Summary

The purpose of the study was to reported the clinical significance of safe surgical division in arthroscopic release for gluteal muscle contracture to reduce the neurovascular injuries.

Abstract

Purpose

Gluteal muscle contracture is common after repeated intramuscular injections, surgery is necessary in severe cases. Neurovascular injuries have been repeated reported partially because of complicated local anatomy and lack of anatomical landmark especially in arthroscopic surgery. The purpose of the study was to reported the clinical significance of safe surgical division in arthroscopic release for gluteal muscle contracture.

Method

We retrospectively reviewed 96 patients with bilateral gluteal muscle contracture (41 males, 55 females) with mean age of 20.9±4.4 years old (18 to 36 years old), each patient had the history of repeated intramuscular injections. The follow signs were positive in all the patients before surgery: squatting and crouching disability, difficulty in crossing the leg, Ober’s sign, clicking sound during rotation of the hip. According to the local anatomy of surgery, 9 safe surgical divisions were defined, the center area was division 5 which covered the greater trochanter of femur, other 8 divisions distributed around the division 5. In the arthroscopic surgery, the contractile band was released mostly in division 5, 8, 2. If necessary, sometimes contractile band in other divisions would be moderately released. The operation time, divisions in which contractile band was released, neurovascular injury, muscular weakness, wound hematoma were recorded. The functional score of gluteal muscle contracture (FGMC) was evaluated before surgery and at the last follow-up.

Results

The average operating time for one side of gluteal muscle contracture was 10min±3.2min. Division 8 was released in 100% patients (96 cases), division 5 in 71% patients (68 cases), division 2 in 54% patients (52 cases), division 4 in 32% patients (31 cases). All the patients were followed a minimum of 1 years after operation, and all could crouch with both knees close to each other, sit with their legs crossed, had no Ober’s sign or clicking sound during rotation of the hip. There was no neurovascular injury, recurrent contracture of the hip abductor, residual hip pain, wound hematoma. One patient occured muscular weakness (four level). FGMC was improved from 49.2 (26 to 70) before surgery to 91.2 (81 to 100) at last follow-up.

Conclusion

Safe surgical division in gluteal muscle contracture will help surgeon to determine the special local anatomy. It can result in less operative bleeding, neurovascular injury and operation time.