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Patients With Concomitant Painful External Snapping Hip and Femoroacetabular Impingement Syndromes Reported Complete Snapping Resolution With Release of the Gluteus Maximus and Iliotibial Band, and Comparable Minimum 2-Year Outcomes to a Propensity-Matched Control Group

Published:December 14, 2021DOI:https://doi.org/10.1016/j.arthro.2021.11.048

      Purpose

      To report minimum 2-year patient-reported outcome measures (PROMs) following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and painful external snapping hip (ESH) treatment and ESH resolution, and to compare these PROMs to a benchmark FAIS propensity-matched control group without ESH.

      Methods

      Data were prospectively collected and retrospectively reviewed between November 2009 and April 2018. Patients were eligible if they were preoperatively diagnosed with FAIS and painful ESH and received primary hip arthroscopy to address these pathologies. ESH was treated with gluteus maximus and iliotibial band releases. Inclusion criteria were baseline and minimum two-year follow-up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. Exclusion criteria were Tönnis grade >1 and previous hip conditions. A secondary subanalysis was performed to benchmark these outcomes to a FAIS propensity-matched control group without ESH, according to age, sex, body mass index (BMI), Tönnis grade, and preoperative lateral center-edge and α-angles using a 1:3 ratio. The minimal clinically important difference (MCID) and the maximum outcome improvement (MOI) rates were reported.

      Results

      Twenty-two hips (21 patients) were included. The mean age, BMI, and follow-up were 31.3 years ± 14.0, 26 kg/m2 ± 5.0, and 31.4 months ± 4.4, respectively, with 68.2% being female. ESH was resolved in 100% of patients. Significant improvement for all PROMs at a minimum two-year (P < .001) was reported. The minimum two-year PROMs and the rate of achieving the MCID and MOI threshold were comparable to the control group.

      Conclusion

      Following primary hip arthroscopy for FAIS and painful ESH, patients demonstrated significant improvement in all PROMs, and the rate of resolution of ESH was 100% at minimum two-year follow-up: with gluteus maximus and iliotibial band releases. Functional outcomes and rates of MCID and MOI achievement were comparable to a FAIS propensity-matched benchmark control group without ESH.

      Level of Evidence

      Level III, retrospective comparative study.
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      References

        • Byrd J.W.T.
        Snapping hip.
        Oper Tech Sports Med. 2005; 13: 46-54https://doi.org/10.1053/j.otsm.2004.09.003
        • Gruen G.S.
        • Scioscia T.N.
        • Lowenstein J.E.
        The surgical treatment of internal snapping hip.
        Am J Sports Med. 2002; 30: 607-613
        • Ilizaliturri V.M.
        • Martinez-Escalante F.A.
        • Chaidez P.A.
        • Camacho-Galindo J.
        Endoscopic iliotibial band release for external snapping hip syndrome.
        Arthroscopy. 2006; 22: 505-510https://doi.org/10.1016/j.arthro.2005.12.030
        • Shrestha A.
        • Wu P.
        • Ge H.
        • Cheng B.
        Clinical outcomes of arthroscopic surgery for external snapping hip.
        J Orthop Surg Res. 2017; 12: 81https://doi.org/10.1186/s13018-017-0584-1
        • Zini R.
        • Munegato D.
        • De Benedetto M.
        • Carraro A.
        • Bigoni M.
        Endoscopic iliotibial band release in snapping hip.
        HIP Int. 2013; 23: 225-232https://doi.org/10.5301/HIP.2013.10878
        • Zhang S.
        • Dong C.
        • Li Z.
        • et al.
        Endoscopic iliotibial band release during hip arthroscopy for femoroacetabular impingement syndrome and external snapping hip had better patient-reported outcomes: A retrospective comparative study.
        Arthroscopy. 2021; 37: 1845-1852https://doi.org/10.1016/j.arthro.2021.01.040
        • Matsuda D.
        • Kivlan B.R.
        • Nho S.J.
        • et al.
        Tenotomy for iliopsoas pathology is infrequently performed and associated with poorer outcomes in hips undergoing arthroscopy for femoroacetabular impingement.
        Arthroscopy. 2021; 37: 2140-2148https://doi.org/10.1016/j.arthro.2021.02.018
        • Gouveia K.
        • Shah A.
        • Kay J.
        • et al.
        Iliopsoas tenotomy during hip arthroscopy: A systematic review of postoperative outcomes.
        Am J Sports Med. 2021; 49: 817-829https://doi.org/10.1177/0363546520922551
        • Maldonado D.R.
        • Diulus S.C.
        • Annin S.
        • et al.
        Borderline dysplastic female patients with painful internal snapping improve clinical outcomes at minimum two-year follow-up following hip arthroscopy with femoroplasty, labral repair, iliopsoas fractional lengthening and capsular plication: A propensity-matched controlled comparison.
        Arthroscopy. 2021; 37: 2473-2484https://doi.org/10.1016/j.arthro.2021.03.034
        • Zhang S.
        • Dong C.
        • Li Z.
        • et al.
        Endoscopic iliotibial band release during hip arthroscopy for femoroacetabular impingement syndrome and external snapping hip had better patient-reported outcomes: A retrospective comparative study.
        Arthroscopy. 2021; 37: 1845-1852https://doi.org/10.1016/j.arthro.2021.01.040
        • Maldonado D.R.
        • Perets I.
        • Mu B.H.
        • et al.
        Arthroscopic capsular plication in patients with labral tears and borderline dysplasia of the hip: Analysis of risk factors for failure.
        Am J Sports Med. 2018; 46: 3446-3453https://doi.org/10.1177/0363546518808033
        • Domb B.G.
        • Chen S.L.
        • Go C.C.
        • et al.
        Predictors of clinical outcomes after hip arthroscopy: 5-year follow-up analysis of 1038 patients.
        Am J Sports Med. 2020; 49: 112-120https://doi.org/10.1177/0363546520968896
        • Byrd J.T.
        Physical examination.
        in: Byrd J.T. Operative hip arthroscopy. Springer, New York2005: 36-50
        • Randelli F.
        • Mazzoleni M.G.
        • Fioruzzi A.
        • Giai Via A.
        • Calvisi V.
        • Ayeni O.R.
        Surgical interventions for external snapping hip syndrome.
        Knee Surg Sports Traumatol Arthrosc. 2021; 29: 2386-2393https://doi.org/10.1007/s00167-020-06305-w
        • Clohisy J.C.
        • Carlisle J.C.
        • Beaulé P.E.
        • et al.
        A systematic approach to the plain radiographic evaluation of the young adult hip.
        J Bone Joint Surg Am. 2008; 90: 47-66https://doi.org/10.2106/JBJS.H.00756
        • Domb B.G.
        • Chaharbakhshi E.O.
        • Rybalko D.
        • Close M.R.
        • Litrenta J.
        • Perets I.
        Outcomes of hip arthroscopic surgery in patients with Tonnis grade 1 osteoarthritis at a minimum 5-year follow-up: A matched-pair comparison with a Tonnis grade 0 control group.
        Am J Sports Med. 2017; 45: 2294-2302https://doi.org/10.1177/0363546517706957
        • Ogata S.
        • Moriya H.
        • Tsuchiya K.
        • Akita T.
        • Kamegaya M.
        • Someya M.
        Acetabular cover in congenital dislocation of the hip.
        J Bone Joint Surg Br. 1990; 72: 190-196
        • Zingg P.O.
        • Werner C.M.L.
        • Sukthankar A.
        • Zanetti M.
        • Seifert B.
        • Dora C.
        The anterior center edge angle in Lequesne’s false profile view: Interrater correlation, dependence on pelvic tilt and correlation to anterior acetabular coverage in the sagital plane. A cadaver study.
        Arch Orthop Trauma Surg. 2009; 129: 787-791https://doi.org/10.1007/s00402-008-0694-7
        • McQuivey K.S.
        • Secretov E.
        • Domb B.G.
        • et al.
        A Multicenter study of radiographic measures predicting failure of arthroscopy in borderline hip dysplasia: Beware of the Tönnis angle.
        Am J Sports Med. 2020; 48: 1608-1615https://doi.org/10.1177/0363546520914942
        • Nötzli H.P.
        • Wyss T.F.
        • Stoecklin C.H.
        • Schmid M.R.
        • Treiber K.
        • Hodler J.
        The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.
        J Bone Joint Surg Br. 2002; 84: 556-560
        • Mansor Y.
        • Perets I.
        • Close M.R.
        • Mu B.H.
        • Domb B.G.
        In search of the spherical femoroplasty: Cam overresection leads to inferior functional scores before and after revision hip arthroscopic surgery.
        Am J Sports Med. 2018; 46: 2061-2071https://doi.org/10.1177/0363546518779064
        • Maldonado D.R.
        • Chen J.W.
        • Walker-Santiago R.
        • et al.
        Radiographic and demographic factors can predict the need for primary labral reconstruction in hip arthroscopic surgery: A predictive model using 1398 hips.
        Am J Sports Med. 2020; 48: 173-180https://doi.org/10.1177/0363546519887749
        • Lall A.C.
        • Saadat A.A.
        • Battaglia M.R.
        • Maldonado D.R.
        • Perets I.
        • Domb B.G.
        Perineal pressure during hip arthroscopy is reduced by use of Trendelenburg: A prospective study with randomized order of positioning.
        Clin Orthop Relat Res. 2019; 477: 1851-1857https://doi.org/10.1097/CORR.0000000000000804
        • Maldonado D.R.
        • Rosinsky P.J.
        • Shapira J.
        • Domb B.G.
        Stepwise safe access in hip arthroscopy in the supine position: Tips and pearls from A to Z.
        J Am Acad Orthop Surg. 2020; 28: 651-659https://doi.org/10.5435/JAAOS-D-19-00856
        • Maldonado D.R.
        • Chen J.W.
        • Walker-Santiago R.
        • et al.
        Forget the greater trochanter! Hip joint access with the 12 o’clock portal in hip arthroscopy.
        Arthrosc Tech. 2019; 8: e575-e584https://doi.org/10.1016/j.eats.2019.01.017
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; : 232-240
        • Hevesi M.
        • Hartigan D.E.
        • Wu I.T.
        • et al.
        The rapidly assessed predictor of intraoperative damage (RAPID) score: An in-clinic predictive model for high-grade acetabular chondrolabral disruption.
        Orthop J Sports Med. 2018; 6 (2325967118799068)https://doi.org/10.1177/2325967118799068
        • Bhatia S.
        • Nowak D.D.
        • Briggs K.K.
        • Patterson D.C.
        • Philippon M.J.
        Outerbridge Grade IV cartilage lesions in the hip identified at arthroscopy.
        Arthroscopy. 2016; 32: 814-819https://doi.org/10.1016/j.arthro.2015.11.053
        • Maldonado D.R.
        • Diulus S.C.
        • Shapira J.
        • et al.
        Hip arthroscopic surgery in the context of femoroacetabular impingement syndrome, labral tear, and acetabular overcoverage: Minimum 5-year outcomes with a subanalysis against patients without overcoverage.
        Am J Sports Med. 2021; 49: 55-65https://doi.org/10.1177/0363546520969985
        • Chen A.W.
        • Yuen L.C.
        • Ortiz-Declet V.
        • Litrenta J.
        • Maldonado D.R.
        • Domb B.G.
        Selective debridement with labral preservation using narrow indications in the hip: Minimum 5-year outcomes with a matched-pair labral repair control group.
        Am J Sports Med. 2018; 46: 297-304https://doi.org/10.1177/0363546517739566
        • Maldonado D.R.
        • Chen S.L.
        • Chen J.W.
        • et al.
        Prospective analysis of arthroscopic hip anatomic labral repair utilizing knotless suture anchor technology: The controlled-tension anatomic technique at minimum 2-year follow-up.
        Orthop J Sports Med. 2020; 8 (232596712093507)https://doi.org/10.1177/2325967120935079
        • Domb B.G.
        • Battaglia M.R.
        • Perets I.
        • et al.
        Minimum 5-year outcomes of arthroscopic hip labral reconstruction with nested matched-pair benchmarking against a labral repair control group.
        Am J Sports Med. 2019; 47: 2045-2055https://doi.org/10.1177/0363546518825259
        • Perets I.
        • Hartigan D.E.
        • Chaharbakhshi E.O.
        • Walsh J.P.
        • Close M.R.
        • Domb B.G.
        Circumferential labral reconstruction using the knotless pull-through technique-surgical technique.
        Arthrosc Tech. 2017; 6: e695-e698https://doi.org/10.1016/j.eats.2017.01.014
        • Domb B.G.
        • Annin S.
        • Chen J.W.
        • et al.
        Optimal treatment of cam morphology may change the natural history of femoroacetabular impingement.
        Am J Sports Med. 2020; 48: 2887-2896https://doi.org/10.1177/0363546520949541
        • Lall A.C.
        • Annin S.
        • Chen J.W.
        • et al.
        Achieving a perfectly spherical femoroplasty: Pearls, pitfalls, and optimal surgical technique.
        Arthrosc Tech. 2020; 9: e303-e313https://doi.org/10.1016/j.eats.2019.10.011
        • Beck E.C.
        • Suppauksorn S.
        • Nho S.J.
        The role of comprehensive capsular management in hip arthroscopy for the treatment of femoroacetabular impingement syndrome.
        Arthroscopy. 2020; 36: 9-11https://doi.org/10.1016/j.arthro.2019.10.028
        • Polesello G.C.
        • Queiroz M.C.
        • Domb B.G.
        • Ono N.K.
        • Honda E.K.
        Surgical technique: Endoscopic gluteus maximus tendon release for external snapping hip syndrome.
        Clin Orthop Relat Res. 2013; 471: 2471-2476https://doi.org/10.1007/s11999-012-2636-5
        • Austin P.C.
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivar Behav Res. 2011; 46: 399-424https://doi.org/10.1080/00273171.2011.568786
        • Austin P.C.
        Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.
        Pharm Stat. 2011; 10: 150-161https://doi.org/10.1002/pst.433
        • Norman G.R.
        • Sloan J.A.
        • Wyrwich K.W.
        Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation.
        Med Care. 2003; 41: 582-592https://doi.org/10.1097/01.MLR.0000062554.74615.4C
        • Maldonado D.R.
        • Kyin C.
        • Shapira J.
        • et al.
        Defining the maximum outcome improvement of the modified Harris Hip Score, The Nonarthritic Hip Score, The visual analogue scale for pain, and the International Hip Outcome Tool-12 in the Arthroscopic Management for Femoroacetabular Impingement Syndrome and Labral Tear.
        Arthroscopy. 2021; 37: 1477-1485https://doi.org/10.1016/j.arthro.2021.01.002
        • Potalivo G.
        • Bugiantella W.
        Snapping hip syndrome: Systematic review of surgical treatment.
        Hip Int. 2017; 27: 111-121https://doi.org/10.5301/hipint.5000464
        • Yen Y.-M.
        • Lewis C.L.
        • Kim Y.-J.
        Understanding and treating the snapping hip.
        Sports Med Arthrosc. 2015; 23: 194-199https://doi.org/10.1097/JSA.0000000000000095
        • Allen W.C.
        • Cope R.
        Coxa saltans: The snapping hip revisited.
        J Am Acad Orthop Surg. 1995; 3: 303-308
        • Annin S.
        • Lall A.C.
        • Meghpara M.B.
        • et al.
        Intraoperative Classification System yields favorable outcomes for patients treated surgically for greater trochanteric pain syndrome.
        Arthroscopy. 2021; 37: 2123-2126https://doi.org/10.1016/j.arthro.2021.01.058
        • Maldonado D.R.
        • Annin S.
        • Chen J.W.
        • et al.
        Full-thickness gluteus medius tears with or without concomitant hip arthroscopy: Minimum 2-year outcomes using an open approach and contemporary tendon repair techniques.
        Orthop J Sports Med. 2020; 8 (2325967120929330)https://doi.org/10.1177/2325967120929330
        • Meghpara M.B.
        • Yelton M.J.
        • Annin S.
        • et al.
        Mid-term outcomes of endoscopic gluteus medius repair with concomitant arthroscopic labral treatment: A propensity-matched controlled study.
        Arthroscopy. 2020; 36: 2856-2865https://doi.org/10.1016/j.arthro.2020.07.020
        • Nazal M.R.
        • Abraham P.F.
        • Conaway W.K.
        • et al.
        Endoscopic repair of full-thickness gluteus medius and minimus tears—Prospective study with a minimum 2-year follow-up.
        Arthroscopy. 2020; 36: 2160-2169https://doi.org/10.1016/j.arthro.2020.04.025
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical Versus Statistical Significance.
        Arthroscopy. 2017; 33: 1102-1112https://doi.org/10.1016/j.arthro.2017.01.053
        • Lubowitz J.H.
        • Brand J.C.
        • Rossi M.J.
        Our measure of medical research should be appreciable benefit to the patient.
        Arthroscopy. 2019; 35: 1943-1944https://doi.org/10.1016/j.arthro.2019.04.033
        • Maldonado D.R.
        • Lall A.C.
        • Walker-Santiago R.
        • et al.
        Hip labral reconstruction: Consensus study on indications, graft type and technique among high-volume surgeons.
        J Hip Preserv Surg. 2019; 6: 41-49https://doi.org/10.1093/jhps/hnz008
        • Go C.C.
        • Kyin C.
        • Maldonado D.R.
        • Domb B.G.
        Surgeon experience in hip arthroscopy affects surgical time, complication rate, and reoperation rate: A systematic review on the learning curve.
        Arthroscopy. 2020; 36: 3092-3105https://doi.org/10.1016/j.arthro.2020.06.033