Endoscopic Trochanteric Bursectomy and Iliotibial Band Release for Persistent Trochanteric Bursitis

Mitchell, Justin J.; Chahla, Jorge; Vap, Alexander R.; Menge, Travis J.; Soares, Eduardo; Frank, Jonathan M.; Dean, Chase S.; Philippon, Marc J.

doi:10.1016/j.eats.2016.07.005

Cited by 13 publications

(8 citation statements)

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“…This is followed by shaver resection of the resulting flaps to create an ellipsoid or diamond-shaped defect, followed by a thorough endoscopic bursectomy. 7,8 Similar to the findings of the aforementioned study on iliopsoas release, I have found that I tend to perform concurrent ITB release during hip arthroscopy less and less over time. Unmistakably, lateral hip pain is a common problem in patients with FAI, but it is important to identify which patients develop this pain as a result of compensation due to their intra-articular pathology versus which patients have developed a separate pathology that won't necessarily improve with hip arthroscopy alone.…”

Section: See Related Article On Page 1845supporting

confidence: 71%

Editorial Commentary: Indications for Concurrent Procedures During Hip Femoroacetabular Impingement Arthroscopic Treatment

Gruskay

Philippon

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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In patients with femoroacetabular impingement (FAI), hip joint pathology often leads to an alteration of gait as well as core and pelvic muscular imbalance. Flexor, abductor, adductor, and hamstring tightness and pain are common patient-reported complaints at the time of evaluation for FAI and potential hip arthroscopy. Surgical interventions have been developed to target all of these potential issues, but the question remains whether these concurrent procedures are necessary, or whether postoperative rehabilitation and other conservative measures may better treat associated conditions. We recommend that iliotibial band release is not indicated for patients with nonsnapping extra-articular lateral hip pain and should be reserved for frank, external snapping hip. Patients with lateral hip pain that prevents them from lying on their side at night are candidates for endoscopic trochanteric bursectomy through a minimal longitudinal ITB incision. Patients with evidence of gluteus medius pathology including positive Trendelenburg test, Trendelenburg gait, or pain with resisted hip abduction are treated with either bioinductive patch gluteus medius tendon augmentation or endoscopic or open abductor repair. The challenge is determining which of these associated conditions are compensatory (i.e., will improve after the underlying hip pathology is addressed during FAI surgery), and which are pathologic (i.e., must separately be addressed at the time of surgery).

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Section: See Related Article On Page 1845supporting

confidence: 71%

Editorial Commentary: Indications for Concurrent Procedures During Hip Femoroacetabular Impingement Arthroscopic Treatment

Gruskay

Philippon

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The Abductive Strength of Operated Hip After ITB Release One of the most critical concerns of ITB release is the possibility of compromise of abductive strength. As far as we know, the cruciate incision or transversal incision technique reported in previous studies had no obvious affection on abductive force of the hip 14,20,28 . In our study, the mean abductive force of affected hips in FAI + ESH group was smaller than that in FAI group 3 months after surgery, but was similar at 2 years after surgery, indicating that ITB release during primary hip arthroscopy would delay the recovery of abductive force of the affected hip but would not have a final negative effect on it.…”

Section: Therapeutic Strategy For Fai Syndrome With Esh Using Itb Release Techniquementioning

confidence: 67%

“…The technique of ITB release is still developing and surgeons have preferred endoscopic to open surgery for ITB release in recent years. Mitchell et al 28 . reported an endoscopic ITB release technique, by performing cruciate incision on ITB, 2 cm horizontally and 2 cm longitudinally, to release the tight ITB and expose the trochanteric bursa.…”

Section: Discussionmentioning

confidence: 99%

“…As a factor in the recovery of hip arthroscopy for FAI syndrome, endoscopic ITB release should be performed during hip arthroscopic surgery to prevent hip snapping for the FAI syndrome patient who also suffers ESH. Some surgeons mentioned that they performed ITB release after intra- 28 reported an endoscopic ITB release technique, by performing cruciate incision on ITB, 2 cm horizontally and 2 cm longitudinally, to release the tight ITB and expose the trochanteric bursa. However, we used to perform a comparatively larger transversal incision to make a large defect on ITB to release the tight ITB.…”

Section: Therapeutic Strategy For Fai Syndrome With Esh Using Itb Release Techniquementioning

confidence: 99%

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Arthroscopic Treatment for Femoroacetabular Impingement Syndrome with External Snapping Hip: A Comparison Study of Matched Case Series

Zhang

et al. 2021

Orthopaedic Surgery

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Objective To determine the effectiveness of hip arthroscopy combined with endoscopic iliotibial band (ITB) release in patients with both femoroacetabular impingement (FAI) syndrome and external snapping hip (ESH). Methods Retrospectively review the preoperative and minimum of 2‐year follow‐up data of patients with both FAI syndrome and ESH who underwent endoscopic ITB release during hip arthroscopy (FAI + ESH group) from January 2014 to December 2018. The same number of age‐ and gender‐matched FAI syndrome patients without ESH undergoing hip arthroscopy were enrolled in the control group (FAI group). Patient‐reported outcomes (PROs) including international Hip Outcome Tool (iHOT‐33), modified Harris Hip Score (mHHS), visual analog scale for pain (VAS‐pain), and abductive force of affected hip at 3 month and 2 years postoperatively were comparatively analyzed. The VAS‐satisfaction score of two groups at 2 years postoperatively were also analyzed. Results The prevalence of ESH in FAI syndrome patients undergoing hip arthroscopy in our institution was 5.5% (39 of 715 hips), including nine males (10 hips) and 29 females (29 hips). The mean age at the time of surgery was 32.1 ± 6.9 years (range, 22–48 years). According to inclusion and exclusion criteria, 23 patients were enrolled in FAI + ITB group. Twenty‐three age‐ and sex‐matched FAI syndrome patients were enrolled in FAI group. At 24 months postoperatively, no patient still suffered ESH symptoms and painful palpation at lateral region in FAI + ITB group. The iHOT‐33, mHHS, and VAS‐pain score of patients in FAI + ESH group were significantly severer than patients in FAI group preoperatively (41.6 ± 7.5 vs 48.8 ± 7.2, 54.8 ± 7.2 vs 59.2 ± 6.9, 5.5 ± 0.9 vs 4.7 ± 1.0; P < 0.05), while there was no significant difference in these scores between the patients in FAI + ESH group and FAI group at 3‐month and 24‐month follow‐up (73.6 ± 8.5 vs 76.1 ± 6.9, 85.3 ± 7.8 vs 84.2 ± 6.6, 0.8 ± 0.9 vs 0.6 ± 0.9; P > 0.05). At 3 months after surgery, the abductive force of operated hip was significantly smaller than that in FAI group (82.4 ± 12.4 N vs 91.9 ± 16.1 N, P < 0.05), whereas there was no significant difference at 24 months after surgery (101.6 ± 14.9 N vs 106.5 ± 13.7 N, P > 0.05). The VAS‐satisfaction scores of patients in the two groups were at a similarly high level (90.5 ± 6.8 vs 88.8 ± 7.3, P > 0.05). There was no complication and no arthroscopic revision in either group until 2‐year follow‐up. Conclusion Although abductive force recovery of the hip was delayed, hip arthroscopy combined with endoscopic ITB release addressed hip snapping in patients with both FAI syndrome and ESH, and could get similar functional improvement, pain relief, recovery speed, as well as patient satisfaction compared with the pure hip arthroscopy in FAI syndrome patients without ESH.

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“…The Z-plasty technique and the modified Z-plasty technique for lengthening the ITB, as well as endoscopic cruciate or transversal incision in the ITB for release, have been reported to have good results. [6][7][8] In another study by Maldonado et al, 9 they described a combination of a transverse incision in the ITB at the level of the tip of the greater trochanter (GT) and a longitudinal incision across the femoral insertion of the GMTda technique described by Polesello et al 10 for ESH. This technique for ITB release is more aggressive than ours.…”

Section: See Related Article On Page 1890mentioning

confidence: 99%

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

Zhang

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Endoscopic Trochanteric Bursectomy and Iliotibial Band Release for Persistent Trochanteric Bursitis

Cited by 13 publications

References 9 publications

Editorial Commentary: Indications for Concurrent Procedures During Hip Femoroacetabular Impingement Arthroscopic Treatment

Editorial Commentary: Indications for Concurrent Procedures During Hip Femoroacetabular Impingement Arthroscopic Treatment

Arthroscopic Treatment for Femoroacetabular Impingement Syndrome with External Snapping Hip: A Comparison Study of Matched Case Series

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

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