Objective To compare the effectiveness of arthroscopic outside-in release for gluteal muscle contracture (GMC) in supine position versus lateral decubitus position. Methods The clinical data of 34 GMC patients meeting selection criteria between January 2022 and May 2023 were retrospectively analyzed. Arthroscopic contracture band release was performed in the lateral decubitus position (lateral group, n=14) or the supine position (supine group, n=20). No significant difference (P>0.05) was observed between groups in baseline data, including gender, age, body mass index, preoperative GMC functional quantitative score, modified Harris hip score (mHHS), visual analogue scale (VAS) pain score, and hip flexion/adduction range of motion (ROM). The total operation time, release procedure time, non-release procedure time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared. Functional outcomes (GMC functional quantitative score, mHHS score, VAS score, hip flexion/adduction ROM) were evaluated preoperatively and at 3, 12, and 24 months postoperatively. Results All incisions healed by first intention without major vascular or neurological complications. In the lateral group, 3 patients developed patchy bruising on bilateral buttocks and posterior thighs at 3 days after operation, which resolved after 2 weeks of ice packs and ultrasonic therapy. The supine group demonstrated significantly shorter total operation time, non-release procedure time, hospital stay, and reduced intraoperative blood loss versus the lateral group (P<0.05). No significant difference was found in release procedure time (P>0.05). All patients were followed up 24 months. Both groups showed significant improvements (P<0.05) in mHHS score, GMC functional quantitative score, VAS score, and hip adduction/flexion ROM at all postoperative timepoints compared to preoperative values, with no significant intergroup differences (P>0.05). Conclusion Both surgical positions effectively improve hip function in GMC patients. However, the supine position offers significant advantages over the lateral decubitus position in operation time, anesthesia management, intraoperative blood loss control, and reduced hospital stay.
ObjectiveTo investigate the effectiveness of arthroscopic iliopsoas tendon tenotomy at the labral level for iliopsoas cyst complicated with internal snapping hip. Methods A retrospective analysis was conducted on the clinical data of 9 patients diagnosed with iliopsoas cyst and internal snapping hip admitted between April 2021 and June 2023. The cohort consisted of 3 males and 6 females, aged 23-58 years with a mean age of 40.7 years. The disease duration ranged from 11 to 24 months, with an average of 16.7 months. Preoperative MRI showed that 9 cases were complicated with glenoid labrum tear, iliopsoas muscle cyst extended from the glenoid level to the proximal end of the lesser trochanter, and compressed the femoral artery and vein. The iliopsoas tendons were cut at the level of glenoid labrum under arthroscopy. Pincer plasty (7 cases), glenoid labrum repair (6 cases), or glenoid labrum debridement (3 cases) was performed according to the lesions during operation, and the cyst drainage and cyst wall debridement were completed. Imaging examinations were performed before operation and at 2 days after operation to measure the lateral central-edge angle (LCE), α angle, off-set value, and the distance from femoral artery and vein to acetabular rim. The modified Harris Hip Score (mHHS), the 12-item International Hip Outcome Tool (iHOT-12), and the visual analogue scale (VAS) score were used to assess hip function before operation and at last follow-up, and the hip flexion and external rotation muscle strength in supine position were compared. ResultsAll patients completed the surgery successfully. The operation time ranged from 50 to 92 minutes (mean, 67.3 minutes), and intraoperative blood loss was 10-25 mL (mean, 18.9 mL). Pain and snapping symptoms resolved immediately after operation, and no complications such as femoral nerve injury, femoral arteriovenous injury, or incision infection occurred. Imaging examinations at 2 days postoperatively showed that the α angle, LCE, and the distances from the femoral artery and vein to the acetabular rim significantly decreased when compared with preoperative values, while the offset value significantly increased, with all differences significant (P<0.05). All the 9 patients were followed up 22-45 months (mean, 35.0 months). During the follow-up, no recurrence of hip snapping was observed; hip pain, daily living ability and activity function were markedly improved. At last follow-up, the mHHS score, iHOT-12 score, VAS score, as well as hip external rotation muscle strength were all significantly improved when compared with preoperative values (P<0.05), but there was no significant difference in hip flexion strength between before and after operation (P>0.05). ConclusionArthroscopic iliopsoas tendon tenotomy at labral level complicated with internal snapping hip can effectively relieve the pain and snapping symptoms of iliopsoas cyst combined with medial snapping hip, and promote the recovery of hip function, which is a safe and effective minimally invasive operation.