Endoscopic Iliotibial Band Release for External Snapping Hip Syndrome

doi:10.1016/j.arthro.2005.12.030

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 22, Issue 5, May 2006, Pages 505-510

https://doi.org/10.1016/j.arthro.2005.12.030 Get rights and content

Purpose: The external snapping hip syndrome is caused by slippage of the iliotibial band over the greater trochanter. Most cases are treated conservatively but if this fails, open surgical treatment is commonly performed by Z-plasty or by creating a defect on the iliotibial band. We present a series of 11 hips that were surgically treated by an endoscopic technique. Type of Study: Prospective consecutive series of patients. Methods: Diagnosis of external snapping hip syndrome was clinical in all cases and anteroposterior pelvis radiographs were taken to evaluate the hip joint. Endoscopic release was performed with the patient in the lateral decubitus position without traction using 2 portals, the superior trochanteric and inferior trochanteric. A standard 4-mm, 30° arthroscope was introduced at the inferior trochanteric portal over the iliotibial band. A needle was placed at the proximal trochanteric portal and visualized endoscopically. The portal was then established and subcutaneous tissue resection was performed with radiofrequency (RF) probes and a shaver until the iliotibial band was identifiable and released with a vertical cut made using an RF hook probe. The arthroscope was introduced into the space created under the iliotibial band and a transverse cut at the middle of the vertical release was then made, creating a cross-shape. Next the 4 resulting flaps were resected to make a diamond-shaped defect. Results: Between September 2001 and December 2003, we treated 11 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years, for external snapping hip syndrome using an endoscopic technique. At an average 2-year follow-up, we had 1 patient with nonpainful snapping. The rest of the patients in the series had no complaints and returned to their previous level of activity. Conclusions: We present a reproducible endoscopic technique for the treatment of external snapping hip syndrome. Our results are comparable to those reported for open procedures. Level of Evidence: Level IV.

Section snippets

Methods

Between September 2001 and December 2003, patients in a consecutive series with the diagnosis of external snapping hip who did not respond to conservative treatment, including physical therapy and local corticosteroid injection, were treated by endoscopic release of the ITB. The preoperative evaluation included the identification of a snap by palpation (sometimes audible) of the trochanteric region with flexion of the hip from the extended position and vice versa, accompanied with pain. The

Results

We treated 10 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years (range, 21 to 35 years). Four patients participated in sports activity (1 tri-athlete, 2 long distance runners, 1 soccer player). The mean duration of the symptoms before endoscopic ITB release was 31 months (range, 10 to 38 months). They had all been treated with physical therapy with no response and had received an average of 3 corticosteroid injections (range, 1 to 6) without improvement. No pathology

Discussion

The incidence of external snapping hip is unknown.⁴ A few studies report on open techniques for the treatment of this condition. In our series, we used an endoscopic technique. Our results compare well with those reported of open release or open Z-plasty (Table 1).

The weakness of this study is that we present a small number of patients with short follow-up (only 7 patients completed 2 or more years). Longer follow-up of a larger series of patients would better demonstrate the results of

Conclusions

In our hands, the endoscopic release of the ITB for the treatment of external snapping is an effective and reproducible procedure. We have presented 11 consecutive cases treated with an endoscopic technique with 100% resolution of pain and 91% resolution of snapping symptoms.

References (7)

W.C. Allen et al.
Coxa saltansThe snapping hip revisited
J Am Acad Orthop Surg
(1995)
M.T. Provencher et al.
The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band
Am J Sports Med
(2004)
T. Jacobson et al.
Surgical correction of the snapping iliopsoas tendon
Am J Sports Med
(1990)

There are more references available in the full text version of this article.

Cited by (138)

Endoscopic Treatment of Recurred External Snapping Hip After Endoscopic Iliotibial Band Release
2022, Arthroscopy Techniques
External snapping hip is caused by snapping of the thickening of the posterior portion of the iliotibial band or the anterior border of the gluteus maximus over the greater trochanter. Surgery is considered for patients who are refractory to conservative treatment. The endoscopic release of the iliotibial band or the endoscopic release of the femoral insertion of the gluteus maximus tendon is the most popular technique. There is a recurrence rate of 7-29% after endoscopic surgery. Although recurrence is often painless, revision surgery may be indicated for symptomatic recurrence. In this Technical Note, the technical details of endoscopic treatment of recurred external snapping hip after endoscopic iliotibial band release. The key to success is adequate release of the iliotibial band, gluteus maximus tendon, and the fibrosis underneath the iliotibial band.
Arthroscopic treatment of type I and II greater trochanteric pain syndrome
2022, Orthopaedics and Traumatology: Surgery and Research
The goal of this study was to describe and evaluate endoscopic bursectomy combined with fascia lata lengthening in the treatment of type I and II greater trochanteric pain syndrome recalcitrant to conservative management. This was a retrospective study of 20 patients (7 type I, 13 type II) reviewed with a minimum follow-up of 2 years. The mean follow-up was 44 ± 11 [26–65] months. While significant improvements in pain, mHHS and NAHS were found, 80% of patients still had hip pain graded at ≥ 3 on VAS. The satisfaction rate was 7/10 ± 2 [3–10]. Snapping in the hip had been eliminated in 100% of cases. No complications were observed. This is a minimally invasive surgery that is feasible in patients who have failed an optimal course of conservative treatment. But patients must be informed that pain might not be completely eliminated by this procedure.
IV; retrospective, case series.
Arthroscopic treatment of type I and II greater trochanteric pain syndrome
2022, Revue de Chirurgie Orthopedique et Traumatologique
Le but était de décrire et d’évaluer les bursectomies endoscopiques associées à une ténotomie d’allongement du fascia lata dans les syndromes douleurs du grand trochanter (SDGT) de grade I et II résistantes au traitement médical.
Il s’agit d’une étude rétrospective portant sur 20 patients (7 de grade I, 13 de grade II) revus au recul minimum de 2 ans.
Le recul moyen était de 44 mois [26–65] ± 11. Il y avait une amélioration significative de la douleur, du mHHS et du NAHS mais 80 % conservaient une EVA ≥ 3. Le taux de satisfaction était de 7/10 [3–10] ± 2. 100 % des ressauts ont disparus. Aucune complication n’a été observée.
Il s’agit d’une chirurgie peu invasive et envisageable pour des patients en échec de traitement médical. Le patient doit être au fait d’une absence de disparition totale des symptômes douloureux.
IV ; rétrospective, série de cas.
Patients With Concomitant Painful External Snapping Hip and Femoroacetabular Impingement Syndromes Reported Complete Snapping Resolution With Release of the Gluteus Maximus and Iliotibial Band, and Comparable Minimum 2-Year Outcomes to a Propensity-Matched Control Group
2022, Arthroscopy - Journal of Arthroscopic and Related Surgery
To report minimum 2-year patient-reported outcome measures (PROMs) following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and painful external snapping hip (ESH) treatment and ESH resolution, and to compare these PROMs to a benchmark FAIS propensity-matched control group without ESH.
Data were prospectively collected and retrospectively reviewed between November 2009 and April 2018. Patients were eligible if they were preoperatively diagnosed with FAIS and painful ESH and received primary hip arthroscopy to address these pathologies. ESH was treated with gluteus maximus and iliotibial band releases. Inclusion criteria were baseline and minimum two-year follow-up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. Exclusion criteria were Tönnis grade >1 and previous hip conditions. A secondary subanalysis was performed to benchmark these outcomes to a FAIS propensity-matched control group without ESH, according to age, sex, body mass index (BMI), Tönnis grade, and preoperative lateral center-edge and α-angles using a 1:3 ratio. The minimal clinically important difference (MCID) and the maximum outcome improvement (MOI) rates were reported.
Twenty-two hips (21 patients) were included. The mean age, BMI, and follow-up were 31.3 years ± 14.0, 26 kg/m² ± 5.0, and 31.4 months ± 4.4, respectively, with 68.2% being female. ESH was resolved in 100% of patients. Significant improvement for all PROMs at a minimum two-year (P < .001) was reported. The minimum two-year PROMs and the rate of achieving the MCID and MOI threshold were comparable to the control group.
Following primary hip arthroscopy for FAIS and painful ESH, patients demonstrated significant improvement in all PROMs, and the rate of resolution of ESH was 100% at minimum two-year follow-up: with gluteus maximus and iliotibial band releases. Functional outcomes and rates of MCID and MOI achievement were comparable to a FAIS propensity-matched benchmark control group without ESH.
Level III, retrospective comparative study.
Editorial Commentary: Indications for Concurrent Procedures During Hip Femoroacetabular Impingement Arthroscopic Treatment
2021, Arthroscopy - Journal of Arthroscopic and Related Surgery
In patients with femoroacetabular impingement (FAI), hip joint pathology often leads to an alteration of gait as well as core and pelvic muscular imbalance. Flexor, abductor, adductor, and hamstring tightness and pain are common patient-reported complaints at the time of evaluation for FAI and potential hip arthroscopy. Surgical interventions have been developed to target all of these potential issues, but the question remains whether these concurrent procedures are necessary, or whether postoperative rehabilitation and other conservative measures may better treat associated conditions. We recommend that iliotibial band release is not indicated for patients with nonsnapping extra-articular lateral hip pain and should be reserved for frank, external snapping hip. Patients with lateral hip pain that prevents them from lying on their side at night are candidates for endoscopic trochanteric bursectomy through a minimal longitudinal ITB incision. Patients with evidence of gluteus medius pathology including positive Trendelenburg test, Trendelenburg gait, or pain with resisted hip abduction are treated with either bioinductive patch gluteus medius tendon augmentation or endoscopic or open abductor repair. The challenge is determining which of these associated conditions are compensatory (i.e., will improve after the underlying hip pathology is addressed during FAI surgery), and which are pathologic (i.e., must separately be addressed at the time of surgery).
Snapping in the lower limbs: a narrative review
2024, Minerva Orthopedics

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Original articleEndoscopic Iliotibial Band Release for External Snapping Hip Syndrome

Section snippets

Methods

Results

Discussion

Conclusions

Coxa saltansThe snapping hip revisited

J Am Acad Orthop Surg

The surgical treatment of external coxa saltans (the snapping hip) by Z-plasty of the iliotibial band

Am J Sports Med

Surgical correction of the snapping iliopsoas tendon

Am J Sports Med

Original article
Endoscopic Iliotibial Band Release for External Snapping Hip Syndrome