External snapping hip

Definition

 

Iliotibial band (ITB) flipping over the greater trochanter

 

Epidemiology

 

Up to 10% of the population

More common in certain activities i.e. ballet dancers

 

Aetiology

 

Thickening of the posterior margin of ITB

Thickening of the anterior border of Gluteus maximus

 

Symptoms

 

Usually painless

Visible and/or audible

Can often be produced voluntarily

 

Examination

 

Hip flexion and internal rotation causes readily palpable snapping sensation

Tight iliotibial band subluxes over the greater trochanter

 

Management

 

Majority of patients no treatment required

- rest

- iliotibial band stretching exercises

- NSAIDS +/- local corticosteroid injections

 

Operative management

 

Options

 

Iliotibial band release

+/- gluteus maximus tendon release

 

ITB vertical split / cruciform release + trochanteric bursectomy

 

ITB release illustration

 

Vumedi video

Arthroscopic technique article

 

Position

- patient lateral / on traction table

 

Portals

- 3cm below and above greater trochanter

 

Technique

- identify ITB

- abduct leg to protect abductor tendon

- vertical incision in ITB

- anterior and posterior split in ITB

- resect corners to create a diamond shaped defect

 

ITB release 2ITB release 1ITB release 1

ITB band                                               Longitudinal split in ITB exposing the trochanteric bursa and abductor insertion

 

ITB release 4ITB release 5

Cruciform release anteriorly                     Bursectomy over abductors

 

Gluteus maximus tendon insertion release

 

Surgical technique article

 

Results

 

Pierce et al Hip Int 2018

- systematic review of surgical management

- 7 papers with 113 hips

- recurrence rate of 7%