The efficacy of gluteal tendinopathy treatments: A systematic review

Objective: To guide clinical practice by synthesising robust evidence concerning gluteal tendinopathy management. Data sources: Five electronic databases were searched from inception to August 2024 for randomised controlled trials (RCTs) of medium or high quality, and low risk of bias, that measured pain and function in adults with clinically diagnosed gluteal tendinopathy. Review methods: Systematic review reporting proof of efficacy. PEDro scale and Cochrane Risk of Bias Tool 2.0 were used to assess internal validity and risk of bias. Efficacy was determined by comparison to minimal intervention. Methodological heterogeneity prevented meta-analysis, but we calculated standardised mean differences (SMD) and 95% confidence intervals (95% CI) for individual study arms to facilitate comparison between interventions. Results: Four interventions from four RCTs demonstrated efficacy. Exercise and education has moderate strength evidence of a medium effect on pain (SMD = 0.95; 95% CI [0.58, 1.33]) and function (SMD = 0.91; 95% CI [0.53, 1.28]) in the short term with small effects in the medium and long term. Corticosteroid injection has moderate strength evidence of a small effect on pain (SMD = 0.51; 95% CI [0.16, 0.86]) in the short term. Platelet-rich plasma injection was superior in the short term compared to corticosteroid injection for function (SMD = 0.46; 95% CI [0.00, 0.91]). For pain, focused shockwave therapy (f-ESWT) demonstrates superiority in the long term (SMD = 5.77; 95% CI [4.84, 6.71]) compared to corticosteroid injection. Conclusions: Exercise and education can be cautiously recommended as the core approach for pain management and function, potentially supplemented by corticosteroid or f-ESWT, while definitive trials of promising interventions are needed to derive robust practice recommendations.