Contemporary Surgical Approaches for Refractory Gluteus Medius Pathology

Trochanteric pain is a highly prevalent clinical entity of lateral hip pain, encompassing bursitis, tendinopathy, and/or rupture of the hip abductor apparatus. It is predominantly observed in middle-aged women. Classically, patients are treated with nonsurgical treatment, consisting of the use of anti-inflammatory drugs, physiotherapy, and infiltrations, owing to the low diagnostic and anatomical precision necessary to indicate the need for surgical management. Within trochanteric pain syndrome, tendinopathy and tendon tears of the abductor musculature are frequent, with degenerative lesions of the gluteus medius and gluteus minimus tendon resulting from a lateral hyperpressure given by the iliotibial band complex, tensor fasciae latae, and gluteus maximus. These lesions may be refractory to conservative management and require surgical management. Endoscopic hip surgery offers a minimally invasive approach with quicker recovery, reduced scarring, and improved aesthetic outcomes; therefore, we have developed our own endoscopic technique for the management of gluteus medius injuries, which encompasses a spectrum of procedures, ranging from lateral decompression and trochanteric perforations in cases of refractory tendinopathy and lesions comprising less than 30% of the gluteus medius tendon thickness to the application of bioinductive collagen patches for lesions exceeding 30%, and culminating in reinsertion with anchors in instances of full-thickness rupture. Our surgical approach provides an alternative for the treatment of gluteus medius lesions refractory to conservative management, obtaining good clinical results with reproducible techniques and a low rate of complications.