“Rotator Cuff” Tears of the Hip: Tear Characteristics and Concomitant Vastus Lateralis Pathology

Jeffrey D. Hassebrock; Jonathan A. Flug; Jeremiah R. Long; Justin L. Makovicka; Logan D. Moews; Joseph C. Brinkman; David E. Hartigan

Abstract

Introduction. The progression patterns of hip abductor tendon tears and their association with lateral thigh pathology are poorly described. The purpose of this study was to evaluate the distribution and progression patterns of abductor tendon tears on MRI, comparing small and large tears, and to assess the prevalence of concomitant vastus lateralis pathology. Methods. Hip MRI studies obtained over a 12-month period were independently reviewed by two fellowship-trained musculoskeletal radiologists. Tear location and thickness of the gluteus medius and minimus tendons, as well as vastus lateralis origin pathology, were assessed. Results. Tears most frequently involved the posterior gluteus minimus (100%) and anterior gluteus medius (100%), while the gluteus medius posterosuperior facet was least commonly involved (19%). Interobserver agreement was moderate for full-thickness tears (κ = 0.60) and substantial for vastus lateralis pathology (κ = 0.70). Full-thickness tears were significantly more likely in the presence of gluteus medius posterosuperior involvement (p < 0.001). Vastus lateralis pathology was also significantly associated with abductor tendon tears (p < 0.001). Conclusion. This study identifies consistent patterns of abductor tendon involvement on MRI, with tears most commonly affecting the gluteus minimus posteriorly and the gluteus medius anteriorly, and larger or full-thickness tears more frequently involving the posterosuperior gluteus medius. These findings suggest a possible central-to-posterior pattern of abductor tendon tear involvement that may reflect a progression pathway; however, given the cross-sectional design, a definitive temporal sequence cannot be established. The observed associations should therefore be interpreted as hypothesis-generating, and prospective longitudinal studies are needed to confirm the natural history of abductor tendon tear progression and its clinical implications.

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