Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair.

OBJECTIVES: (1) To compare MRI and surgical findings in patients with refractory greater trochanter pain syndrome and (2) to assess surgical outcomes.
METHODS: All consecutive patients seen between 2002 and 2006 by a single clinician were selected for surgical treatment according to the following criteria: (1) tendinopathy confirmed by physical tests; (2) painful disability persisting for at least 6 months despite treatment; (3) on MRI: area of high signal intensity on T2-weighted images, in the area of gluteus medius and/or minimus tendon; and (4) absence of marked muscle atrophy or fatty degeneration. Two musculoskeletal radiologists interpreted images by consensus. A single surgeon operated on all patients.
RESULTS: Eight patients met the criteria for surgery. All were women, aged 71.1 (SD: 9.4). Mean symptoms duration before surgery: 14.3 months (11.8). Surgery confirmed the presence of a tear of the lateral part of the gluteus medius tendon in all eight patients, with an associated tear of its main tendon in one patient, all tears revealed on MRI. An associated tear of the gluteus minimus tendon was present at surgery in five patients, of which three were not seen on MRI (false negative). Bursitis was confirmed in all eight patients. Steady complete remission of spontaneous and provoked (physical examination) pain was observed in seven patients and partial remission in one (mean follow-up: 22.4 months (SD: 16.3)). Six MRIs performed after 20+/-12 months showed good reinsertion of the sutured tendon.
CONCLUSION: The eight MR images of tear of the lateral part of the gluteus medius tendon were all confirmed at surgery. Three of five associated tendon tears (gluteus minimus only) were not seen on MRI. Surgical treatment was very effective in all patients but one.