Gluteal Tendon Repair
Surgical Repair to Restore Strength and Function Following A Gluteal Tendon Tear
Gluteal tendon injuries are a leading cause of hip pain, especially in middle-aged and older adults. These injuries affect the tendons of the gluteus medius and gluteus minimus muscles, which are essential for stabilising the hip and enabling movements such as walking, climbing stairs, and balancing on one leg.
In the past, pain on the outer side of the hip was often misdiagnosed as ‘trochanteric bursitis’ however, recent advancements in imaging and research have revealed that this pain is frequently due to tears in the gluteal tendons where they attach to the bone. Damage to these tendons – whether from degeneration, overuse, or trauma can lead to significant pain, weakness, and reduced mobility so, when conservative treatments like physiotherapy, anti-inflammatory medications, and activity modifications do not provide sufficient relief, gluteal tendon repair surgery may be recommended to restore function and alleviate discomfort.
WHAT ARE THE GLUTEAL TENDONS?
The gluteal tendons are essential structures that connect the gluteal muscles—specifically the gluteus medius and gluteus minimus to the greater trochanter, which is the bony prominence on the side of your hip. These muscles play a crucial role in stabilising the hip and pelvis, ensuring balance and enabling smooth, coordinated movements, such as walking or shifting weight from one leg to the other.
The highly developed gluteal muscles allow for steady, aligned movement when walking. When these muscles or their tendons are damaged, it can lead to difficulty walking and may result in a noticeable limp.
WHAT HAPPENS WHEN THE GLUTEAL TENDONS ARE TORN?
When a tear occurs in the gluteal tendons, it can lead to significant discomfort, particularly around the outer hip, often radiating down the thigh to the knee. You might also notice a limp or difficulty with certain movements.
Typically, such tears are preceded by tendinopathy—a condition where the tendon undergoes internal changes that weaken it, making it more prone to tearing.
Gluteal tendon tears are commonly classified into:
- Partial Thickness Tears: The tear does not extend through the entire depth of the tendon.
- Full Thickness Tears: The tear extends through the tendon, potentially causing significant pain and functional impairment.
- Avulsion Tears: In severe cases, the tendon can be completely detached from the bone.
Common symptoms of a gluteal tendon tear include:
- Persistent pain on the outside of the hip, which may radiate down the thigh.
- Difficulty lying on the affected side.
- Weakness in the hip, making it difficult to walk or climb stairs.
- A limp or altered gait to avoid putting weight on the affected hip.
THE GLUTEAL TENDON REPAIR PROCEDURE
Gluteal tendon repair is a surgical procedure aimed at reattaching the torn tendons to the greater trochanter to restore hip function and alleviate pain. Traditionally, this surgery was performed through an open technique with a large incision, similar to that used in hip replacement surgery however, advancements in surgical techniques now allow for minimally invasive arthroscopic repair, which involves smaller incisions and the use of specialised instruments.
SURGICAL TECHNIQUES
Gluteal tendon repair can be performed using open surgery or minimally invasive arthroscopic techniques, depending on the extent of the tear and your specific condition. Dr Liddell will assess the best approach for you based on your specific conditions.
- Arthroscopic Repair: This technique involves making two or three small incisions around the hip. Thin telescopes and instruments are inserted to visualise and repair the tendons. This approach is less invasive, potentially leading to a quicker recovery and reduced post-operative pain.
- Open Repair: In cases of severe damage or when the tendon is completely detached from the bone, an open surgical approach may be necessary. This method provides direct access to the tendons, allowing for a more robust and thorough repair.
WHAT TO EXPECT AFTER GLUTEAL REPAIR SURGERY
After surgery, the hip will be immobilised to allow the tendon to heal. Weight-bearing on the affected leg may be limited for several weeks, and crutches or a walker may be necessary during this time.
Pain management is achieved through medications prescribed by Dr Liddell, and ice therapy may be recommended to reduce swelling.
Rehabilitation: Physiotherapy is a critical component of recovery, beginning with gentle range-of-motion exercises to prevent stiffness. As healing progresses, strengthening exercises will be introduced to rebuild muscle strength and improve hip stability.
Full recovery can take several months, and adherence to the rehabilitation program is essential to achieving the best possible outcome.
LONG-TERM OUTCOMES AND FOLLOW-UP FOLLOWING GLUTEAL TENDON REPAIR
Most patients experience significant pain relief and improved function after gluteal tendon repair surgery. However, it is important to follow all post-operative care instructions and engage in ongoing physiotherapy to maximise the chances of a successful recovery.
RISKS AND COMPLICATIONS
As with any surgical procedure, gluteal tendon repair carries potential risks, including:
- Infection at the surgical site.
- Blood clots (deep vein thrombosis)
- Nerve or blood vessel damage
- Re-tear of the tendon, particularly if rehabilitation protocols are not followed
- Persistent pain or stiffness.
Dr Liddell will discuss these risks with you and take steps to minimise them, ensuring you are well-informed and prepared for the procedure.
Gluteal tendon repair is a specialised procedure aimed at restoring hip function and relieving pain for patients who have not responded to conservative treatments. With the expertise of Dr Scott Tulloch and a comprehensive rehabilitation program, patients can expect a significant improvement in their quality-of-life following surgery.