Low quality evidence supports surgery for gluteal tendon tears, no non-surgical evidence was identified: a systematic review

Gluteal tendon tears (GTT) are associated with significant morbidity, similar to end stage, hip osteoarthritis. To date, there is unclear evidence as to what best management for GTT constitutes, and what are the subsequent outcomes for the different management approaches (surgical, non-surgical). The purpose of this systematic review is to document treatments, synthesise evidence, and assess the quality of available evidence regarding the treatments and outcomes associated with symptomatic GTT. A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Six databases were searched, from inception to November 2024 (Cinahl, Scopus, Web of Science, Medline, ClinicalTrial.gov, Cochrane). Inclusion criteria were any research on the management of GTT, exclusion criteria were any other intra-articular pathology. The primary outcome measures were pre-and post-intervention measures for Quality of Life (QoL)(iHOT-12/33) and pain severity (visual analogue scale (VAS)) and were compared to minimally clinically important change. Joanna Briggs Institute (JBI) critical appraisal tool was used to assess methodological quality and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to evaluate certainty of evidence. Datum and graphs were synthesised using RevMan software, in accordance with Cochrane guidelines. In total 1,584 participants across the 38 papers involving 49 studies met inclusion criteria. All investigated surgery – 35 papers were case-series and three were cohort studies. No randomised controlled studies were identified. Interventions were sub-grouped as: Endoscopic Repair (n = 507), Open Repair (n = 950) and Gluteus maximus transfer (n = 127). 58% of studies were categorised as low quality, scoring < 65% on the JBI critical appraisal tool. High heterogeneity (clinical and methodological) was observed, and very low certainty of evidence was found according to GRADE assessment. Surgical intervention for people with GTT was associated with improvement of QoL (range, 22.1/100 to 48.8/100) and pain severity (range, -7.0/10 to -1.2/10) at minimum 12-month follow-up. Very low quality and certainty of evidence found surgical intervention for GTT was associated with improvements in QoL and pain severity. No non-surgical treatments studies for this condition were identified.