Surgical Technique: Endoscopic Iliotibial Band Lengthening

Abstract Background Greater trochanteric pain syndrome encompasses a range of causes of lateral hip pain including greater trochanteric bursitis, tendinopathy and tears of the gluteus minimus and medius, and lateral snapping hip (LSH). Surgical options for LSH range from open surgery to endoscopic surgery, including a diamond-shaped cut or a simple transversal release to gluteus maximus tendon release. Resection of an area of proximal iliotibial band (ITB) and step-cut or z-plasty lengthening have not proven superior to transverse release of the ITB. Therefore, making a complete and effective transverse cut guided by ultrasound may represent a potential advance over endoscopic surgery. Purpose In this case series study, we describe how to perform proximal release of the ITB guided by ultrasound. Methods The surgical technique—either z-plasty or transverse section of the ITB—was first validated on 10 cadaver specimens and then used in clinical practice. Fourteen patients (5 males and 9 females) were operated from 2014 to 2018. Mean age was 43 years (29–62). Results The snap resolved in all patients, as verified actively during the surgical procedure as the patient has only local anesthesia. The VAS score for sports activity improved from 7 (5–9) before surgery to 0 (0–2) after 1 year. The HSS score improved from 58 points (47–72) to 96 at 1–2 years. There were no complications other than minor hematomas nor recurrences. Conclusion Ultrasound-guided release of the LSH is a novel surgical option with encouraging results in patients for whom conservative protocols have failed. It can be performed under local anesthesia in an outpatient setting with minimal aggressiveness. It is relatively easy, quick, and painless; no stitches are required. Weight bearing is immediate, and patients usually need crutches for only 2–3 days. Although complete recovery may take 3 months, the rehabilitation protocol is fast and painless.

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Medial Closing-Wedge Distal Femoral Varus Osteotomy via Lateral Approach: The New Surgical Technique for Treating Valgus Osteoarthritic Knee

10.21203/rs.3.rs-471882/v1 ◽

2021 ◽

Author(s):

Chaturong Pornrattanamaneewong ◽

Pakpoom Ruangsomboon ◽

Rapeepat Narkbunnam ◽

Keerati Chareancholvanich

Keyword(s):

Surgical Technique ◽

Case Series ◽

Lateral Approach ◽

Joint Disease ◽

Iliotibial Band ◽

Varus Osteotomy ◽

Closing Wedge ◽

Satisfactory Outcome ◽

The Mean ◽

New Surgical Technique

Abstract Background and purpose: The medial closing-wedge distal femoral varus osteotomy (MCW-DFVO) was an excellent operation for painful valgus lateral unicompartmental osteoarthritic (OA) knee, especially in the young patient. Originally, it requires a medial approach that has more precarious. On top of that, releasing of the iliotibial band (ITB) that is the deforming force needs added incision. Therefore, this study aims to describe the new surgical technique of MCW-DFVO that uses a lateral approach and lateral plating to treat the valgus OA knee. Additionally, we also reveal the outcomes of our technique as the case series.Materials and method: Ten patients (12 knees) who underwent MCW-DFVO via a lateral approach were retrospectively reviewed. The inclusion criteria were age > 18 years, isolated lateral compartmental OA knee, no significant patellofemoral pain, and ROM > 90 degrees. We excluded the inflammatory joint disease, unstable knee (femorotibial joint subluxation > 1 cm), and prior surgical procedure. Demographic data, pre- and postoperative ROM, radiographic outcomes, complications, and survivorship were recorded.Results: The mean age, body mass index, and preoperative ROM were 55.3 ± 4.0 years, 25.4 ± 3.7 kg/m2and 113.3 ± 11.5 degrees, respectively. The preoperative valgus deformity was 162.3 ± 4.8 degrees, and the Final post-operative alignment was 182.3 ± 2.6 degrees. Overall mean operative time of this technique was 92.5 ± 26.7 minutes. During the follow-up period, post-operative ROM was decreased to 108.8 ± 11.7 degrees. One knee required plate removal due to hardware irritation, and another knee required subsequent total knee arthroplasty (TKA) at 1 and 8.5 years after DFVO, respectively. The survivorship of this technique was 91.7% at the mean survival time of 13.8 years (95% confidence interval, 11.9 – 15.7 years).Conclusion: This study proposed the new surgical technique of MCW-DFVO via a lateral approach. This technique provided a satisfactory outcome and excellent survivorship. However, further research with a larger sample size was required.

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