Simon Karissa N, Meta Fabien, Reuter Zachary C, Krych Aaron J, Levy Bruce A, Hevesi Mario
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Video J Sports Med. 2024 Oct 30;4(5):26350254241283497. doi: 10.1177/26350254241283497. eCollection 2024 Sep-Oct.
Patients with persistent symptomatic iliopsoas tendonitis following total hip arthroplasty may benefit from iliopsoas fractional lengthening. We present an arthroscopic approach utilizing an air bursogram that provides safe and predictable access to the iliopsoas tendon for efficient tendon lengthening without violating the capsule or unintentional instrumentation of the nearby medial neurovascular bundle.
Arthroscopic iliopsoas fractional lengthening is indicated for patients with clinical evidence of symptomatic iliopsoas tendonitis following total hip arthroplasty and have no radiographic evidence of frank acetabular malpositioning. A diagnosis of iliopsoas tendinitis amenable to surgical management can be established with substantial but nondurable relief following image-guided anesthetic injection to the iliopsoas bursa.
Under fluoroscopic guidance, an air bursogram is employed in the anatomic plane of the iliopsoas tendon to accurately identify its course. This allows for hip portal placement with precise subsequent instrumentation. This technique is preferred in the setting of postarthroplasty anatomy because it avoids capsular violation and the challenge of working in an altered anatomic space with a nearby, medially based neurovascular bundle.
Arthroscopic and endoscopic approaches to iliopsoas release have been shown to provide excellent functional and patient-reported outcomes in >85% of patients, and several studies have shown that an arthroscopic approach not only provides a less invasive technique but also results in comparable or improved clinical outcomes with lower revision rates compared to open release or acetabular cup revision. Our technique for arthroscopic iliopsoas fractional lengthening using the air bursogram is both safe and reproducible and offers distinct advantages, including maintenance of an intact capsule, visual confirmation of the correct anatomic structure to be released, and percutaneous access with standard arthroscopic access cannulas without the need for hip distraction.
Arthroscopic fractional iliopsoas lengthening is a minimally invasive and successful treatment option for patients with persistent groin pain after total hip arthroplasty, especially without substantial acetabular component malpositioning. This technique includes using an air bursogram to safely identify and navigate to the iliopsoas tendon without violating the hip capsule, thereby reducing the risk of inadvertent instrumentation of adjacent critical neurovascular structures.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
全髋关节置换术后持续性症状性髂腰肌肌腱炎患者可能受益于髂腰肌部分延长术。我们介绍一种利用空气造影的关节镜手术方法，该方法能安全、可预测地进入髂腰肌肌腱，以有效地延长肌腱，同时不侵犯关节囊或意外损伤附近的内侧神经血管束。
关节镜下髂腰肌部分延长术适用于全髋关节置换术后有症状性髂腰肌肌腱炎临床证据且无明显髋臼位置异常影像学证据的患者。在影像引导下对髂腰肌滑囊进行麻醉注射后，若疼痛得到显著但非持久缓解，则可确立适合手术治疗的髂腰肌肌腱炎诊断。
在荧光透视引导下，在髂腰肌肌腱的解剖平面采用空气造影，以准确确定其走行。这有助于在后续精确器械操作时确定髋关节入路位置。在关节置换术后解剖结构的情况下，这种技术是首选，因为它避免了侵犯关节囊以及在解剖结构改变且附近有基于内侧的神经血管束的空间中操作的挑战。
关节镜和内镜下髂腰肌松解术已被证明在超过85%的患者中能提供出色的功能和患者报告的结果，并且多项研究表明，与开放松解或髋臼杯翻修相比，关节镜手术不仅提供了一种侵入性较小的技术，而且能带来相当或更好的临床结果，翻修率更低。我们使用空气造影进行关节镜下髂腰肌部分延长的技术既安全又可重复，具有明显优势，包括保持关节囊完整、视觉确认要松解的正确解剖结构，以及通过标准关节镜入路套管进行经皮操作，无需髋关节牵引。
关节镜下髂腰肌部分延长术是全髋关节置换术后持续性腹股沟疼痛患者的一种微创且成功的治疗选择，尤其是在髋臼组件无明显位置异常的情况下。该技术包括使用空气造影安全地识别并进入髂腰肌肌腱，同时不侵犯髋关节囊，从而降低意外损伤相邻关键神经血管结构的风险。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能可识别，作者已随本投稿附上患者的豁免声明或其他书面批准形式以供发表。
