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

TL;DR

This study shows that incomplete arthroscopic release for external snapping hip syndrome can still lead to symptom improvement without needing further surgery.

Contribution

The study is the first to describe clinical outcomes of incomplete arthroscopic iliotibial band release for ESH syndrome.

Findings

Incomplete release occurred in 8.9% of cases but did not lead to recurrent symptoms or need for open surgery.

Residual snapping symptoms resolved spontaneously within 3 months after routine rehabilitation.

Patients showed significant improvement in VAS and mHHS scores post-surgery.

Abstract

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.

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.

“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.

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.

Natural course of incomplete release of external snapping hip. When refractory external snapping hip (ESH) syndrome is identified during arthroscopic surgery, appropriate iliotibial band (ITB) release and removal of the major lesion causing snapping are expected to lead to resolution of residual symptoms without conversion to open surgery.

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