Trochanteric Pain Research Articles

Musculoskeletal mimics for lumbosacral radiculopathy. Part 2: Specific disorders.

Lumbosacral radiculopathy is a common disorder evaluated by the electrodiagnostic medicine (EDX) consultant. Making this task difficult is the abundance of radiculopathy mimics. Peripheral neurologic mimics are common, but musculoskeletal mimics are not rare and may be less familiar to many EDX consultants. Awareness of the most common musculoskeletal mimickers-particularly key historical and physical examination features that can distinguish them from radiculopathies-can lead to an accurate diagnosis for the patient and referring provider. Part 1 of this monograph covered theoretical issues surrounding why radiculopathy mimics occur. This second part reviews the most common musculoskeletal mimics, including facet arthropathy, myofascial pain syndrome, hip pathology, greater trochanteric pain syndrome, piriformis syndrome, sacroiliac joint dysfunction, hamstring pathology, iliotibial band syndrome, and plantar fasciitis. Diagnosis of these musculoskeletal mimickers is complicated by nonspecific physical examination and imaging findings, and diagnostic injections are frequently necessary to confirm the diagnosis. Treatment for most mimickers includes physical therapy, anti-inflammatory medications, guided injections, and other conservative measures, only rarely followed by surgical intervention. EDX consultants can efficiently incorporate a few high-yield maneuvers into their physical examination based on the location of the pain to provide answers to patients presenting with a musculoskeletal mimic of a lumbosacral radiculopathy.

Surgical Technique: Using an Acellular Dermal Allograft and Bioresorbable Wick Scaffold During Endoscopic Gluteus Medius and Minimus Repair

Lateral hip pain, also known as greater trochanteric pain syndrome, encompasses a spectrum of pathology, including trochanteric bursitis, gluteus medius and minimus tears, and iliotibial band pathology. Patients with greater trochanteric pain syndrome can have tearing of the hip abductors, leading to refractory pain that may necessitate surgical repair. Compared to an open approach, endoscopic gluteus tendon repair is becoming more popular and has been shown to decrease morbidity. Similar to rotator cuff repairs, hip abductor repairs are subject to failure secondary to many factors. These include poor biology, tear size, tissue quality, and deficiency of tendon-to-bone healing. Previous work included the use of acellular dermal allograft to augment at-risk gluteus medius and minimus repairs and improve repair strength. The following technique utilizes a rotium bioresorbable wick scaffold at the bone-tendon interface in addition to an acellular dermal allograft covering the repair in a “biological sandwich” to further augment repair. This technique focuses on the addition of rotium augment implementation and fixation in a safe and reproducible manner.

Transarterial Embolization for Musculoskeletal Pain Management: AJR Expert Panel Narrative Review.

Musculoskeletal embolization has emerged in recent years as a treatment for chronic joint pain, as the inflammatory cascade responsible for such pain has become better understood. Studies have demonstrated a complex interplay between joint inflammation and synovial hypervascularity that causes growth of new unmyelinated nerve fibers responsible for pain. Embolization targets joint hypervascularity, to disrupt the inflammatory cycle and provide pain relief. The standard treatment algorithm for chronic joint pain is well-established and entails escalating therapeutic options that include exercise, self-management programs, analgesic medications, intra-articular injections, and finally surgical replacement or release. Genicular artery embolization (GAE), targeting abnormal vasculature around the knee joint, is the most heavily studied musucloskeletal embolization procedure, reflecting the high worldwide prevalence and increasing incidence of knee osteoarthritis. GAE is now supported by multiple prospective studies, including randomized control trials comparing GAE versus sham treatment. Embolization has also extended outside of the knee joint to include the shoulder (treatment of adhesive capsulitis or secondary stiff shoulder), elbow (medial/lateral epicondylitis), hip (osteoarthritis, great trochanteric pain syndrome), and ankle (plantar fasciitis). This AJR Expert Panel Narrative Review discusses the current status of transarterial embolization for musculoskeletal pain management, focusing on treatment of knee osteoarthritis and chronic shoulder pain.

Greater Trochanteric Pain Syndrome and the Efficacy of Platelet-Rich Plasma Injections: A Systematic Review

Greater Trochanteric Pain Syndrome and the Efficacy of Platelet-Rich Plasma Injections: A Systematic Review

Change in Femoral Offset after Closed Reduction and Dynamic Hip Screw Osteosynthesis Via Lateral Approach in Patients with Medial Femoral Neck Fracture: A Retrospective Analysis.

Closed reduction and dynamic hip screw (DHS) osteosynthesis are preferred as joint-preserving therapy in case of medial femoral neck fractures (MFNFs). A change in the femoral offset (CFO) can cause gait abnormality, impingement, or greater trochanteric pain syndrome. It is unknown whether the femoral offset (FO) can be postoperatively fully restored. The aim of the study was to investigate the extent of a possible CFO in hip joints after DHS osteosynthesis in the case of an MFNF. In this retrospective study, 104 patients (mean age: 71.02 years, men: n = 50, women: n = 54) with MFNF who underwent closed reduction and DHS osteosynthesis were analyzed by postoperative x-rays to assess CFO between the operated (OS) and nonoperated joint side (NOS). The studies covered the time period 2010-2020. A statistical comparison was performed between the mean values of FO between OS and NOS, taking into account patient age, gender, and fracture severity. All operated hip joints showed a CFO. In 76.0% (79 of 104), the FO decreased (FOD), and in 24.0% (25 of 104), the FO increased (FOI). A critical CFO (>15% CFO) was detected in 52.9% (55 of 104). In hip joints with postoperative FOD, the mean FO between NOS (49.15 mm [±6.56]) and OS (39.32 mm [±7.87]) and in hip joints with postoperative FOI the mean FO between NOS (41.59 [±8.21]) and OS (47.27 [±6.68]) differed significantly (p < 0.001). Preoperative FO (rS: -0.41; p > 0.001) and caput-collum-diaphyseal angle (CCD; rS: 0.34; p > 0.001) correlated with postoperative CFO. FOD was found in hip joints with a preoperative FO >44 mm and CCD <134° vice versa FOI in hip joints with a preoperative FO <44 mm and CCD >134°. Closed reduction and DHS osteosynthesis in patients with MFNF result in a clustered significant CFO. The individual FO should be taken into account pre- and intraoperatively to avoid a postoperative extensive CFO.

Offset Considerations in Total Hip Arthroplasty.

To perform total hip arthroplasty (THA) successfully, a surgeon must be able to place the implants in a position that will restore and duplicate the patient's baseline anatomy and soft-tissue tension. One of the critical factors is the restoration of femoral offset. It is the goal of this review to precisely define measurement of offset in THA, describe its role in hip joint biomechanics, outline alterations that can be performed intraoperatively, and explain how it can create potential pathologic states. If there is a lack of offset restoration, it can result in a host of complications, including bony impingement with pain, edge loading or prosthetic joint instability, and alterations in the muscle length-tension relationship leading to reduced motor performance. Excessive femoral offset can increase hip abductor muscle and iliotibial band tension resulting in greater trochanteric pain regardless of the surgical approach. The purpose of this review was to analyze intraoperative surgical factors, choice of prosthetic implant type and position that are required to maximize stability, and dynamic motor performance after THA.

UK physiotherapists’ perceptions on providing face-to-face and virtual rehabilitation for patients with Greater Trochanteric Pain Syndrome (GTPS): A cross-sectional survey

BackgroundGreater Trochanteric Pain Syndrome (GTPS) is a prevalent and debilitating cause of lateral hip pain. Physiotherapists often prescribe exercises and educate patients on self-management strategies. Virtual consultations have increased since COVID-19. Rehabilitating patients with GTPS virtually may offer benefits to patients and healthcare providers. ObjectivesUnderstand physiotherapists' perceived effectiveness of providing rehabilitation for people with GTPS virtually compared to face-to-face. DesignCross-sectional survey. MethodsAn internet-based survey was distributed via Twitter (now X). The survey included participant characteristics and 5-point Likert scales to rate the perceived effectiveness (higher score is more effective) of each consult method to deliver treatments for GTPS. Descriptive and inferential statistics were calculated to compare effectiveness between consultation types. Results54 physiotherapists responded. Overall, physiotherapists felt they were more effective at managing patients face-to-face compared to virtually with median scores of 5 (IQR 4–5) to 3 (IQR 2–4) respectively (P < 0.001). Physiotherapists rated themselves more effective at delivering exercise interventions and most educational components face-to-face compared to virtually. Coaching exercises and checking exercise technique received the lowest rating with virtual consults. Higher levels of post-graduate education and confidence in technology were associated with higher perceptions of virtual consults (P < 0.05). There has been a significant increase in virtual practice since COVID-19 (P < 0.001), despite few physiotherapists receiving training. ConclusionPhysiotherapists rated themselves as more effective in treating patients with GTPS face-to-face compared to virtually in almost all aspects of rehabilitation. However, virtual consultations still scored highly in self-management support and specific aspects of exercise and education.

The effect of corticosteroid injections in the treatment of greater trochanteric pain syndrome: lessons for advanced practitioners

Greater trochanteric pain syndrome (GTPS) is a broad term employed to characterise lateral hip pain originating from the structures attached to the greater trochanter of the femur. It can lead to a decrease in work participation, elevated levels of pain and dysfunction impeding physical activity and a diminished quality of life; these features align with those observed in individuals with severe hip osteoarthritis. Effectively managing GTPS can present considerable challenges. Generally, patients with GTPS tend to respond favourably to conservative management techniques, such as corticosteroid injections. However, there is still some debate regarding the specific estimation of effect that corticosteroid injections have. This was recently explored in a systematic review by Wang et al (2022) . This commentary critically assesses the methodologies used in the review and provides a broader understanding of its findings in the context of the four pillars of advanced practice: clinical practice, leadership, education and research.

Do platelet-rich plasma lateral hip (Greater Trochanteric Pain Syndrome) injections improve patient pain scores compared to corticosteroid injections?

Do platelet-rich plasma lateral hip (Greater Trochanteric Pain Syndrome) injections improve patient pain scores compared to corticosteroid injections?

Reliability of ultrasound shear-wave elastography in assessing tensor fascia latae, gluteus medius, and iliotibial band elasticity in health individuals

Purpose: Gluteus medius (GMed), tensor fascia latae (TFL), and iliotibial band (ITB) play important roles in stabilizing the hip joint and are often prone to overuse syndromes such as greater trochanteric pain syndrome and runner’s knee. Shear-wave elastography (SWE) presents a new avenue for rapidly assessing these structures in an out-patient setting. This study aims to assess the intra- and interobserver reliability of sWE in evaluating the GMed, TFL, and ITB. Materials and Methods: Twelve healthy volunteers (6 men and 6 women) were examined by two physiatrists using SWE. To assess inter-observer reliability, both physiatrists measured the thickness, velocity, and stiffness of GMed, TFL, and proximal and distal ITB. One physiatrist repeated the same measurements under identical conditions one week later to assess intra-observer reliability. Intra-class correlation coefficients (ICC) were calculated to evaluate reliability. Results: Inter-observer measurements showed poor reliability (ICC &lt; 0.4) for all parameters, except for GMed thickness (ICC=0.412), which was moderately reliable. Intra-observer measurements showed varying degrees of reliability, with TFL thickness (ICC=0.733), ITBP thickness (ICC=0.592), ITBD velocity (ICC=0.634), and ITBD stiffness (ICC=0.701) demonstrating moderate reliability. However, no excellent ICC scores were observed across both intra- and inter-observer assessments. Conclusion: While SWE demonstrates promise in assessing hip stabilizers, its inconsistent reliability across different parameters highlights the need for further research. Comparative studies involving healthy and pathological groups are needed for better understanding of SWE’s applicability in clinical settings.

Ultrasound-Guided Blockade of the Lateral Cutaneous Branch of the Iliohypogastric Nerve to Differentiate Neuropathy From Greater Trochanteric Pain Syndrome: Cadaver Study and Initial Case Series

ObjectiveNeuropathy of the lateral cutaneous branch of the iliohypogastric nerve (LCBIN) may represent a differential diagnosis for greater trochanteric pain syndrome (GTPS). Ultrasound-guided neural blockade of the LCBIN may lead to diagnosis of this neuropathy. The aim of this study was to evaluate the accuracy of ultrasound-guided nerve block in cadavers and to present a first clinical case series of patients with neuropathy of the LCBIN where the workup for GTPS remained unremarkable. Ultrasound-guided nerve block led to pain relief in these patients, indicating LCBIN neuropathy. MethodsFirst, ultrasound-guided injections at the LCBIN were performed bilaterally in 24 fresh, non-frozen, non-embalmed body donors. Accuracy and nerve localization were validated by anatomic dissection. Second, a clinical case series of nine patients with suspected GTPS who underwent ultrasound-guided diagnostic LCBIN blockade was retrospectively analyzed. ResultsUltrasound-guided injections at the LCBIN yielded 91.7% accuracy (95% confidence interval: 0.80–0.98). On the right side the nerve was found within a range of 3–14 cm from the anterior superior iliac spine, and within a range of 7–15 cm on the left side. This clinical case series indicates that ultrasound-guided blockade at the LCBIN provides temporary pain relief and indicates the presence of LCBIN neuropathy. ConclusionUltrasound has demonstrated high accuracy for localization and injection guidance in the examination of LCBIN. Ultrasound-guided injection of local anesthetics may help to identify LCBIN neuropathy as a differential diagnosis in patients with suspected GTPS.

Victorian Institute of Sport Assessment questionnaire specifically tailored for greater trochanteric pain syndrome for the Dutch population

Abstract Greater trochanteric pain syndrome (GTPS) is a highly prevalent condition characterized by lateral hip and thigh pain. The Victorian Institute of Sport Assessment (VISA) questionnaire specifically tailored for GTPS (VISA-G) questionnaire was developed for the purpose of assessing and quantifying the severity of symptoms related to gluteal tendinopathy or GTPS. It is commonly used in research and clinical settings to evaluate the impact of GTPS on patient function and quality of life. The VISA-G questionnaire was developed for English-speaking populations. Before this questionnaire can be used in non-English-speaking populations, it has to be translated and validated for a particular population. The current study aimed to translate and validate the VISA-G questionnaire for a Dutch-speaking context (VISA-G-Dutch). In this study, we conducted a comprehensive process involving forward and back translation, along with a thorough comparison with other established hip-related questionnaires. The COSMIN checklist was used to ensure uniformity in the validation study. A sample of 100 participants, 50 symptomatic and 50 asymptomatic, completed the VISA-G-Dutch, Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, Oxford Hip Score, and Nonarthritic Hip Score questionnaires. Internal consistency and test–retest reliability were measured. Construct validity was assessed through positive correlations between the VISA-G-Dutch and gold standard questionnaires. Strong internal consistency and test–retest reliability correlations were found in both the asymptomatic and symptomatic groups. The test–retest reliability also demonstrated strong positive correlations for the symptomatic group. The standard error of measurement was ∼2.3 for the symptomatic group. These results prove that the VISA-G-Dutch is a reliable and valid tool for assessing GTPS and gluteal tendinopathy in Dutch-speaking individuals, providing clinicians with a valuable assessment tool.

Extracorporeal Shockwave Therapy for Greater Trochanteric Pain Syndrome: A Systematic Review with Meta-Analysis of Randomized Clinical Trials.

Greater trochanteric pain syndrome (GTPS) affects 17.6% of adults aged 50 to 79 years, particularly women. While exercise therapy and corticosteroid injections (CSIs) are common treatments, their limitations include inadequate pain control and potential tendon weakening. Extracorporeal shockwave therapy (ESWT) is an emerging alternative for GTPS. This systematic review assessed ESWT's efficacy in GTPS by evaluating pain and functional outcomes at different follow-up intervals. A literature search of PubMed, Embase, and Web of Science for randomized clinical trials (RCTs) was conducted comparing ESWT with other GTPS treatments up to March 1, 2024. Two reviewers independently extracted data, assessing study quality using the Cochrane risk-of-bias tool. A random-effects pairwise meta-analysis compared ESWT with other treatments. Eight RCTs involving 754 patients (169 male, 585 female patients) were included. Seven RCTs were deemed high risk of bias, and 1 RCT had some concerns. Five RCTs investigated focused on focused ESWT, and 3 examined radial ESWT. ESWT provided significantly lower pain scores than other treatments at 2 to 4 months (standardized mean difference = -0.431; 95% confidence interval [CI], -0.82 to -0.039; I2 = 83%). Functional improvement (Lower Extremity Functional Scale) was significantly higher at 6 months (weighted mean difference = 6.68; 95% CI, 3.11-10.25; I2 = 0%) but did not exceed the minimal clinically important difference. Focused ESWT provided greater pain reduction than radial ESWT. Three weekly ESWT sessions offer short-term pain relief at 2 to 4 months for patients with GTPS, especially with focused ESWT. Functional improvements at 6 months were notable but not clinically significant. These findings suggest ESWT may complement or serve as an alternative to CSIs and exercise. However, caution is needed when interpreting these results due to high risk of bias with the included RCTs and heterogeneity across the studies. Further high-quality trials are needed to confirm ESWT's long-term benefits over other treatments. Level II. See Instructions for Authors for a complete description of levels of evidence.

La instilación preoperatoria de epinefrina y lidocaína puede reducir el tiempo quirúrgico del tratamiento endoscópico del SDTM

IntroductionGreater Trochanteric Pain Syndrome (GTPS) is a multifactorial clinical condition affecting the lateral area of the hip. Although conservative treatment shows good results, some patients may still require surgical bursectomy, which can be performed either openly or endoscopically. One of the main technical difficulties of the endoscopic procedure is intraoperative bleeding, which can hinder the medical team's vision and increase the operation time for endoscopic treatment of GTPS. Hypothesis: An instillation of vasoconstrictors and local anesthetics before endoscopy will cause less intraoperative bleeding, which will translate into shorter surgical time. Materials and methodsA prospective cohort was retrospectively divided based on the use or absence of a preoperative instillation of physiological saline solution with epinephrine and lidocaine. Surgical time was measured in each procedure and compared between the two groups. ResultsOne hundred thirty-nine hips from 139 patients were included in the analysis. One hundred two patients were included in the instillation group versus 37 in the control group. The surgical time was significantly shorter in the instillation group than in the control group, with an average (standard deviation) of 52.01 (14.71) and 72.30 (11.70) minutes, respectively (P<.001). ConclusionThe instillation of a physiological saline solution with epinephrine and lidocaine prior to the surgical treatment of GTPS is effective in reducing surgical times, likely due to a reduction in intraoperative bleeding. Future research should focus on more direct outcomes such as intraoperative blood loss and between different instillation protocols.

CSP2023: 268 - A service evaluation of NHS musculoskeletal rehabilitation for patients with greater trochanteric pain syndrome (GTPS)

CSP2023: 268 - A service evaluation of NHS musculoskeletal rehabilitation for patients with greater trochanteric pain syndrome (GTPS)

CSP2023: 349 - What factors influence the outcomes of corticosteroid injections in patients with Greater Trochanteric Pain Syndrome (GTPS)? A systematic review

CSP2023: 349 - What factors influence the outcomes of corticosteroid injections in patients with Greater Trochanteric Pain Syndrome (GTPS)? A systematic review

The Morbidity of Greater Trochanteric Pain Syndrome Versus That of Patients Awaiting Total Hip Replacement.

Greater trochanteric pain syndrome (GTPS) is a commonly diagnosed medical issue, yet there are little data assessing the relative morbidity of GTPS. We sought to characterize the morbidity on presentation of GTPS and compare it to that of patients with end-stage hip osteoarthritis awaiting total hip arthroplasty. We hypothesized that patients with GTPS would have morbidity similar to or worse than that of patients with osteoarthritis. This retrospective case-control study examined patient-reported outcome measures of 156 patients with GTPS (193 hips) and 300 patients with hip osteoarthritis before total hip arthroplasty (326 hips). Patients with secondary hip conditions or previous hip surgeries were excluded from the study. Patient-reported outcome measures were analyzed using an equivalence test and two one-sided t tests. Equivalence in mean visual analog scale pain scores between GTPS and osteoarthritis was established with a tolerance margin of ±10. The difference in mean visual analog scale pain scores was 0.35 (95% CI, -0.86 to 0.16; P=.02). The Hip disability and Osteoarthritis Outcome Score Quality of Life was much worse for patients with GTPS, placed well outside of the ±10 tolerance margin, and the difference in mean scores was 1.72 (95% Cl, -2.17 to -1.26; P=.99). Equivalence in mean UCLA Activity scores between GTPS and osteoarthritis was established with a tolerance margin of ±5. The difference in mean UCLA Activity scores was 0.002 (95% CI, -0.45 to 0.43; P<.01). The morbidity and functional limitations of patients with GTPS were similar to those of patients undergoing total hip arthroplasty. GTPS remains a functional problem for patients, and clinicians and researchers should consider GTPS as seriously as hip osteoarthritis. [Orthopedics. 2024;47(4):205-210.].

Is shockwave therapy effective in the management of greater trochanteric pain syndrome? A systematic review and meta-analysis.

Evidence is lacking for the efficacy of shockwave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS). To investigate the efficacy of SWT on pain and function in the management of GTPS. A systematic search of electronic databases and grey literature was conducted up to May 2023. Studies utilising SWT on adults for GTPS, providing measures of pain and/or function at baseline and at follow-up were considered for inclusion. Meta-analysis was undertaken using converted pain and functional outcomes. Studies were assessed for quality and risk of bias, and assigned a level of evidence as per the Grading of Recommendations, Assessment, Development and Evaluations criteria. Twelve articles (n=1121 subjects) were included, including five randomised controlled trials (RCTs) and seven non-RCTs. No statistical differences were observed for pain over time f(1,5)=1.349 (p=0.298) or between SWT and control f(1,5)=1.782 (p=0.238). No significant differences in functional outcomes in short- (H=2.591, p=0.181) and medium-term follow-up (H=0.189, p=0.664) were identified between SWT and control. Moderate magnitude treatment effects for pain (Hedges-G [HG] 0.71) favouring SWT groups over control was identified, decreasing to low for function (HG 0.20). Further pain and functional treatment effects were identified at higher magnitudes across follow-up time-points in SWT groups compared to control. Moderate-quality evidence demonstrated no statistically significant improvements in pain and function post-SWT compared to control. Low-quality evidence established clinical improvements throughout all included studies favouring SWT over control. Consequently, owing to relatively low incidence of side effects, SWT should be considered a viable option for the management of GTPS. Issues with both clinical and statistical heterogeneity of studies and during meta-analysis require consideration, and more robust RCTs are recommended if the efficacy of SWT for the management of GTPS is to be comprehensively determined.

Musculoskeletal mimics of lumbosacral radiculopathy.

Electrodiagnostic evaluations are commonly requested for patients with suspected radiculopathy. Understanding lower extremity musculoskeletal conditions is essential for electrodiagnostic medicine specialists, as musculoskeletal disorders often mimic or coexist with radiculopathy. This review delineates radicular pain from other types originating from the lumbosacral spine and describes musculoskeletal conditions frequently mimicking radiculopathy, such as those that cause radiating pain and sensorimotor dysfunction. In clinical evaluation, a history of pain radiating along a specific dermatomal territory with associated sensory disturbance suggests radiculopathy. Physical examination findings consistent with radiculopathy include myotomal weakness, depressed or absent muscle stretch reflexes, focal atrophy along a discrete nerve root territory, and potentially positive dural tension maneuvers like the straight leg raise. However, electrodiagnostic medicine specialists must be knowledgeable of musculoskeletal mimics, which may manifest as incomplete radiation within or beyond a dermatomal territory, non-radiating pain, tenderness, and give-way weakness, in the context of a normal neurological examination. A systematic approach to musculoskeletal examination is vital, and this review focuses on high-yield physical examination maneuvers and diagnostic investigations to differentiate between musculoskeletal conditions and radiculopathy. This approach ensures accurate diagnoses, promotes resource stewardship, enhances patient satisfaction, and optimizes care delivery. Musculoskeletal conditions resembling L1 to S4 radiculopathy are reviewed, emphasizing their distinctive features in history, physical examination, and diagnostic investigation. Among the more than 30 musculoskeletal disorders reviewed are hip and knee osteoarthritis, lumbar facet syndrome, myofascial pain syndrome, greater trochanteric pain syndrome, and plantar fasciitis.

EARLY RESULTS OF GLUTEAL CUFF RECONSTRUCTION AND AUGMENTATION

Gluteal Tendinopathy is a poorly understood condition that predominantly affects post-menopausal women. It causes lateral hip pain, worse when lying on the affected side or when walking up a hill or stairs. It has been labelled ˜Greater Trochanteric Pain Syndrome” a name that recognises the lack of understanding of the condition.Surgical reconstruction of the gluteal cuff is well established and has been undertaken numerous times over the last 16 years by the senior author (AJL). However, the quality of collagen in the tendons can be very poor and this leads to compromised results. We present the results of gluteal cuff reconstruction combined with augmentation using a bioinductive implant.14 patients (11 female, 3 male; mean age 74.2 ± 6.3 years) with significant symptoms secondary to gluteal tendinopathy that had failed conservative treatment (ultrasound guided injection and structured physiotherapy) underwent surgical reconstruction by the senior author using an open approach. In all cases the iliotibial band was lengthened and the trochanteric bursa excised. The gluteal cuff was reattached using Healicoil anchors (3–5×4.75mm anchors; single anchors but double row repair) and then augmented using a Regeneten patch. Patients were mobilised fully weight bearing post-operatively but were asked to use crutches until they were no longer limping. All had structured post-surgery rehabilitation courtesy of trained physiotherapists.There were no post-operative complications and all patients reported an improvement in pain levels (Visual Analogue Scale 7.8 pre-op; 2.6 post-op) and functional levels (UCLA Activity Score 3.5 pre-op; 7.1 post-op) at 6 months post surgery.Surgery for gluteal tendinopathy produces good outcomes and the use of Regeneten as an augment for poor quality collagen is seemingly a safe, helpful addition. Further comparative studies would help clarify this.