Abductor (Gluteus) Repair

Gluteus Medius and Minimus (Abductor) Repair

What are hip abductors?

The movement of the leg away from the midline of the body is called hip abduction. This movement is a combined contraction of 4 muscles found in the buttocks. The muscle grouping, called hip abductors, include the tensor fascia lata, gluteus maximus, gluteus medius and gluteus minimus. The hip abductors contribute to the ability to walk, stand and rotate the legs. During a traumatic event, such as direct impact sustained during sports competition or a hard fall, the tendinous attachment of these muscles can peel-off at their attachment site on the greater trochanter, an area near the top portion of the femur (thigh bone). Most commonly the gluteus medius and gluteus minimus tendons sustain injury and tearing. This can occur as a result of trauma or chronic degeneration of the tendon. Dr. Benedict Nwachukwu, orthopedic hip surgeon serving patients in Manhattan, New York City and the surrounding New York boroughs, specializes in hip abductor repair and treatment.

What is a gluteus medius/minimus (hip abductor) tear?

The gluteus medius and minimus are situated on the outer surface of the hip. The specific function of these glute muscles is to assist with pelvis stability, hip abduction, as well as internal and external rotation of the hip. Tears of the gluteus medius and minimus usually occur where the tendons insert at the greater trochanter, causing lateral hip pain. Gluteus medius tears in particular often occur from an injury or degenerative conditions such as tendinopathy (chronic inflammation of the gluteus medius tendon).

What are the symptoms of a hip abductor tear?

One of the main symptoms of a gluteus medius or minimus tear is the presence of Trendelenburg sign – dropping of the pelvis towards the unaffected side by being unable to bear weight on the affected limb. Other symptoms include:

• Pain and tenderness over the lateral aspect of the hip
• Pain that worsens with activity such as walking, running or climbing stairs
• Deep pain that worsens when sitting or lying on the affected side of the hip

What is an abductor or gluteus repair?

Non-Surgical Treatment:

Injury to the gluteus medius and minimus muscles may cause significant pain and interfere with daily activities. When this occurs, a gluteus medius and/or gluteus minimus treatment may be recommended by Dr. Nwachukwu. He prefers to treat an initial strain or tear conservatively by controlling pain and strengthening the surrounding muscles through physical therapy.

Surgical Treatment:

If a patient’s symptoms and functional limitations fail to improve, Dr. Nwachukwu may recommend repair of the tendon at the attachment site. Recent advances in orthopedic surgery allow this procedure to be done endoscopically, which offers a minimally invasive technique that can ease recovery and improve outcomes.

Often endoscopic repair of the gluteus medius or minimus tendons is accompanied with removal of surrounding tissue that can become irritated, known as the greater trochanter bursa. Additionally, a tight band of tissue overlying the area, the iliotibial band, may be released. This helps improve visualization of the normal tendon attachment site and can help decrease pain associated with bursitis.

During an endoscopic abductor repair, small “key-hole” type incisions are made in the skin on the outside of the hip. Small, narrow instruments are used to secure the torn gluteus medius or minimus tendon back down to their attachment site near the top of the femur on the greater trochanter. Suture anchors are embedded in the bone and the strands of sutures are then passed through the pulled-off portion of the tendon using specialized passing instruments. By tying these sutures down tightly, the torn tendon is once again attached to the bone.

What is an open abductor or gluteal repair?

If a patient in New York has experienced a large or complete tear of the abductor muscles, Dr. Nwachukwu may manage the injury with an open procedure to maximize the success of the repair.

Chronic abductor tears or tears where there is significant muscle atrophy and tendon retraction can be difficult to treat since, in some of these cases, there is nothing left to repair. In these challenging cases, reconstructive surgery may be a viable option. Hip abductor reconstruction involves taking a piece of cadaver tissue and augmenting the repair of the abductor. This open surgery technique can be very effective when performed by Dr. Nwachukwu and under the right circumstances.

How long is the recovery after an abductor repair?

Following an abductor repair, patients are instructed to avoid full weight bearing on the affected limb for 4 to 6 weeks to allow the body to heal the repair. During this recovery time, patients will avoid certain hip motions but will be allowed to move the hip with the guidance of a therapist. Ongoing precautions should be used for the first 4 months, with a return to normal activities in about 6 months.

For more information on abductor repair or on treatment options available for a torn gluteus, please contact the office of Benedict Nwachukwu, MD, orthopedic hip surgeon, serving Manhattan, New York City and surrounding New York boroughs.  

Hip Abductor Tear