EP3.32 Peritrochanteric decompression via endoscopic release of the proximal insertion of the gluteus major

Pathology in the peritrochanteric space (PTS) can range from post-traumatic tendon ruptures to degenerative lesions of the abductor tendons (gluteus medius and minimus) at their insertion points on the various facets of the greater trochanter, associated with trochanteric bursitis. Two endoscopic approaches have been described for addressing this compartment: an outside-in approach, involving a rhomboid fasciectomy of the iliotibial band, and an all-inside approach, using different portals to access this space. In some cases, iliotibial band fasciectomy is necessary to decompress the PTS roof, protect our repair, or limit friction on the greater trochanter.

However, this technique tends to be very traumatic, painful, and in some cases, limiting. Which results in less satisfactory outcomes for both the physician and the patient. We propose a new surgical approach to the PTS, using portals through the iliotibial band and releasing the proximal portion of the gluteus maximus insertion (approximately 3 cm) to address the lateral compression component in patients with painful trochanteric syndrome.

This aims to protect the repair of the abductor tendons and reduce friction of the iliotibial band over the greater trochanter. This alternative is less traumatic to soft tissues, less painful, and less limiting for patients undergoing a procedure in the peritrochanteric compartment.