2025 ISAKOS Biennial Congress ePoster
Gluteal Complex Is Important In External Snapping Hip: Intraoperative Identification Of Syndrome Origin And Endoscopic Stepwise Release – A Case Series.
Marcin Mostowy, MD, Łódź POLAND
Dong Woon Kim, MS, Krakow POLAND
Michalina Bawor, MS, Łódź POLAND
Pawel Piotr Skowronek, MD, PhD, Krakow POLAND
Przemyslaw Pekala, Krakow POLAND
Robert F. LaPrade, MD, PhD, Edina, MN UNITED STATES
Konrad Malinowski, PhD, Belchatow POLAND
Artromedical Orthopaedic Clinic, Belchatow, POLAND
FDA Status Not Applicable
Summary
Endoscopic stepwise “fan-like” release of the tissues involved in external snapping hip syndrome (ESHS) was an effective, tailor-made treatment option for ESHS with no recurrences at follow-up of 24-56 months, even though more than 75% of cases necessitated not only the isolated iliotibial band release, but also release of fascial or even muscular part of the gluteus maximus complex.
ePosters will be available shortly before Congress
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.