‘A proposed endoscopic classification of gluteus medius injuries’

Abstract Gluteus medius tendinopathy encompasses a spectrum of injuries, from partial to full thickness tears, often associated with tendon retraction and fatty degeneration, and remains a common cause of lateral hip pain. This study aimed to describe an intraoperative classification system for gluteus medius tears that integrates focal degenerative lesions, tendon involvement, tear retraction, tissue quality, and fatty degeneration with corresponding surgical and rehabilitation strategies. A focused literature review identified five previously described classification systems and their limitations, including magnetic resonance imaging-based and intraoperative frameworks. Based on these findings, a novel classification was developed, categorizing tears from type 0 (normal) to type 4c (full-thickness tear with retraction and fatty degeneration), with each type linked to suggested surgical techniques, including single or double-row anchor repair, augmentation with bioinductive patches, or gluteus maximus transfer, and general postoperative rehabilitation considerations with proposed timelines for weight bearing and physical therapy. These recommendations reflect expert-guided considerations rather than evidence-based protocols. This classification is applicable to both endoscopic and open repairs. Compared with previous systems, this approach emphasizes intraoperative therapeutic guidance, potentially facilitating real-time intraoperative decision-making and more standardized surgical assessment, regardless of preoperative imaging availability. In conclusion, the proposed intraoperative classification provides a practical framework for the assessment and management of gluteus medius tears. By incorporating clinically relevant intraoperative and degenerative features, the system may facilitate more standardized surgical assessment and support future investigation of functional and clinical outcomes. This classification has not yet undergone validation; further studies should assess reproducibility, interobserver reliability, and prognostic utility.