Treatment of Acute Full-Thickness Gluteus Minimus Tear

Initial Diagnostic Workup

• The American Academy of Orthopaedic Surgeons recommends obtaining standard hip radiographs first to exclude bony pathology, fractures, or other structural abnormalities, and then proceeding with non-contrast MRI of the hip as the definitive imaging study, which has 33-100% sensitivity and 92-100% specificity for detecting gluteus minimus tears 2
• Non-contrast MRI of the hip can assess tear size, retraction, and fatty degeneration, and is the preferred imaging modality over ultrasound, which has inferior sensitivity (79%) 2

Treatment Algorithm

Acute Tears (< 3 months from injury)

• The American Academy of Orthopaedic Surgeons recommends surgical repair as the preferred option for acute full-thickness tears, particularly when performed within 3 weeks of injury, as this timing produces superior outcomes compared to delayed repair 1
• Early surgical repair (within 3 weeks to 3 months) should be strongly considered to prevent worse outcomes due to tendon retraction and fatty degeneration 1

Conservative Management (Only for Select Cases)

• Conservative treatment may be attempted initially for less than 6 months in patients with minimal functional deficit, no Trendelenburg gait, and patient preference for non-operative care, and includes activity modification, physical therapy with eccentric strengthening of hip abductors, NSAIDs for pain management, cryotherapy, and a single ultrasound-guided corticosteroid injection into peritrochanteric space 1, 3
• The American Academy of Orthopaedic Surgeons recommends avoiding repeated corticosteroid injections, as they have deleterious effects on tendon substance, and injecting corticosteroids only into the peritendinous space, not directly into the tendon 3, 4