Tears in the gluteus medius and minimus tendons are a common cause of greater trochanter pain syndrome (GTPS). Given the non-specific clinical signs and imaging findings, they are often misdiagnosed, with delayed treatment. The lesions can show several aspects: trochanteric bursitis, simple tendinopathy, partial or full-thickness tear, tendon retraction, or fatty degeneration. Non-surgical treatment associates physical rehabilitation and activity modification, oral analgesics, anti-inflammatories and peri-trochanteric injections (corticosteroids, PRP). In the event of symptoms recalcitrant to medical treatment, surgery may be indicated. A 5-stage classification according to intraoperative observations and elements provided by MRI is used to guide technique: isolated bursectomy with microperforation, single or double row tendon repair, or palliative surgery such as muscle transfer (gluteus maximus with or without fascia lata). The development of conservative hip surgery now makes it possible to perform all of these surgical techniques endoscopically, with significant improvement in functional scores and pain in the short and medium term and a lower rate of complications than with an open technique. However, tendon retraction and fatty degeneration have been reported to be factors of poor prognosis for functional results and tendon healing and palliative tendon transfer gives mixed results for recovery of tendon strength. It is therefore preferable not to wait for the onset of Trendelenburg gait to propose endoscopic repair of the gluteus medius tendon in case of pain with a tear visible on MRI and failure of more than 6 months’ medical treatment. Based on expert opinion, this article provides an update on the diagnosis of gluteus medius lesions, treatment, and in particular the place of endoscopy, indications and current results.

Level of evidence

V.

中文翻译：

---

臀中肌腱撕裂的内镜治疗

臀中肌和小肌腱撕裂是大转子疼痛综合征 (GTPS) 的常见原因。鉴于非特异性临床体征和影像学发现，它们经常被误诊，延误治疗。病变可表现为几个方面：转子滑囊炎、单纯性肌腱病、部分或全层撕裂、肌腱收缩或脂肪变性。非手术治疗包括身体康复和活动调整、口服镇痛药、消炎药和转子周围注射（皮质类固醇，PRP）。如果症状难以通过药物治疗，则可能需要进行手术。根据术中观察结果和 MRI 提供的要素，采用 5 级分类来指导技术：微穿孔孤立性滑囊切除术、单排或双排肌腱修复、或姑息性手术，如肌肉转移（臀大肌有或没有阔筋膜）。保守髋关节手术的发展现在使得通过内窥镜进行所有这些手术技术成为可能，与开放技术相比，功能评分和短期和中期疼痛显着改善，并发症发生率更低。然而，据报道，肌腱收缩和脂肪变性是功能结果预后不良的因素，肌腱愈合和姑息性肌腱转移对肌腱强度的恢复给出了混合结果。因此，最好不要等到出现特伦德伦堡步态时才建议对臀中肌肌腱进行内镜修复，以防 MRI 上可见撕裂疼痛和超过 6 个月的药物治疗失败。根据专家意见，

证据等级

五、