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

Abstract

Purpose The aim of this retrospective study was 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. Methods Patients of all ages with external snapping hip syndrome were treated with endoscopic gluteus maximus tendon release. Outcome measures evaluated included: visual analog scale (VAS), modified Harris Hip Score (mHHS), and Non-Arthritic Hip Score (NAHS). The gluteus maximus strength and the circumference of the thigh were also evaluated. Results 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. Conclusions Endoscopic gluteus maximus tendon release is an excellent surgical option to treat snapping hip syndrome. The evaluated muscle strength revealed no functional impairment. The significance of the limb circumference reduction has yet to be determined. Level of evidence IV: retrospective comparative trial.

Editorial Commentary: The Indication and Technique of Iliotibial Band Release for External Snapping Hip During Hip Arthroscopy in Patients With Femoroacetabular Impingement Syndrome

“…1,5 The technique for ITB release used in the study of Maldonado et al 4 seems more aggressive. Although a recent study revealed no functional or strength impairment after GMT release in patients with symptomatic ESH, 12 the authors confirmed a significant reduction in limb circumference compared with the contralateral side (3.7%). It is unclear whether this technique, composed of a transverse incision in the ITB and GMT release, will have an adverse effect on the involved hip, such as reduced extension and external rotation strength of the GM and reduced abductive strength of the abductors.…”

Gluteal Complex is important in External Snapping Hip: intraoperative identification of syndrome origin and endoscopic stepwise release–a case series.

“…Various surgical techniques for the treatment of ESHS have been reported in the literature, including Z- or N-plasty lengthening of the ITB [ 2 , 6 , 7 ], release or resection of a portion of the ITB [ 2 , 8 – 12 ], and release of the GM femoral insertion [ 1 , 13 , 14 ], all of which can be performed via either an open or endoscopic approach. A review by Randelli et al reported endoscopic techniques, as compared to open surgery to have fewer complications, lower recurrence rates, and better clinical and cosmesis [ 15 ].…”