Clinical Outcomes Following Incomplete Arthroscopic Iliotibial Band Release for External Snapping Hip Syndrome: An Observational Study.

OBJECTIVES: Arthroscopic treatment is indicated for external snapping hip (ESH) syndrome in patients refractory to conservative treatment, but snapping does not disappear completely in some case. No previous studies have described the clinical course of ESH syndrome in patients who presented with persistent snapping after an arthroscopic procedure. We demonstrated the clinical outcomes following an incomplete arthroscopic iliotibial band (ITB) release for ESH syndrome. METHODS: This retrospective observational study was performed at two teaching hospitals between October 2015 and December 2021. We reviewed the data of 33 patients (34 hips) aged ≥18 years, diagnosed with ESH syndrome, who were treated with arthroscopic ITB release. Patients who presented with persistent snapping despite sufficient arthroscopic ITB release following systematic order were defined as having an incomplete release. We collected the data for recurrent symptomatic snapping hip as the primary outcome after a minimum 2-year follow-up. The visual analogue scale (VAS) and modified Harris hip (mHHS) scores were measured as secondary outcome. RESULTS: "Incomplete release" was identified in three of the 34 hips (8.9%). Cases of recurrent symptomatic snapping or conversion to open surgery were not observed. The symptoms of residual snapping spontaneously disappeared in all cases following routine postoperative rehabilitation within a 3-month follow-up period. The VAS (4 ± 1) and mHHS (17 ± 6) scores of all the patients improved. CONCLUSION: When refractory ESH syndrome is identified during arthroscopic surgery, appropriate ITB release and removal of the major lesion causing snapping are expected to lead to resolution of residual symptoms without conversion to open surgery.

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

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.

Síndrome de la banda iliotibial / Iliotibial band syndrome

Introducción: El dolor en la rodilla responde a múltiples causas. Entre ellas se encuentra el síndrome de la banda iliotibial que afecta, principalmente, a pacientes jóvenes que practican cierta actividad deportiva. Objetivo: Actualizar y ofrecer información sobre el síndrome de la banda iliotibial. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 92 días (01 de julio al 30 de septiembre de 2020). Se emplearon las siguientes palabras: iliotibial band syndrome, iliotibial band friction syndrome AND lateral knee pain. Se realizó una revisión bibliográfica de un total de 186 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 40 citas seleccionadas para realizar la revisión, 38 de los últimos cinco años. Desarrollo: Se mencionan las características anatómicas más importantes relacionadas con la banda iliotibial. Se refiere a las maniobras empleadas, así como los exámenes imagenológicos de mayor utilidad. Se exponen las principales entidades implicadas en el diagnóstico diferencial. Con relación al tratamiento se mencionan las modalidades conservadoras y quirúrgicas. Conclusiones: El síndrome de la banda iliotibial es una enfermedad que tiene como característica fundamental dolor lateral de la rodilla el cual aumenta con la actividad física. El tratamiento conservador constituye la primera línea y el quirúrgico está justificado a los seis meses de respuesta limitada a la primera modalidad del enfrentamiento terapéutico(AU)

Introduction: Knee pain responds to multiple causes such as the iliotibial band syndrome that mainly affects young patients who practice certain sports activities. Objective: To update and offer information on iliotibial band syndrome. Methods: The search and analysis of the information was carried out in a period of 92 days - from July 1 to September 30, 2020, with the words iliotibial band syndrome, iliotibial band friction syndrome AND lateral knee pain. A bibliographic review of 186 articles published in PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference manager, Forty citations were selected to perform the review, 38 of them were from the last five years. Development: The most important anatomical characteristics related to the iliotibial band are mentioned. They refer to the maneuvers used, as well as the most useful imaging tests. The main entities involved in the differential diagnosis are presented. Regarding treatment, conservative and surgical modalities are mentioned. Conclusions: The iliotibial band syndrome is a disease, main characterized by lateral knee pain, which increases with physical activity. Conservative treatment constitutes the first option; in addition, surgical treatment is justified after six months of limited response to the first option of therapeutic management(AU)

Ultrasound-guided release for iliotibial band syndrome: A novel ultraminimally invasive surgical procedure.

BACKGROUND: Iliotibial band (ITB) syndrome is the most common cause of lateral knee pain in runners (affecting 7-14%) and in persons taking part in other sports. The aim of this study was to show how to perform a distal release of the ITB guided by ultrasound and present our initial results with this new technique. METHODS: The surgical technique - either Z-plasty or transverse section of the ITB - was first validated on 14 cadaver specimens and then applied in clinical practice. We operated on 32 patients (27 males and five females, 34 cases) from 2013 to 2018. Mean age was 40 years (25-60). The patients comprised 21 recreational middle- or long-distance runners (23 cases), five cyclists, two basketball players, two military personnel, one fireman, and one boxer. RESULTS: All patients were satisfied after 3 months and returned to their sporting activities without restrictions. The visual analog scale score for the practice of sports activities improved from 7 (6-9) before surgery to 0 (0-1) after. The average Lysholm score was 68 points before surgery and 97 (91-100) after, with five good results and 29 excellent results. No patients complained of instability or muscle weakness after 3 months. CONCLUSION: Ultrasound-guided release of the ITB is a novel minimally aggressive surgical approach that potentially enables faster recovery. It is relatively easy, quick, and painless, with a small incision, and can be performed under local anaesthesia in an outpatient setting. It does not require limb exsanguination or stitches, and complications are minimal.

Iliotibial band friction syndrome after knee arthroplasty.

Iliotibial band (ITB) friction syndrome is known to be one of the main causes of lateral knee pain related to an overuse injury. In the field of knee arthroplasty, ITB traction syndrome has been reported following guided motion total knee arthroplasty, due to posterior femoral translation and internal tibial rotation during knee flexion. However, ITB friction syndrome following conventional knee arthroplasty has not been reported. This paper reports four cases of this syndrome following conventional knee arthroplasty, mainly caused by an obstruction just under the ITB. Cases 1 and 2 presented extruded cement at the femoral component's lateral side after total knee arthroplasty. Case 3 presented a highly sharp-edged bearing at the lateral compartment after bicompartmental knee arthroplasty. Case 4 presented an osteophyte at the femoral component's lateral side after total knee arthroplasty. Although none of the cases responded well to conservative treatment, ITB friction syndrome was completely relieved just after excising the obstruction. Excision of an obstruction should be considered for ITB friction syndrome caused by obstruction just under the ITB following knee arthroplasty.

Outcome of Low-Invasive Local Split-Thickness Lengthening for Iliotibial Band Friction Syndrome.

Conventional surgical methods for iliotibial band friction syndrome (ITBFS) may affect the iliotibial band (ITB), delaying return to sports activities or impeding performance. We have developed a minimally invasive method. This study retrospectively analyzed the outcomes of this procedure in individuals with ITBFS. This study included 34 knees of 31 individuals. Surgery involved lengthening the central part of the ITB by splitting it into a superficial and a deep layer, maintaining the anterior and posterior fibers immediately above the lateral epicondyle. Outcomes included time to resume sports activity, personal best times to run a 5000-m race before and after surgery, and 2-month post-surgery muscle strengths. The mean postoperative time to return to competition was 5.8 weeks. Personal best times of 5000-m race improved in 13 of 17 runners. Two months post-surgery, the mean extensor muscle strengths on the healthy and affected sides did not significantly differ nor did the flexor muscle strengths. In ITBFS, the ITB itself is normal. Lengthening the limited region of the ITB immediately above the lateral femoral epicondyle removes the cause of ITBFS, with a reduction in inflammation. This technique resulted in early return to competition without degrading performance.

Iliotibial band syndrome: evaluation and management.

Iliotibial band syndrome is a common overuse injury typically seen in runners, cyclists, and military recruits. Affected patients report lateral knee pain associated with repetitive motion activities. The diagnosis is usually made based on a characteristic history and physical examination, with imaging studies reserved for cases of recalcitrant disease to rule out other pathologic entities. Several etiologies have been proposed for iliotibial band syndrome, including friction of the iliotibial band against the lateral femoral epicondyle, compression of the fat and connective tissue deep to the iliotibial band, and chronic inflammation of the iliotibial band bursa. The mainstay of treatment is nonsurgical; however, in persistent or chronic cases, surgical management is indicated.

Response to diagnostic injection in patients with femoroacetabular impingement, labral tears, chondral lesions, and extra-articular pathology.

PURPOSE: The purpose of this study was to compare the percent relief from injection among subjects with arthroscopic findings of femoroacetabular impingement (FAI) and labral and chondral pathologies while controlling for coexisting extra-articular pathology. METHODS: We retrospectively reviewed 72 consecutive subjects (54 female and 18 male subjects), aged 29.9 ± 10.4 years (range, 16 to 55 years), who underwent hip arthroscopy. Three separate analyses of covariance compared the percent relief after injection between groups based on surgically confirmed type of impingement (none, cam, pincer, or combined), labral pathology (none, mild, or torn), and chondral pathology (none, mild acetabular abnormality, acetabular delamination, or femoral lesion) while controlling for the presence of extra-articular pathology (iliotibial band, iliopsoas tendinopathy, or bursitis). RESULTS: The results of analysis 1 (F3,67 = 1.96, P = .128, partial η² = .081) and analysis 2 (F2,68 = 0.008, P = .992, partial η² = .000) indicated no significant main effect for FAI and labral pathology, respectively, on percent relief from injection. The results for analysis 3 indicated a significant main effect for chondral pathology of the hip on the percent relief from injection (F3,67 = 3.03, P < .05, partial η² = .128). Post hoc analysis showed that those with mild chondral pathology of the acetabulum and those with acetabular delamination had significantly greater percent relief compared with those without chondral pathology. Extra-articular pathology did not influence the percent relief from injection in any of the analyses. CONCLUSIONS: Subjects with chondral damage had greater relief from injection than those without, regardless of severity. The presence and severity of FAI and labral pathology did not influence the percent relief from injection. Concurrent extra-articular pathology did not alter the interpretation of the percent relief from injection. Therefore the interpretation and diagnostic value of an anesthetic injection in those with primary intra-articular pathology does not need to be altered by the presence of coexisting extra-articular hip pathology. LEVEL OF EVIDENCE: Level IV, therapeutic case series.