Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome.

PURPOSE: To evaluate the short-term results of 2 different techniques of endoscopic iliopsoas tendon release for the treatment of internal snapping hip syndrome. METHODS: Between January 2005 and January 2007, a consecutive series of patients with the diagnosis of internal snapping hip syndrome was treated with endoscopic release of the iliopsoas tendon. The patients were randomized into 2 different groups. Patients in group 1 were treated with endoscopic iliopsoas tendon release at the lesser trochanter, and patients in group 2 were treated with endoscopic transcapsular psoas release from the peripheral compartment. Hip arthroscopy of both the central and peripheral compartments was performed in both groups using the lateral approach. Associated injuries were identified and treated arthroscopically. Postoperative physical therapy was the same for both series, and each patient received 400 mg of celecoxib daily for 21 days after surgery. Preoperative and postoperative Western Ontario MacMaster (WOMAC) scores and imaging studies were evaluated. RESULTS: Nineteen patients were included in the study: 10 in group 1 (5 male and 5 female; average age, 29.5 years) and 9 in group 2 (8 female and 1 male; average age, 32.6 years). No statistical difference was found in group composition. Associated injuries were found and treated in 8 patients in group 1 and 7 patients in group 2. No statistical difference was found between groups in preoperative WOMAC scores, and every patient in both groups had an improvement in the WOMAC score. Improvements in WOMAC scores were statistically significant in both groups, and no difference was found in postoperative WOMAC results between groups. No complications were seen. CONCLUSIONS: Iliopsoas tendon release at the level of the lesser trochanter or at the level of the hip joint using a transcapsular technique is effective and reproducible. We found no clinical difference in the results of both techniques.

A complication of soft tissue graft tibial fixation with the IntraFix device.

BACKGROUND: One potential complication of interference devices to fix anterior cruciate ligament (ACL) grafts is divergence between the implant and the graft-tunnel. Tunnel-screw divergence >15-30 degrees significantly reduces graft-tunnel fixation and may compromise the stability of the knee. CASE REPORT: A complication of the IntraFix device is presented. A 43-year-old male sustained a primary ACL reconstruction. The autologous hamstring graft was fixed in the tibia with the IntraFix device. The procedure went without apparent incidents or complications. During postoperative follow-up he developed pain and crepitus over the anteromedial aspect of the operated knee. A flexion contracture slowly developed up to 10 degrees and did not improve with aggressive physiotherapy. At eight postoperative weeks, second-look arthroscopy was performed. The intraoperative findings were a healthy-looking ACL graft and a grade III chondral injury in the medial femoral condyle (MFC) caused by the tip of the IntraFix device, which protruded through the medial tibial plateau. During flexion-extension motion of the knee, the tip eroded the chondral surface of the MFC. This was treated with mechanical and thermal chondroplasty and the tip of the IntraFix device was burred flat to match the surface of the medial tibial plateau. The patient's symptoms improved. CONCLUSIONS: Divergence of the interference screws in the femur is not uncommon, but on the tibia it is rare. Although this technical error did not affect stability, it did produce intrarticular injury. Strict adherence to the surgical technique is recommended and several hints on how to avoid complications with this implant are suggested.