[Extra-articular impingement of the hip : Treatment of snapping hip by lengthening of the iliotibial band].

OBJECTIVE: Snapping of the iliotibial band over the greater trochanter should be eliminated by reducing tension via lengthening, release, and incision of the iliotibial band.

INDICATIONS: Positive clinical examination and painful snapping of the iliotibial band over the greater trochanter, despite extensive conservative treatments, for over 6 months.

CONTRAINDICATIONS: Weakness of the abductor muscles with positive Trendelenburg sign.

SURGICAL TECHNIQUE: Direct approach to the iliotibial tract. The snapping of the tract over the greater trochanter can be provoked and observed in situ via internal rotation and adduction of the hip. Lengthening of the iliotibial band is performed with a tongue-shape flap technique ("Griffelschachtelplastik") directly over the greater trochanter. This leads to simultaneous release and incision over the greater trochanter. Hereafter, no snapping of the tract should be observed upon motion analysis.

POSTOPERATIVE MANAGEMENT: Pain-adapted mobilization with full weightbearing, no active abduction against resistance, and no adduction over and exceeding the 0‑degree level for 6 weeks.

RESULTS: The snapping of the iliotibial band could be eliminated in all cases. Apart from 2 patients with previous surgery who still complain of unimproved pain, improvement of symptoms with consequent subjective satisfaction with the outcome of surgery was reported in all cases.