Arthroscopic Lesser Trochanter Osteoplasty, Quadratus Femoris Debridement, and Sciatic Neurolysis via Posterior Approach for Ischiofemoral Impingement.

Qingguo Zhang,Xiaobo Zhou,Liwei Ying,Peihong Liu,Lingchao Ye,Tao-Hsin Tung,Xiangdong Yang,Dawei Han

doi:10.3389/fsurg.2022.805866

Abstract

Ischiofemoral impingement (IFI) syndrome is considered the narrowing of the ischiofemoral space (IFS), leading to pathological changes in the quadratus femoris and sciatic nerve, causing posterior hip and sciatica-like pain. Open or arthroscopic resection of the lesser trochanter to enlarge the IFS is the main surgical procedure. However, there is a lack of research on isolated IFI, and currently known surgical procedures are at risk of weakening the flexion strength of the hip joint. In this study, four patients, who were diagnosed with isolated IFI and had undergone arthroscopic treatment with partial resection of the lesser trochanter, debridement of the quadratus femoris, and decompression of the sciatic nerve, were reviewed. To the best of our knowledge, this is the first study to describe the management of IFI using a series of surgical procedures via a posterior approach as an effective treatment option. The outcomes of this study broadened the strategies for IFI management.

Highlights

Ischiofemoral impingement (IFI) syndrome is defined as the narrowing of the ischiofemoral space (IFS) between the lesser trochanter and the ischial tuberosity, causing pathological changes in the quadratus femoris [1]
It is hypothesized that arthroscopic partial resection of the lesser trochanter via a posterior approach would sufficiently enlarge the IFS and simultaneously debridement of the quadratus femoris and decompression of the sciatic nerve, which would effectively relieve buttock pain in patients with IFI
This study aimed to evaluate the outcomes of arthroscopic treatment via a posterior approach with partial resection of the lesser trochanter and simultaneously debridement of the quadratus femoris and decompression of the sciatic nerve in isolated IFI

Summary

Introduction

Ischiofemoral impingement (IFI) syndrome is defined as the narrowing of the ischiofemoral space (IFS) between the lesser trochanter and the ischial tuberosity, causing pathological changes in the quadratus femoris [1]. Patients with IFI usually exhibit chronic posterior hip pain (buttock pain) and sciatica-like pain (non-discogenic sciatica). Conservative treatments, such as local injection, physical therapy, and non-steroid anti-inflammatory medicines, are usually recommended as initial treatment. Hatem described that arthroscopic partial resection of the lesser trochanter via a posterior approach could enlarge the IFS and QFS and achieve good functional outcomes [13]. It is hypothesized that arthroscopic partial resection of the lesser trochanter via a posterior approach would sufficiently enlarge the IFS and simultaneously debridement of the quadratus femoris and decompression of the sciatic nerve, which would effectively relieve buttock pain in patients with IFI

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Conclusion