University of Occupational and Environmental Health Wakamatsu Hospital
orthopedics・Sports arthroscopy
Wakamatsu Hospital for University of Occupational and Environmental Health
Orthopedic and Sports Arthroscopy Surgery
ISAKOS approved Teaching Center
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gluteus medius rupture
Gluteus Medius Tear
Anatomy of the gluteus medius
Origin: Attached to a wide range of the gluteal line from the front to the back of the lateral surface of the ilium.
At rest; lateral surface of greater trochanter
Action; Responsible for hip abduction and pelvic stability.
The anterior portion is responsible for flexion and internal rotation of the hip, and the posterior portion is responsible for external rotation and extension of the hip.
Innervation; superior gluteal nerve (L5-S1)
arterial supply; superior gluteal artery
Gluteus medius rupture is a disorder that causes lateral thigh pain and abductor muscle insufficiency. Gluteus medius and gluteus minimus tears are sometimes referred to as "rotator cuff tears of the hip", mimicking a rotator cuff tear in the shoulder. Causes are classified into traumatic and idiopathic with unknown causes, and are said to be common in women in their 40s to 60s35).
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symptoms
The main symptoms are lateral thigh pain and greater trochanteric tenderness. A Trendelenburg gait may be permitted due to decreased abductor muscle strength.
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diagnose
If weakness of the abductor muscles and lateral thigh pain during abduction load are observed, MRI should be performed. Signal changes at the trochanteric attachment of the gluteus medius muscle and concomitant trochanteric bursitis are often observed 36) (Fig. 9).
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treatment
Surgery if resistant to conservative therapy. In recent years, arthroscopic suturing of the gluteus medius muscle has become possible, and a comparison between open surgery and arthroscopic surgery has been conducted. Although the clinical results are similar, systematic reviews35)36) show that the rate of re-tear is lower with endoscopic surgery, and we also perform endoscopic suturing (Fig. 10). If the gluteus medius muscle is severely degenerated, reconstruction of the gluteus medius muscle with the gluteus maximus flap37) or gluteus medius patch method38) may be performed.