Operative Repair of Bilateral Spontaneous Gluteus Medius and Minimus Tendon Ruptures

Abstract

Spontaneous avulsion or rupture of the gluteus medius and minimus tendons may be an unrecognized source of debilitating pain in the lateral part of the hip1-3. Because of the difficulty in diagnosing the condition on the basis of routine history and physical examination, patients who present with ruptures of the gluteus medius or minimus tendons are often diagnosed as having greater trochanteric pain syndrome, which is a term used to denote trochanteric bursitis1,4. Patients with pain in the lateral part of the hip are often treated for bursitis, and therefore a ruptured tendon may go undiagnosed. As radiographic findings are generally absent, it may be necessary to acquire magnetic resonance images to make an accurate diagnosis2,5-7. Common conditions associated with greater trochanteric pain syndrome include degenerative diseases of the lumbar spine, arthritis of the hip, pelvic obliquity, iliotibial band and abductor tendinitis, and difference in the lengths of the lower limbs4,8,9. The cause of tendinosis and ruptures of the gluteus medius and minimus tendons is uncertain, but may be related to local mechanical trauma or predisposing systemic conditions10,11. The gluteus medius and minimus are part of the abductor apparatus. They can be considered analogous to the rotator cuff of the shoulder and thus are predisposed to rupture in a similar manner12-14. We report the clinical presentation, radiographic findings, and surgical management of a patient diagnosed with bilateral spontaneous ruptures of the gluteus medius and minimus tendons. Our patient is unique in that she was young and had bilateral ruptures, yet she had no known predisposing condition for tendon rupture. In addition, the ruptures occurred five years apart. Our patient was informed that …