Arthroscopic Gluteal Muscle Contracture Release With Radiofrequency Energy

Abstract

Gluteal muscle contracture is common after repeated intramuscular injections and sometimes is sufficiently debilitating to require open surgery. We asked whether arthroscopic release of gluteal muscle contracture using radiofrequency energy would decrease complications with clinically acceptable results. We retrospectively reviewed 108 patients with bilateral gluteal muscle contractures (57 males, 51 females; mean age, 23.7 years). We used inferior, anterosuperior, and posterosuperior portals. With the patient lying laterally, we developed and enlarged a potential space between the gluteal muscle group and the subcutaneous fat using blunt dissection. Under arthroscopic guidance through the inferior portal, we débrided and removed fatty tissue overlying the contractile band of the gluteal muscle group using a motorized shaver introduced through the superior portal. Radiofrequency then was introduced through the superior portal to gradually excise the contracted bands from superior to inferior. Finally, hemostasis was ensured using radiofrequency. Patients were followed a minimum of 7 months (mean, 17.4 months; range, 7-42 months). At last followup, the adduction and flexion ranges of the hip were 45.3°± 8.7°a nd 110.2°± 11.9°, compared with 10.4°± 7.2°and 44.8°± 14.1°before surgery. No hip abductor contracture recurred and no patient had residual hip pain or gluteal muscle wasting. We found gluteal muscle contracture could be released effectively with radiofrequency energy.

Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture

“…GMC is widely reported in Asian countries, with a reported incidence of 1% to 2.5% in children in China [6]. Numerous authors believe GMC is secondary to repeated intramuscular injections, regardless of the type of medication injected into the buttocks [2,6,8,9,14] and/or a constitutional fibrogenic diathesis [2,7].…”

“…Numerous authors believe GMC is secondary to repeated intramuscular injections, regardless of the type of medication injected into the buttocks [2,6,8,9,14] and/or a constitutional fibrogenic diathesis [2,7]. GMC is characterized by variable degrees of muscle atrophy and intramuscular fibrosis of the gluteus maximus muscle, which leads to restriction of internal rotation, adduction, and flexion of the affected hips.…”

“…Although in the past, the diagnosis of GMC usually was derived from the history and physical examination, additional objective imaging studies are indicated not only for military certification but also for detailed evaluation of disease extent, degrees of muscle atrophy, and preoperative planning [2]. Operative release of fibrotic tissue with surgical division, resection [2,14], or radiofrequency energy [6] effectively restores reasonably normal squatting in patients with severe GMC; nonoperative management such as passive stretching is recommended as a primary treatment for mild GMC [14].…”

“…1). Instead, they typically present with hip abduction and external rotation when crouching [2,6]. Individuals with severe cases cannot sit or squat without abduction of Each author certifies that he or she has no 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.…”

“…In the literature, frog-leg squatting has been considered the result of and pathognomonic for gluteal muscle contracture (GMC) [2,6]. Most of the reported patients are school-aged children (6-18 years old), and the lesions are often secondary to repeated intramuscular injections in the buttocks [2,6,8,9,14] and a constitutional fibrogenic diathesis in many patients [2,7]. GMC has been used as one of the criteria for exemption from military service in Taiwan.…”