Arthroscopic Release of Gluteal Muscle Contracture Provides Satisfactory Functional Outcomes
The arthroscopic release of gluteal muscle contracture (GMC) is a relatively new technique and mainly limited in China.
The primary aim of our study is to introduce arthroscopic F and C release technique and secondary aim is to evaluate the functional outcomes and complications.
Materials And Methods
From Jan 2013 to Jan 2017, a total of 192 patients with 373 hips has been treated arthroscopically using F and C method. One hundred and eighty-one patients had bilateral GM, and remaining 11 patients had unilateral. According to Zhao classification system of GMC, 72 hips were Level 1; 226 hips cases were level 2, and remaining 75 hips were Level 3. The mean age of the patients was 24.6 years (10-47years). Surgical Technique: Important anatomical landmarks such as greater trochanter, anterior and posterior border of contracted gluteus muscles and course of sciatic nerve were marked. 2 or 3 portals technique was applied in the neutral lateral position. An artificial space of about 8cmX6cm, was created between the interval of subcutaneous tissue and contracted gluteal muscles. Contracted gluteal muscles appeared as a silvery white structure under arthroscopy. Initially, division of the ITB was started from the center of the GT and continued superiorly up to about 10cm longitudinally. Then, the radiofrequency device was faced anteriorly to divide contractures of TFL, and continued up to the ASIS. Gluteus maximus contractures were then divided transversely from 1cm below superior pole of GT until silvery white bands of contractures were visible, which completed the F shaped release of GMC. The instruments were then advanced deeper to visualize and divide contractures of deeper gluteal muscles and hip external rotators around the GT in C shape fashion. Any visible bleeders were meticulously cauterized. Eventually, complete division of contracture was assessed carefully with flexion adduction and internal rotations of the leg, Ober’s sign, cross leg sign, and palpable click. Wounds were closed. Rehabilitation was initiated within 24 to 48 hours post-operation.
Patients were followed up for 1-5 years (mean 2.8 years). Cosmetic satisfaction of the patients was 100%. According to Ye et al. evaluation criteria, 367 hips had an excellent clinical outcome, 4 hips had good outcome. One patient with severe bilateral hip involvement had a recurrence on his left hip but refused for the second operation as he could perform all the activity normally. Three hips had post-operative small hematomas, 2 hips had positive Trendelenburg gait but relieved after 6 months. No other complications occurred.
Discussion And Conclusion
As GMC mostly affects adolescent and adult individuals, there has been a great aesthetic concern. Arthroscopic GMC release has been introduced as a minimally invasive method to overcome complications of open procedure such as hypertrophic scar . However, very limited previous reports have explained appropriate steps by which the contractile band of GMCs can completely be released. Arthroscopic 'F and C' method allows a very precise and step by step release of contracted GMC. This procedure is not only effective but also safe with a negligible amount of known complications.