Arthroscopic C-Shaped Release Around the Greater Trochanter for Gluteal Muscle Contracture.

Objective: To investigate the outcomes of C-shaped release around the greater trochanter in gluteal muscle contracture under arthroscopy.

Methods: From December 2016 to January 2018, 185 patients with gluteal muscle contracture who treated under arthroscopy were reviewed, including 69 males and 116 females. All patients had a history of repeated intramuscular injection into the buttocks. The follow signs were positive in all the patients before surgery: squatting and crouching disability, difficulty in crossing the leg, Ober's sign positive, clicking sound during rotation of the hip. The C-shaped release around the greater trochanter under arthroscopy was performed in 96 cases (C-shaped release group) with an average age of 24.6 ± 4.9 years old, and conventional gluteal muscle contracture release under arthroscopy was performed in 89 cases (conventional release group) with an average age of 25.1 ± 5.0 years. The released tissues in the C-shaped release group: iliotibial band (ITB) about 5 cm distal to the proximal end of the greater trochanter, the contracture tissue near the posterior and superior of the greater trochanter, which depended on both intraoperative physical examination and arthroscopic observation. The released tissues in conventional release group: the contracture tissues in gluteal muscles according to observation under arthroscopy. The gluteal muscle contracture disability scale (GDS) and Visual analogue scale (VAS) were evaluated before surgery and at the last follow-up.

Results: The average release time after making arthroscopic operation space for each lower limb were 12.2 ± 3.2 min in the C-shaped release group, and 21.4 ± 6.1 min in the conventional release group (P = 0.000). All the patients were followed for at least of 2 years after operation. There was one case of wound hematoma in the C-shaped release group and five cases in the conventional release group(P = 0.079), abductor weakness (IV level)occurred in two patients in the C-shaped release group and five cases in the conventional release group (P = 0.208). GDS was 49.3 ± 17.3 (22 to 70) in theC-shaped release group and 48.1 ± 15.6 (23 to 69) in the conventional release group before surgery (P = 0.622), 91.7 ± 5.2 (83 to 100) in the C-shaped release group and 90.2 ± 6.1 (83 to 98) in the conventional release group (P = 0.073) with difference nearly significant at last follow-up.

Conclusion: Arthroscopic C-shaped release around the greater trochanter had less operation time, acceptable complication occurrence, and it has an optimistic outcome for gluteal muscle contracture under arthroscope.