Revista de Medicina Desportiva (English) September 2018 - Page 12

Rev. Med. Desp. informa, 2018; 9(5):10–13.
Hip Abductor Apparatus
Ruptures
Dr. Diogo Lino Moura 1 , Dr. José Pedro Marques 2 , Dr. António Figueiredo 3 , Prof. Doutor António
Bernardes 4 , Prof. Doutor Fernando Fonseca 5
1
Resident of orthopedics at the hospital and University Center of Coimbra (CHUC); Invited Assistant of
Anatomy at the Faculty of Medicine of the University of Coimbra (FMUC); 2 Hospital Assistant of Sports
Medicine at the CHUC; 3 Hospital assistant graduate of orthopedics – hip department of the CHUC; 4
Regent of Anatomy at the FMUC; 5 Director of the orthopedics department at CHUC. Coimbra, Portugal
ABSTRACT
Gluteus medius and minimus muscle disease has beed increasingly recognized as an important
cause and probably underdiagnosed of the common persistent trochanteric pain. Also known as hip
rotator cuff, the abductor apparatus of the hip can be affected by more frequent chronic degenera-
tive tears and also by acute traumatic tears. Besides the trochanteric pain, it is also present the
typical abductor weakness gait. When these symptoms are unresponsive to anti-inflammatory
and rehabilitation conservative treatment, the magnetic resonance is indicated. If a gluteus tear is
confirmed and is consistent with the symptoms, its surgical repair is indicated. In this paper we
present a review of the current scientific literature about anatomy and biomechanics of the abductor
apparatus of the hip, and the symptoms, diagnosis and treatment of gluteus tears.
KEYWORDS
Abdutor apparatus, hip, medius gluteus, rotator cuff, tear, tendon, great trochanteric pain
Anatomy and biomechanics of the
hip abductor apparatus
The hip abductor apparatus is com-
posed by the trochanteric abductor
muscles (responsible for 70% of the
abduction force are the medium and
the small gluteus) and by tension-
ers muscles of the iliotibial band,
which are the upper portion of the
large gluteus, the fascia lata tensor
and the vastus lateralis (figure 1).
The hip abductor complex involves
the hip joint in a manner similar to
the rotator cuff of the glenohumeral
joint, being fundamental for the
dynamic stability of the hips and
the pelvis and, consequently, it is
essential for the gait. 1-4 The muscle
gluteus medium It is the iliofemoral
muscle (because it is directed from
the ilium to the femur) most impor-
tant of this complex and this is the
one we are looking at in this text.
It is the primary abductor muscle
and the main controller of the hip
rotation, being still responsible for
supporting and stabilizing the pelvis,
in order to maintain both hips at
the same height during the gait and
the unipodal support, and its nor-
mal function is fundamental for a
normal gait. The muscle is mostly in
the sagittal plane and its amplitude
10 september 2018 www.revdesportiva.pt
allows the various groups of mus-
cle bundles to function as a cuff
involved on hip rotation (hip rotator
cuff). 1-3,5-9
Ruptures of the abductor apparatus
of the hip
The gluteal pathology has been
increasingly recognized as an impor-
tant, and probably underdiagnosed,
cause of the frequent persistent
pain in the trochanteric area or
lateral side of the hip, the so-called
trochanteric pain syndrome. The
tendinopathy and the total or partial
ruptures of hip abductors are cur-
rently considered primary injuries
Figure 1 – Hip abductor apparatus 1,4
and secondary lesions, consequent
to the primary, are trochanteric bur-
sitis, retraction and gluteal adipose
degeneration and the development
of sclerosis and osteophytes at the
level of the great trochanter, par-
ticularly with the chronic tendon
ruptures. 1-5,10-21
The ruptures of the hip abductor
muscles may be: 1,3-5,13-16,22-26
Chronic degenerative ruptu-
res, coming from a sequence of
the continuous process of gluteal
tendinosis (by imbalance between
anabolism-catabolism in the tendon,
due to repeated friction and micro-
trauma, tension and compressive
forces exerted by the iliotibial band,
that favors the catabolism), without
known acute traumatic cause;
Traumatic acute ruptures, result-
ing from the strong contraction
of the hip abductors (after falls or
vigorous exercises on hip abduction),
and also due to acute aggravation of
pre-existing chronic ruptures;
Ruptures associated with hip
arthroplasty, particularly with
incomplete or dehiscence of the inci-
sion made in the gluteus medium
after hip arthroplasty on the lat-
eral (transgluteus) or anterolateral
approach.
Throughout this text we only
will focus on tendon ruptures not
associated with hip arthroplasty.
The ruptures are more frequent in
the gluteus medium and in a third
of these ruptures there are also
concomitant ruptures in the small
gluteus. They usually occur on the
tendon, at the insertion on the large
trochanter, because this section is
more subject to tension forces, is
less vascularized and is subjected to
a mechanical conflict where a large
prominent trochanter or osteophytes