A new operative approach in the correction of external coxa saltans: the snapping hip

BACKGROUND: External snapping hip is an entity that describes a snap that is felt on the lateral aspect of the hip. Several surgical interventions are described. HYPOTHESIS: The external snapping hip can be corrected with a simple procedure that is minimally invasive and less demanding than other techniques. STUDY DESIGN: This is a retrospective review from June 1994 until January 2002 looking at released external snapping hips. METHODS: There were 16 patients with 17 hips; follow-up was in 15 patients with 16 snapping hips. Twelve patients with 13 hips were contacted by telephone interview, and 3 were followed up by their most recent chart note. All underwent the same procedure performed by the senior author. The questionnaire was conducted at an average of 32.5 months after surgery (range, 9-74 months). For 3 patients, chart-only follow-up was at 6 weeks, 3 months, and 6 months, respectively. RESULTS: Fourteen of 16 hips remained asymptomatic after final surgical release (2 hips needed a second release). All patients contacted by telephone would undergo the same procedure again if faced with the same symptoms. CONCLUSIONS: This technique is simpler than most of those previously described with the benefit of no formal postoperative regimen and comparable results.     

The surgical treatment of internal snapping hip

BACKGROUND: Internal snapping hip is an underdiagnosed cause of hip pain that sidelines many recreational and competitive athletes. It originates from a taut iliopsoas tendon that snaps across bony prominences when the hip is extended from a flexed position. When nonoperative treatment methods fail, fractional tendon-lengthening procedures may be used. HYPOTHESIS: Surgical tendon lengthening through a true ilioinguinal approach, which has not been previously reported, will achieve good results in patients with internal snapping hip. STUDY DESIGN: Retrospective cohort study. METHODS: In 30 patients with symptoms in their anterior hip, internal snapping hip was diagnosed by history and physical examination. All patients were initially treated nonoperatively; 19 (63%) improved and did not require further intervention. Eleven patients (12 hips) whose symptoms were recalcitrant to physical therapy were offered the surgical option of iliopsoas tendon lengthening. The procedure was performed via an ilioinguinal intrapelvic approach. Patients were followed up for an average of 3 years. RESULTS: All 11 surgically treated patients (100%) had complete postoperative mitigation of their snapping hip. Nine (82%) reported excellent pain relief. Moreover, nine patients thought that they had greatly benefited from the tendon lengthening and would repeat the surgery. CONCLUSION: Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy.     

Coxa saltans externa treated with Z-plasty of the iliotibial tract in a military population

Coxa saltans, or snapping hip, can be attributable to a number of causes. Coxa saltans externa typically occurs when the thickened portion of the iliotibial band snaps over the greater trochanter as the hip is flexed. This condition generally resolves with a course of nonoperative treatment. We have treated three patients with Z-plasty of the iliotibial band, which has the highest published success rate in the English language literature. Only one of three patients was able to return to full activities postoperatively. In our small series, this method of surgical treatment in an active duty military population yielded less than optimal results.     

局部浸润麻醉下弹响髋关节镜辅助手术的疗效分析

23例(25髋)弹响髋分别在局部浸润麻醉(21髋)与椎管内麻醉(14髋)下关节镜辅助手术治疗,前者较后者手术疗效更为理想,平均手术时间更短;两者平均功能恢复时间无显著性差异,均无严重并发症发生.局部浸润麻醉下关节镜辅助手术治疗弹响髋疗效肯定.     

The treatment of iliotibial band friction syndrome.

Iliotibial band friction syndrome is a common cause of knee pain in long distance runners. The pain is caused by friction of the iliotibial band over the lateral epicondyle of the femur. Two hundred and twenty one cases were seen in a two year period. Tenderness over the lateral epicondyle associated with pain at 30 degrees of flexion on compressing the iliotibial band against the lateral epicondyle is diagnostic. Conservative treatment consisted of treating the cause, mostly training irregularities and the local inflammation mostly with steroid injections and rest. Nine cases failed to respond to conservative treatment and these were treated by surgical release of the posterior fibres of the iliotibial band.     

Surgical treatment of the iliotibial band friction syndrome

A selected group of 23 patients underwent surgery for iliotibial band friction syndrome. Among the patients presenting with this exertional pain syndrome were runners, football players, and cyclists. Diagnosis was clinical since radiographs were negative and an ultrasound examination was positive in only one case, showing an aberrant picture around the lateral femoral epicondyle. Although conservative treatment is effective in most cases, an alternative is needed for patients with complaints that are resistant to conservative means. Surgery was done with the knee held in 60 degrees of flexion and consisted of a limited resection of a small triangular piece at the posterior part of the iliotibial band covering the lateral femoral epicondyle. The uniform good results, low morbidity, and quick return to sports demonstrate that this type of surgery offers a solution for selected cases of failed prolonged conservative treatment.     

The anatomy of the iliopatellar band and iliotibial tract

Based on an extensive review of the literature and dissections of 17 fresh-frozen knee specimens, the authors divide the lateral fascia lata of the knee into two functional components: the iliopatellar band and the iliotibial tract. Aponeurotic, superficial, middle, deep, and capsulo-osseous layers contribute to these two functional components. The superficial layer of the iliotibial tract, combined with the deep, and capsulo-osseous layers, is hypothesized to function as an anterolateral ligament of the knee. The iliopatellar band provides stabilization of the patella against a medially directed force and is dynamically influenced by the vastus lateralis. The relationship of the iliotibial tract to extraarticular reconstructions of the knee with anterolateral rotatory instability is discussed.     

Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement

An association between hip pain and quadratus femoris MRI abnormality with concurrent narrowing of the ischiofemoral space has been reported in a number of patients to date, raising the possibility that the muscular damage observed is due to ischiofemoral impingement [1]. Possible impingement has been noted primarily in middle-aged females either with or without a history of trauma or surgery, and associated snapping of the hip is a rarely described feature [1–3]. We report here on a 17-year-old girl who presented with post-traumatic hip pain; she later developed evidence of ischiofemoral narrowing and quadratus femoris edema on MRI in addition to an audible snapping. Surgical resection of the lesser trochanter was performed, relieving both her hip pain and the snapping. To our knowledge, this is the first reported case of non-iatrogenic ischiofemoral impingement with surgical confirmation. The diagnosis of ischiofemoral impingement should be considered in patients complaining of a snapping hip.     

The role of the iliotibial band during the pivot shift test

Purpose

Several studies have suggested that the iliotibial (IT) band plays a role in knee laxity and that it may affect the magnitude of the pivot shift observed. However, the extent of the role played by the IT band, as well as its mechanism of action, is not currently known. This cadaveric study aimed to quantify the effect of the IT band and the hip abduction angle on the magnitude of anterior tibial translation (ATT) during the pivot shift.

Methods

Six fresh-frozen hip-to-toes specimens were used. Serial sectioning of the anterior cruciate ligament (ACL) and the IT band was performed. Lachman and mechanized pivot shift manoeuvres were employed at each stage, and ATT of the lateral and medial compartments was measured using navigation. Three hip abduction angles were tested for each condition: 0°, 15° and 30°.

Results

Sequential sectioning of the ACL and the IT band resulted in a significant increase in ATT in both the lateral (Intact = 0 ± 0.5 mm; ACL deficient = 8.1 ± 0.2 mm; ACL + IT deficient = 10.8 ± 0.3 mm) and medial (Intact = 6.7 ± 0.4 mm; ACL deficient = 8.4 ± 0.3 mm; ACL + IT deficient = 9.9 ± 0.3 mm) compartments. No significant increase in ATT was observed after changing the hip abduction angle at each stage.

Conclusions

An increase in the magnitude of the pivot shift and the Lachman was observed as the constraint of the IT band was removed. Additionally, it was shown that the hip abduction angle at which the pivot shift test was performed did not significantly affect the magnitude of ATT in this cadaveric model.     

Surgical treatment of iliotibial band friction syndrome A retrospective study of 45 patients

Iliotibial band friction syndrome is an overuse injury mainly affecting runners, but also other athletes. The treatment of choice is conservative. If this treatment is unsuccessful, surgical treatment can be performed. The posterior half of the iliotibial band is transsected where it passes over the lateral epicondyle of the femur. Optionally the underlying bursa is removed. Between 1989 and 1996 45 patients were operated in Trondheim. The mean age was 27 (14-46) years. Of the patients, 22 (48.9%) had excellent results, 16 (35.5%) had good results, 6 (13.3%) had fair results and 1 (2.2%) patient had a poor result. One patient had a minor postoperative infection. Had the postoperative result been known beforehand, 75.6% of the patients would have been operated on again. We conclude that surgical treatment of iliotibial band friction syndrome produces good results in patients with insufficient relief of symptoms after conservative treatment.     

Efficient radiological assessment of the internal snapping hip syndrome

The aim of this study was to evaluate the diagnostic value/significance of various imaging techniques for demonstrating the underlying causative pathology of clinically suspected internal snapping hip syndrome. We intended to define the most efficient diagnostic imaging algorithm that leads to a specific definite therapy for this rare hip disorder. The imaging studies of 54 patients (43 women, 11 men, average age 58 years) with the clinical suspicion of internal snapping hip syndrome were compared for their diagnostic value/significance for finding the underlying pathology. Radiological workup included plain radiographs of the pelvis and hip joints (n=54), ultrasound (US) of the hip joints (n=29), computed tomography (CT) of the pelvis and proximal femur (n=17), and magnetic resonance imaging (MRI) of the pelvis/hip joint (n=21). In order to establish an efficient diagnostic algorithm we compared the diagnostic value of each imaging technique alone and in combination with the other methods. The underlying causative pathology could be established in 37% of patients (n=20) by the use of conventional radiographs alone and in 46% of the patients (n=25) by US alone, and in combination in 83% of the patients (n=45). By adding CT to the radiological workup, we established final diagnosis in 88% (in combination with X-ray; n=15/17) and 94% (together with X-ray and US; n=16/17) of the patients. Whenever MR imaging was used a causative pathology was found in all patients (100%; n=21). The most efficient radiological algorithm in the assessment of patients with internal snapping hip syndrome is the combination of plain radiography and US. MR imaging can be retained for unresolved and difficult cases.     

Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?

ObjectiveIliotibial band syndrome (ITBS) is presumably caused by excessive tension in the iliotibial band (ITB) leading to compression and inflammation of tissues lying beneath it. Usually managed conservatively, there is a lack of scientific evidence supporting the treatment recommendations, and high symptom recurrence rates cast doubt on their causal effectiveness. This review discusses the influence of common physiotherapeutic measures on risk factors contributing to tissue compression beneath the ITB.MethodsThe potential pathogenic factors are presented on the basis of a simple biomechanical model showing the forces acting on the lateral aspect of the knee. Existent literature on the most commonly prescribed physiotherapeutic interventions is critically discussed against the background of this model. Practical recommendations for the optimization of physiotherapy are derived.ResultsAccording to biomechanical considerations, ITBS may be promoted by anatomical predisposition, joint malalignments, aberrant activation of inserting muscles as well as excessive ITB stiffness. Hip abductor strengthening may correct excessive hip adduction but also increase ITB strain. Intermittent stretching interventions are unlikely to change the ITB's length or mechanical properties. Running retraining is a promising yet understudied intervention.ConclusionsHigh-quality research directly testing different physiotherapeutic treatment approaches in randomized controlled trials is needed.     

Magnetic resonance imaging depiction of tight iliotibial band in melorheostosis associated with severe external rotation deformity, limb shortening and patellar dislocation in planning surgical correction

We present the case of a 14-year-old male with melorhesotosis and severe iliotibial band tightness which was associated with femoral shortening, severe external rotational deformity of the femur, genu valgum and patellar dislocation in the right lower extremity. Skeletal survey revealed irregular radiodense streaks involving the pelvis, femoral head, femoral shaft, distal femoral epiphysis, talus and middle phalangeal bones of the foot. Magnetic resonance (MR) imaging showed thickening of the iliotibial band in addition to low MR signal changes in the bone. Intraoperatively fibrosis in the subcutaneous layer and a thickened iliotibial band were found. MR images were very useful in understanding the soft tissue pathoanatomy in melorheostosis and planning surgical correction.     

The iliotibial band and anterolateral capsule have a combined attachment to the Segond fracture

The purpose of this report was to describe the injury mechanism, surgical findings, and outcomes in a 21-year-old professional female football player who presented with a complete anterior cruciate ligament (ACL) rupture and Segond fracture. Interview and video analysis were performed to elicit the injury mechanism. Clinical examination and imaging revealed a complete ACL tear, Segond fracture, lateral meniscus tear, MCL sprain, and posterolateral corner sprain. Examination under anaesthesia revealed Grade 2 pivot shift and varus/valgus instability. Surgical examination revealed attachment of the posterior fibres of the iliotibial band and the lateral capsule to the Segond fragment. The fracture was reduced with suture fixation, and an anatomic ACL reconstruction was performed. Follow-up demonstrated rotatory and anterior tibial translation stability, and imaging at 7 months post-operatively revealed no movement and continued osseous integration of the Segond fragment. Level of evidence V.     

The iliotibial band in acute knee trauma: patterns of injury on MR imaging

Objective

To delineate the spectrum of knee injuries associated with sprains and tears of the distal iliotibial band (ITB).

Materials and methods

A retrospective review of 200 random MRI scans undertaken for acute knee trauma was performed. Scans were excluded if there was a history of injury over 4 weeks from the time of the scan, septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. In each scan, the ITB was scored as normal, minor sprain (grade 1), severe sprain (grade 2), and torn (grade 3). The menisci, ligaments, and tendons of each knee were also assessed.

Results

The mean age was 27.4 years (range, 9–69 years) and 71.5 % (n?=?143) of the patients were male. The ITB was injured in 115 cases (57.5 %). The next most common soft tissue structure injured was the anterior cruciate ligament (ACL) in 53.5 % of cases (n?=?107). Grade 1 ITB injury was seen in 90 of these 115 cases (45 %), grade 2 injury in 20 cases, and grade 3 injury in only five cases. There is a significant association between ITB injury and ACL rupture (p?p?Conclusions ITB injury is common in acute knee trauma and is associated with significant internal derangement of the knee, especially cruciate ligament rupture, posterolateral corner injury, and patellar dislocation.     

The iliotibial band lateral sling procedure and its effect on the results of anterior cruciate ligament reconstruction

The effect of iliotibial band "lateral sling" augmentation on long-term outcome in ACL reconstruction using free autogenous central-third patellar tendon was evaluated retrospectively. Eighty reconstructions were reviewed; the minimum followup was 2 years and the average was 4 years. Sixty percent of the procedures involved supplementation with a lateral sling. By both clinical evaluation and KT-1000 measurement, there were no differences in the results of patients with lateral sling augmentation and those without it. In addition, 40% of patients had chronic pain and/or swelling related to the lateral sling. We do not currently recommend the routine use of a lateral sling augmentation for ACL reconstruction using central-third patellar tendon.     

全髋置换术后股骨侧假体周围骨折的手术治疗进展

股骨假体周围骨折(PFF)是全髋关节置换术(THA)后严重并发症,也是骨科医师面临的具有挑战性的难题.骨折分型对骨折的治疗有重要的指导意义,Vancouver分型不仅参考了骨折的部位,还参考了原假体的稳定性和患者股骨的质量,对术中和术后治疗方案的选择及制定都有全面的指导作用,是目前应用最广且易于接受的分型方法.该文就V...