Contrasting Force Reduction at the Greater Trochanter Using Different Surgical Procedures for Relief of Greater Trochanteric Pain Syndrome

Greater Trochanteric Pain Syndrome (GTPS) is associated with hip pain from repeated trauma to the greater trochanter bursa. Surgical procedures cut the iliotibial tract (ITT) in order to relieve the pressure on the greater trochanter. We propose the ITT may not be the primary cause of GTPS. In this study, I hypothesize that in addition to the ITT, the tendon of the gluteus maximus (GMax) also exerts force on the greater trochanter. Force measurement tests were performed on fresh cadavers donated to the University of North Texas Health Science Center. In addition, an anatomical study of the hip was performed on partially dissected embalmed cadavers to better describe the GMax tendon and ITT insertion at the greater trochanter. In the anatomical study, fibers from the ITT were observed comingling with the GMax tendon to insert at the gluteal tuberosity. Multiple variation of the GMax tendon were observed, some presenting with three or four tendinous slips. In this study, 157 hips were examined. 63 hips (40%) had only one tendinous slip, 57 hips (36%) had 2 tendinous slips, 34 (22%) had 3 slips, and only 3 (2%) were observed with 4 tendinous slips. One unique variation was found during the course of this study and was submitted for publication. To measure the force exerted by the ITT at the greater trochanter, six unembalmed cadavers were used to contrast the effects of different surgical approaches used for force reduction. Force measurements were first taken for normal ITT (no cuts) and then for one of two types of ITT incisions on one hip. Next, force measurements were taken for a normal ITT and then after the GMax tendon was transected on the contralateral hip. Overall, both surgical approaches showed a strong trend in reducing force at the greater trochanter as the hip was subjected to a range of specified movements. Even though a significant force reduction occurred with transection of the GMax tendon, making this procedure a potential new treatment for GTPS, the depth of the structure in the gluteal region might prove impractical as a practical surgical approach.