EP3.30 Endoscopic Treatment of External Coxa Saltans (Snapping Hip) in the Supine Position

Introduction: External coxa saltans, or “snapping hip,” is present in up to 5% of the population and stems from a tight iliotibial band (ITB) snapping over the greater trochanter. For patients who have failed nonoperative treatments, endoscopic intervention can be effective in relieving symptoms. Various techniques have been described, including those involving lateral decubitus positioning, alternative portal placement, and outside-in release of the ITB. In this technique, we describe an endoscopic partial ITB release for external coxa saltans utilizing supine positioning, standard hip arthroscopy portals, and inside-out release from the peritrochanteric space, which allows treatment of concomitant intra-articular pathology and direct visualization of the posterior undersurface of the ITB for a more precise release of the involved pathologic tissue.

Technique: The patient is positioned supine on a standard hip arthroscopy table. After mid-anterior, anterolateral, and distal anterolateral (DALA) portals are established and work in the central and peripheral compartments is completed, the leg is slightly abducted, and the peritrochanteric space is established via the interval between the ITB and greater trochanter. Viewing from the mid-anterior portal, a trochanteric bursectomy is performed to allow for adequate visualization of the ITB, gluteus maximus insertion, vastus lateralis, and abductor tendons. The offending portion of the ITB involved in external coxa saltans is posterior and is usually thickened and erythematous. Working through the anterolateral and/or DALA portals, a cruciate release is made centered on the involved portion of the ITB. The four resultant flaps are then resected with a shaver, leaving a diamond-shaped defect. The hip can then be checked for resolution of snapping with flexion and extension of the hip after the ITB release.

Conclusion: When symptomatic, external coxa saltans can be treated with endoscopic partial ITB release. Our technique involves endoscopic ITB release utilizing standard hip arthroscopy portals, supine positioning, and inside-out release from the peritrochanteric space. This technique allows for concomitant arthroscopy in the central and peripheral compartments and direct visualization of the offending portion of the ITB for a more precise ITB release.