The role of arthroscopic release of gluteal muscle contracture in improving patellofemoral instability
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(2019) 14:159
RESEARCH ARTICLE
Open Access
The role of arthroscopic release of gluteal muscle contracture in improving patellofemoral instability Jing Biao Huang, Heng’an Ge, Ying Lei Zhang, Cen Tao Liu, Chao Xue, Yi Chao Chen, Peng Wu and Biao Cheng*
Abstract Background: Gluteal muscle contracture (GMC) is a notable problem in some developing countries and includes features such as a snapping sound of the hip, abnormal gait, and unusual posture when patients squat with the knees together. Arthroscopic release can not only resolve symptoms, as previously reported, but can also greatly improve accompanying patellofemoral instability. This study was conducted to evaluate the effect of arthroscopic release of GMC on patellofemoral instability and its underlying mechanism. Methods: A total of nearly 500 patients who underwent arthroscopic release of GMC over 2.5 years were filtered, and 54 patients were enrolled in the study. The selected research subjects all had combined patellofemoral instability preoperatively. The Lysholm scores and CT scans of the knee were evaluated pre- and postoperatively. Results: The mean follow-up time was 12.2 months. All of the surveyed patients had satisfactory clinical outcomes for hip snapping sounds and abnormal gait. In addition, a significant difference (p < 0.05) was observed between pre- and postoperative Lysholm scores, along with significant knee pain relief. Furthermore, the changes in CT scan parameters were significant as well. The average patellar tilt angle (PTA), patellofemoral index (PFI), and lateral patellar displacement (LPD) were obviously decreased (p < 0.05) after the release. Conversely, the mean lateral patellofemoral angle (LPFA) showed a clear difference (p < 0.05) between preoperative and postoperative CT examinations. Conclusions: Arthroscopic release of GMC can reduce the tilt and lateral shift of the patella and enhance its stability due to the release of the iliotibial band. Keywords: GMC, Arthroscopy, Patellofemoral instability, CT
Background Gluteal muscle contracture (GMC) is a disease that mainly occurs in adolescents and infants, and the majority of these patients receive repetitive buttock injections at very young ages [1]. GMC was first identified by Valderrama, a British doctor [2]. However, in China, this phenomenon is rather ubiquitous, with an incidence rate ranging from 1 to 2.5% [3]. Due to the contracture and fibrous degeneration of gluteal muscle, patients present with snapping sounds of the hip, an abnormal gait, and unusual posture when they squat with the knees * Correspondence: [email protected] Department of Orthopedics, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, 301 Yanchang Middle Road, Shanghai 200072, China
together [4]. The onset of GMC is usually bilateral, and boys have a higher incidence rate than girls. Indisputably, surgery is the first treatment choice, and arthroscopic release is the gold standard globally, as first proposed by Wentao Zhang in 2002 [5]. Arthroscopic release of GMC has the
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