the Elite Athlete: Gluteal Tears and Proximal Hamstring Tears

The proximal hamstring origin and gluteal insertion are 2 common sources of hip pain in elite athletes. Acute proximal hamstring tendon injuries may occur secondary to rapid simultaneous hip flexion and knee extension. Chronic proximal hamstring tendinopathy and partial tearing typically is observed in endurance athletes and most commonly seen in runners. A frequent mechanism responsible for this is ischiofemoral impingement from the lesser trochanter with repetitive damage to the proximal hamstring origin. A weak abductor moment and narrowing of the ischiofemoral space results in the attritional injury, beginning anteriorly at the junction of the quadratus femoris and semimembranosus. Gluteal tendon pathology is a common inciting event for proximal hamstring pain. The cornerstone of nonsurgical treatment for proximal hamstring is education-driven supervised and skilled physical therapy. Endoscopic repair may be performed for partial-thickness and full-thickness tears without significant retraction. Open repair may be performed for both partial- and full-thickness tears with or without retraction. Symptomatic gluteal tendon pathology most frequently occurs in older individuals. Lateral peritrochanteric hip pain with walking is a common chief complaint. Nocturnal symptoms are also often reported. The mainstay of nonsurgical treatment is education-driven supervised physical therapy. Surgical treatment, similar to that of the proximal hamstring, can be safely and effectively performed with either endoscopic or open approaches. Endoscopic repair may be performed for partial- and small full-thickness tears without significant retraction. Open repair may be performed for all tear types and patterns.