Artroskopická transkapsulární tenotomie iliopsoatu u vnitřního typu syndromu lupavé kyčle z periferního versus centrálního kompartementu: krátkodobé výsledky prospektivní randomizované studie

PURPOSE OF THE STUDYIn this prospective randomised study, the short-term results of arthroscopic transcapsular iliopsoas tenotomy approached from the peripheral versus the central compartment for internal snapping hip syndrome are presented.MATERIAL AND METHODSA group of 19 patients (15 women and four men; mean age, 24.3 years) who underwent arthroscopic transcapsular iliopsoas tenotomy for internal snapping hip syndrome in the period between September 2010 and December 2011 were prospectively evaluated. No injury, hip surgery or feeling of hip instability was recorded in their personal histories. Radiographs did not show any dysplasia, retroversion of the acetabulum or cam lesions. The patients were allocated to two groups using sealed envelope randomisation: Group 1 patients (n = 10) were treated by tenotomy from the peripheral compartment and group 2 patients (n = 9) underwent tenotomy from the central compartment during traction of the lower extremity.The evaluation included pre-operative 3T MRI findings, arthroscopically detected intra-articular lesions, duration of traction and post-operative complications. The pre-operative WOMAC scores were compared with those at one-year follow-up. In comparison of the two groups, the Mann-Whitney exact test was used for WOMAC scores and Fisher's exact test for post-operative complications. Statistical significance was set at a 0.05 level.RESULTSIn comparing post-operative complications, a significant difference (p = 0.0468) between the groups was found only for genital paresthesia, which did not occur in group 1. The other differences were not statistically significant. The pre-operative WOMAC scores did not differ significantly between the groups (p = 0.79). The post-operative WOMAC scores were significantly higher in group 1 (p = 0.02). In each group the change in WOMAC scores was different and was statistically significant in group 1 (p = 0.0014). Associated intra-articular hip pathologies, most frequently synovitis of the peripheral compartment, acetabular chondropathy, or labral lesions, were diagnosed in 90% of group 1 patients and in 66.7% of group 2 patients.DISCUSSIONMost of the authors comparing the results of two different ilioproas tenotomy techniques at one-year follow-up did not report any statistically significant differences in WOMAC scores between them. In accordance with the data reported, an increase in the post-operative WOMAC score, i.e., improvement of clinical outcome, was achieved in all our patients and, in group 1, it was significantly higher (p=0.0015), as compared with a similar study by Ilizaliturri. However, further follow-up of the patients and evaluation of long-term results will be necessary.CONCLUSIONSThe technique of arthroscopic ilioproas tenotomy approached from the peripheral compartment resulted in significantly fewer cases of genital paresthesia and provided significantly better clinical outcomes in comparison with tenotomy from the central compartment.