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Surgical Technique: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome.
MedLine Citation:
PMID:  23086213     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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.
Authors:
Giancarlo C Polesello; Marcelo C Queiroz; Benjamin G Domb; Nelson K Ono; Emerson K Honda
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-20
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  -     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
The Hip Group, Department of Orthopedic Surgery and Traumatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Rua Dr. Cesario Mota Jr, 112, CEP 01221-020, São Paulo, SP, Brazil, giancarlopolesello@hotmail.com.
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