Endoscopic Resection of Distal Femoral Exostosis That Causes Distal Iliotibial Band Syndrome
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ABSTRACT:
SUBMITTER: Cheung Y
PROVIDER: S-EPMC11293314 | biostudies-literature | 2024 Apr
REPOSITORIES: biostudies-literature
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Project description:Lateral knee pain in athletes is commonly seen in the sports medicine clinic, and the diagnosis of iliotibial band (ITB) syndrome is frequently made. Although conservative management including rest from activity, equipment modification, oral nonsteroidal anti-inflammatory drug use, and physical therapy is the mainstay of treatment initially, refractory cases do exist. Multiple surgical techniques have been described including an arthroscopic technique. Arthroscopic release of the ITB attachment to the lateral femoral epicondyle and resection of the lateral synovial recess for recalcitrant ITB syndrome comprise a valid option that can have a good outcome. This option avoids the complications associated with open surgery and allows for a complete arthroscopic knee examination. Division or lengthening of the ITB band itself is not a necessary step in this technique.
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Project description:External snapping hip is caused by snapping of the thickening of the posterior portion of the iliotibial band or the anterior border of the gluteus maximus over the greater trochanter. Surgery is considered for patients who are refractory to conservative treatment. The endoscopic release of the iliotibial band or the endoscopic release of the femoral insertion of the gluteus maximus tendon is the most popular technique. There is a recurrence rate of 7-29% after endoscopic surgery. Although recurrence is often painless, revision surgery may be indicated for symptomatic recurrence. In this Technical Note, the technical details of endoscopic treatment of recurred external snapping hip after endoscopic iliotibial band release. The key to success is adequate release of the iliotibial band, gluteus maximus tendon, and the fibrosis underneath the iliotibial band.
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Project description:Pediatric and adolescent anterior cruciate ligament reconstruction is a commonly performed procedure that has been increasing in incidence. Multiple techniques for graft fixation have been described. Button-based femoral cortical suspension fixation of the anterior cruciate ligament graft allows for fast, secure fixation with strong load-to-failure biomechanical properties. The biomechanical properties of button-based femoral cortical suspension fixation are especially beneficial with soft-tissue grafts such as hamstring autografts. Confirmation of a successfully flipped button can be achieved with intraoperative fluoroscopy or indirect viewing; however, these techniques do not provide direct visualization of the flipped button. Our trans-iliotibial band endoscopic portal allows the surgeon to safely and directly visualize the flipped button on the lateral femoral cortex and ensure that there is no malpositioning in the form of an incompletely flipped button or from soft-tissue interposition between the button and the lateral femoral cortex. This portal therefore allows for direct visual confirmation that the button is fully flipped and resting flush against the femoral cortex, deep to the iliotibial band and vastus lateralis.
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Project description:PurposeTo systematically review the operative versus nonoperative methods for management of iliotibial band syndrome (ITBS) with comparison of the respective clinical outcomes.MethodsBy adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, 3 databases (Medline, Scopus, Web of Science) searched from inception to October 2019 for randomized clinical trials (RCTs) and observational studies on humans that reported the outcomes following operative or nonoperative management of ITBS. Excluded were case reports, case series with <5 participants, review articles, non-English articles, and non-peer-reviewed articles. The Methodological Index for Non-Randomized Studies (MINORS) criteria for observational studies and the Cochrane Risk of Bias Tool for RCTs were used for quality control.ResultsThere were 15 eligible studies (9 for operative,6 for nonoperative treatment) examining 179 athletes (mean age 27.3 years, range: 17-53) who received conservative therapy for ITBS and 200 athletes (mean age 30.1 years, range: 14-63) who underwent surgical treatment. Most athletes were runners (65%). The mean follow-up time was significantly longer in studies reporting the outcomes following operative compared with nonoperative ITBS treatment (33.5 vs 2 months, respectively, P < .05). Significant variability in the methods used to assess the clinical outcomes precluded meta-analysis. The most commonly reported (7/9 studies, 77.7%) variable for postoperative evaluation in athletes was the return to sport rate (range: 81%-100%). Significant reduction in pain was consistently (6/6 studies,100%) found among the studies reporting the results of conservative ITBS treatment. The included RCTs were of good (1/5, 20%), fair (2/5, 40%), or poor (2/5, 40%) quality, whereas the average MINORS score was 7.4 (range: 3-13) for observational studies. The level of evidence ranged from Level II (6/15 studies) to IV (9/15 studies).ConclusionsBased on the current literature and at a maximum follow-up time of 6 months, conservative therapy can effectively reduce ITBS symptoms in athletes. Multiple surgical options exist for athletes who do not respond to nonoperative measures, with a reported return to sport rate between 81% and 100%.Level of evidenceSystematic review of Level II and IV studies.
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Project description:Lateral hip pain associated with trochanteric bursitis is a common orthopedic condition, and can be debilitating in chronic or recalcitrant situations. Conservative management is the most common initial treatment and often results in resolution of symptoms and improved patient outcomes. These modalities include rest, activity modification, physical therapy, anti-inflammatory medication, or corticosteroid injections. However, there is a subset of patients in which symptoms persist despite exhaustive conservative modalities. For these patients, trochanteric bursectomy is a surgical option to address persistent pathology. Previous literature indicates that both open and arthroscopic surgical techniques can be used to address the inflamed bursa and results in good patient outcomes. However, recent advances in hip arthroscopy have allowed for improvements in minimally invasive techniques to address intracapsular and extracapsular pathology of the hip, including recalcitrant trochanteric bursitis. The purpose of this manuscript is to describe our technique for a minimally invasive arthroscopic trochanteric bursectomy.
| S-EPMC5310191 | biostudies-literature
Project description:Common injuries, such as anterior cruciate ligament (ACL) tears, can result in both anterior and rotational instability of the knee. An arthroscopic anterior cruciate ligament reconstruction (ACLR) method has been shown to be effective in restoring anterior translational stability, but this could be followed by persistent rotational instability by means of residual pivot shifts or repeat instability episodes. Alternative techniques, such as a lateral extraarticular tenodesis (LET), has been proposed as a technique for preventing persistent rotational instability following ACLR. This article presents a case of a LET using an autologous central slip of iliotibial (IT) band with fixation to the femur using a 1.8-mm knotless all-suture anchor.
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Project description:Anterior cruciate ligament injuries are increasingly frequent in skeletally immature patients. However, treatment within this subpopulation remains controversial. Conventional transphyseal reconstruction techniques have been questioned because of potential physeal injuries. Conservative treatment, on the other hand, may lead to degenerative meniscal and chondral lesions. This Technical Note describes the femoral physeal-sparing over-the-top technique using an iliotibial band. It is a safe and effective method for anterior cruciate ligament reconstruction in skeletally immature patients.
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Project description:BACKGROUND:Iliotibial band syndrome (ITBS) carries marked morbidity in runners. Its management is not standardized and lacks evidence base. We evaluated the effectiveness of three different exercises programs in reducing ITBS symptoms. METHODS:Patients were divided into three equal treatment groups: ITB stretching (group A), conventional exercise (group B), and experimental hip strengthening exercise (group C). Numeric pain rating scale (NPRS; every week), lower extremity functional scale (LEFS; every 2 weeks), dynamometer (DN; weeks 0, 2, 4, 6, 8), single-limb mini squat (SLMS; week 0, 8), and Y-balance test™ (YBT), between and within group's differences were evaluated using ANOVA model. RESULTS:Twenty-four female runners (age 19-45 years) were included into one of three groups (A, B, and C). Statistical significance (p < 0.05) within group C was observed for composite YBT and DN for injured and non-injured leg, the YBT (injured leg for the posterior medial), LEFS, NPRS, and the SLMS. Statistical significance (p < 0.05) was found between group A and group C. The stretching group exhibited statistically significant (p < 0.05) YBT anterior reach for the injured/non-injured leg and the LEFS. CONCLUSION:There were no statistical differences between the three groups. The subjects who underwent experimental hip strengthening exercises consistently showed improvements in outcome measures, and never scored less than the other two groups. TRIAL REGISTRATION:ClinicalTrials.gov identifier (NCT number): NCT0229615.
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Project description:This Technical Note describes the minimally invasive surgical techniques for insertional Achilles tendinopathy: fluoroscopic and endoscopic calcaneal exostosis resection and Achilles tendon debridement. First, two portals are placed 1 cm proximal and distal to the exostosis on the lateral heel. Next, blunt dissection around the exostosis and exostosis resection is performed under fluoroscopic guidance. The remaining space after the exostosis resection is used as the working space for endoscopy. Finally, the degenerated Achilles tendon is debrided endoscopically.
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