Published in:
01-08-2013 | Symposium: Advanced Hip Arthroscopy
Surgical Technique: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome
Published in: Clinical Orthopaedics and Related Research® | Issue 8/2013
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Background
While many authors have recommended surgery for patients with persistent symptoms of external snapping hip, it is unclear which one best relieves symptoms. Concerns with iliotibial band (ITB)-modifying techniques include altering the shape of the lateral thigh and overload of the contralateral abduction mechanism. We describe a new endoscopic technique that decreases the tension of the ITB complex by releasing the femoral insertion of the gluteus maximus tendon (GMT).
Description of Technique
Via an endoscopic approach, we tenotomize the GMT near its insertion at the linea aspera through two trochanteric portals, developing a space beneath the ITB.
Methods
We reviewed eight patients (nine hips) with external snapping hip nonresponsive to nonoperative treatment treated by endoscopic GMT release. There were seven women (one bilateral) and one man, with a mean ± SD age of 35 ± 13.1 years (range, 18–55 years). Mean symptom duration was 36 ± 20.3 months (range, 16–84 months). Minimum followup was 22 months (mean, 32 ± 9.3 months; range, 22–45 months).
Results
Snapping and pain resolved in seven patients after the initial procedure. We performed one revision procedure with complete relief of symptoms. All eight patients returned to their previous level of activity. Average modified Harris hip score was 61 points (range, 45–70 points) preoperatively and 78 points (range, 62–93 points) at latest followup. We observed no neurovascular complications.
Conclusions
Our small series suggests endoscopic release of the GMT resolves pain and snapping symptoms in most patients.
Level of Evidence
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.