Endoscopic gluteus maximus tendon release excellent surgical option to treat snapping hip syndrome

Filippo Randelli et al found in a study that - endoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. The evaluated muscle strength revealed no functional impairment.

The authors conducted a retrospective study to investigate the clinical follow-up of patients with external snapping hip syndrome (ESHS) treated with endoscopic gluteus maximus tendon release and to compare the residual muscular strength and thigh circumference as an indirect outcome measure. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS).

The procedure was performed under general anesthesia with the patient placed supine on a dedicated traction operating table. The GT was marked and two portals were created: the superior trochanteric (ST) portal was located 2 cm anterior and 4 cm superior to the tip of the GT, and the second portal, the distal anterolateral accessory portal (DALA), along the axis of the femur, 10 cm below the tip of the GT. A needle was inserted through the superior trochanteric portal under fluoroscopy followed by a guidewire and the arthroscopic cannula for a standard 30° arthroscope with 4 mm diameter. Normal saline solution was pumped at low pressure (40 mmHg) to expand the virtual space between the vastus lateralis and the ITB.

The DALA portal was used for direct visualization. Then, a shaver blade and a radiofrequency device were alternately introduced to create the working space. After visualizing the vastus lateralis at its superior posterior border, the femoral insertion of the GMT on the linea aspera was identified. The tenotomy was performed with the radiofrequency device until a visible tendon gap was made. Once the procedure was completed, the fluid was aspirated, and the skin closed.

A semi-compressive dressing was applied. Postoperatively the patient was allowed progressively to full weight bearing with the help of two crutches for 3 weeks. Enoxaparin, 4000 UI daily, was indicated for 2 weeks for thromboprophylaxis, and Rofecoxib, 90 mg daily, for 3 weeks for heterotropic ossification prevention. The patients were encouraged to start strengthening and stretching exercises of the gluteus complex after 3 weeks from surgery.

The results of the study were:

• Among 25 patients, 23 fulfilled the inclusion criteria and one patient was lost to follow-up.

• The series included 22 patients, 6 males and 16 females with a mean age of 27.9±13.4 years (range 16–76 years).

• All patients had resolution of the snapping symptoms after the procedure.

• The mean follow-up was 18±9.3 months.

• All outcomes improved in a statistically significant manner:

VAS value decreased from 6.8 (range 6–8) to 0.6 (range 0–4) (p < 0.001), mHHS increased from 48.6 (range 17.6–67) to 88.2 (range 67–94.6) (p < 0.001),

NAHS increased from 49.0 (range 21.5–66) to 90.8 (range 66–98.75) (p < 0.001).

• A statistically significant reduction of operated limb thigh circumference compared to the contralateral side (3.7%) was also found, while there were no statistical differences regarding the strength of gluteus maximus muscles.

The authors concluded that - endoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. Muscle strength evaluated after the tendon release of the gluteus maximus revealed no functional impairment. The significance of the limb circumference reduction has yet to be determined.

Level of evidence: IV: retrospective comparative trial. 

Further reading:

Endoscopic gluteus maximus tendon release for external snapping hip syndrome: a functional assessment.

Filippo Randelli, Alberto Fioruzzi et al

Journal of Orthopaedics and Traumatology (2021) 22:45

https://doi.org/10.1186/s10195-021-00610-x