Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon.

PURPOSE: The internal snapping hip syndrome is caused by slippage of the iliopsoas tendon over the iliopectineal eminence or the femoral head. Open surgical techniques have been successfully used to treat this condition. More recently, endoscopic techniques have become available to address this problem. The purpose of this study was to investigate an endoscopic technique for release of the iliopsoas tendon and its short-term results. TYPE OF STUDY: Consecutive case series. METHODS: Six patients (7 hips) with an average age of 38.5 years had an endoscopic release of the iliopsoas tendon for internal snapping hip syndrome. Hip arthroscopy was performed in every patient. Special inferior portals were used for psoas bursoscopy. The iliopsoas tendon was identified and released at the level of the lesser trochanter in all cases. RESULTS: Intra-articular concomitant injuries were identified and treated in 4 cases. No snapping symptoms were present in any patient after surgery nor at the last follow-up at, on average, 21 months. Significant loss of flexion strength was present after surgery but had improved by 8 weeks. CONCLUSIONS: In our hands, the endoscopic technique for iliopsoas tendon release was effective and reproducible and our results compare well with results of open procedures in the short term. LEVEL OF EVIDENCE: Level IV.

Hip arthroscopy after previous acetabular osteotomy for developmental dysplasia of the hip.

PURPOSE: The purpose of this study was to examine the arthroscopic findings in the hips of patients with long-term follow-up of Chiari osteotomies. TYPE OF STUDY: Prospective consecutive series of patients. METHODS: Seven consecutive patients (1 male, 6 female; average age, 23 years) having a Chiari osteotomy performed in 1 hip during childhood or adolescence for developmental dysplasia of the hip were studied. They presented mechanical hip symptoms and had adequate head coverage as a result of the osteotomy with preservation of joint space. Hip arthroscopy was performed in all cases. RESULTS: A massive labral tear dislocated in the midportion of the joint was found in all cases with varying degrees of cartilage damage in the acetabulum or femoral head. The labral tear was resected, cartilage lesions were repaired, and microfracturing of the exposed subchondral bone was performed. Mechanical symptoms improved after surgery and all of the patients were able to go back to activities of daily living. CONCLUSIONS: In the Chiari osteotomy, medial displacement of the acetabulum leaves the labrum in the center of the load-bearing area of the resulting acetabulum. Over time this can produce a tear of the labrum, which may be the cause of the mechanical symptoms in our series. It has been documented that labral tears can lead to early degenerative hip disease and, combined with the cartilage lesions, may explain in part the long-term bad results of the Chiari osteotomy. LEVEL OF EVIDENCE: Level IV.

An aiming guide for anterior portal placement in hip arthroscopy.

Hip arthroscopy has become a standard surgical procedure. Specific portals and portal placement techniques are well described and routinely used. The anterior portal placement relies on the ability of the surgeon to introduce a needle into the joint from the landmark located at the crossing of a vertical line from the anterior superior iliac spine and a horizontal line from the greater trochanter. Directing the needle at 30 degrees medially and 45 degrees proximally is recommended, but some adjustment is always necessary to access the joint. Multiple punctures are often needed to place the needle in the correct path into the hip. This increases the risk of injury by puncture of the structures adjacent to the site of the anterior portal and increases surgical time. This study reports the use of a guide device we developed to assist anterior portal placement. The device consists of an intra-articular probe attached to an extra-articular aiming guide that introduces the needle into the hip joint. The needle enters at the previously described landmark and is directed towards the tip of the probe inside the joint. Early clinical results are presented.