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. 2024 Feb;48(2):401-408.
doi: 10.1007/s00264-023-05961-0. Epub 2023 Sep 5.

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

Konrad Malinowski  1   2 , Marcin Mostowy  3   4 , Dong Woon Kim  5 , Michalina Bawor  6 , Paweł Skowronek  7 , Michael T Hirschmann  8 , Przemysław A Pękala  5   9 , Robert F LaPrade  10
Affiliations

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

Konrad Malinowski et al. Int Orthop. 2024 Feb.

Abstract

Purpose: External snapping hip syndrome (ESHS) was historically attributed to isolated iliotibial band (ITB) contracture. However, the gluteus maximus complex (GMC) may also be involved. This study aimed to intraoperatively identify the ESHS origin and assess the outcomes of endoscopic treatment based on the identified aetiological type.

Methods: From 2008-2014, 30 consecutive patients (34 hips) with symptomatic ESHS cases refractory to conservative treatment underwent endoscopic stepwise "fan-like" release, gradually addressing all known reasons of ESHS: from the isolated ITB, through the fascial part of the GMC until a partial release of gluteus maximus femoral attachment occurred. Snapping was assessed intra-operatively after each surgical step and prospectively recorded. Functional outcomes were assessed via the MAHORN Hip Outcome Tool (MHOT-14).

Results: Twenty seven patients (31 hips) were available to follow-up at 24-56 months. In all cases, complete snapping resolution was achieved intra-operatively: in seven cases (22.6%) after isolated ITB release, in 22 cases (70.9%), after release of ITB + fascial part of the GMC, and in two cases (6.5%) after ITB + fascial GMC release + partial release of GM femoral insertion. At follow-up, there were no snapping recurrences and MHOT-14 score significantly increased from a pre-operative average of 46 to 93(p<0.001).

Conclusion: Intraoperative identification and gradual addressing of all known causes of ESHS allows for maximum preservation of surrounding tissue during surgery while precisely targeting the directly involved structures. Endoscopic stepwise "fan-like" release of the ITB and GMC is an effective, tailor-made treatment option for ESHS regardless of the snapping origin in the patients with possibility to manually reproduce the snapping.

Keywords: Endoscopy; External snapping hip; Gluteus maximus complex; Iliotibial band; Release; Stepwise.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of patients screening and inclusion. ESHS, External Snapping Hip Syndrome
Fig. 2
Fig. 2
Schematic representation of the technique. Reproduced with modifications from Malinowski et al. [7]
See this image and copyright information in PMC

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References

    1. Dai Z, Chen Z, Liao Y, et al. Comparison of arthroscopic versus open surgery on external snapping hip caused by gluteal muscle contracture. Hip Int. 2018;28:173–177. doi: 10.1177/1120700017754013. - DOI - PubMed
    1. Ilizaliturri VMJ, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. 2006;22:505–510. doi: 10.1016/j.arthro.2005.12.030. - DOI - PubMed
    1. Kim CH, Lee SK, Kim JH, Yoon PW. External snapping hip: classification based on magnetic resonance imaging features and clinical correlation. HIP Int. 2020;32(1):118–123. doi: 10.1177/1120700020944139. - DOI - PubMed
    1. Yoon TR, Park KS, Diwanji SR, et al. Clinical results of multiple fibrous band release for the external snapping hip. J Orthop Sci. 2009;14:405–409. doi: 10.1007/s00776-009-1350-y. - DOI - PubMed
    1. Musick SR, Varacallo M (2023) Snapping Hip Syndrome. Treasure Island (FL) - PubMed