Percutaneous ultrasound guided iliotibial band release cost effective option to endoscopic technique in snapping hip syndrome

Snapping hip syndrome is a visible, palpable and often audible phenomenon occurring during active flexion or extension of the hip that can be painful. External snapping hip (ESH), occurring in the lateral peri-trochanteric area, arises due to an abrupt movement of the iliotibial band (ITB) over the great trochanter (GT) and is enhanced by a thickening of the posterior part of the ITB or the anterior margin of the gluteus maximus muscle.

Remy Coulomb et al conducted a study to compare a technique of ultrasound-guided iliotibial band release versus an endoscopic technique. The study has been published in ‘Knee Surgery, Sports Traumatology, Arthroscopy.’

An anatomical study was performed on 10 cadavers (20 hips). The same operator performed ultrasound-guided and endoscopic iliotibial band release on either side of each specimen. An independent operator performed an open control to verify the outcome measures. The primary outcome was iliotibial cutting percentage, defined as the ratio of the transversal cut distance and the width of the iliotibial at the most prominent portion of the great trochanter. Secondary outcomes included nerve injuries. The surgical time was assessed and disposable medical supplies costs were estimated.

Key findings of the study were:

• The average cutting percentage was 95% ± 8 by ultrasound, compared with 91% ± 11 by endoscopy (n.s.).

• No iatrogenic lesions were found, particularly nerve damage.

• The average duration of the ultrasound procedure was 12.3 minutes ± 6 compared to 21 minutes ± 10.7 for endoscopy (p=0.04), with a 3-fold decrease between the first and last procedure, regardless of the technique.

• The ultrasound procedure was 3 times less expensive in terms of disposable medical supplies (120.5€ versus 353.5€).

The authors concluded that – “this technique of ultrasound-guided iliotibial band release appears to be as effective and safe as a similar endoscopic technique. The surgical time is reasonable for a surgeon trained in ultrasound, with lower disposable supplies costs. A comparative clinical study is further needed to assess the actual benefits of each technique.”

Further reading:

A percutaneous ultrasound guided iliotibial band release technique reduces surgical time and costs compared to an endoscopic technique, Remy Coulomb, Valentin Cascales et al, Knee Surgery, Sports Traumatology, Arthroscopy (2023) 31:2754–2761, https://doi.org/10.1007/s00167-023-07366-3