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Surgical Technique: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome

  • Symposium: Advanced Hip Arthroscopy
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

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Acknowledgments

The authors thank Sheila Ingham MD, PhD (Federal University of São Paulo, Brazil) for valuable advice, reviewing of the paper, and help with the English version.

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Authors and Affiliations

  1. 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

    Giancarlo C. Polesello MD, PhD, Marcelo C. Queiroz MD, Nelson K. Ono MD, PhD & Emerson K. Honda MD, PhD

  2. American Hip Institute and Hinsdale Orthopedics, Chicago, IL, USA

    Benjamin G. Domb MD

Authors
  1. Giancarlo C. Polesello MD, PhD
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  2. Marcelo C. Queiroz MD
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  3. Benjamin G. Domb MD
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  4. Nelson K. Ono MD, PhD
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  5. Emerson K. Honda MD, PhD
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Corresponding author

Correspondence to Giancarlo C. Polesello MD, PhD.

Additional information

One of the authors (BGD) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of $10,000 to $100,000 from Arthrex Inc (Naples, FL, USA) and an amount less than $10,000 from MAKO Surgical Corp (Ft Lauderdale, FL, USA). Each other author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at FCMSCSP (São Paulo, Brazil) and the American Hip Institute and Hinsdale Orthopedics (Chicago, IL, USA).

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Polesello, G.C., Queiroz, M.C., Domb, B.G. et al. Surgical Technique: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome. Clin Orthop Relat Res 471, 2471–2476 (2013). https://doi.org/10.1007/s11999-012-2636-5

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  • DOI: https://doi.org/10.1007/s11999-012-2636-5

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