Surgical Technique: Arthroscopic Posterior Lesser Trochanterplasty for Ischiofemoral Impingement

Abstract

Ischiofemoral impingement (IFI), defined as a decreased interval between the medial lesser trochanter (LT) and the lateral ischium leading to mechanical impingement, represents a rare cause of posterior deep gluteal pain and snapping. Patients often present with symptoms of catching or clunking in the deep gluteal or groin region as the leg is moved to extension, adduction, and external rotation during examination or while the patient performs a long stride test. Previous treatments have centered around nonsurgical modalities, reserving surgery for patients with refractory pain. Surgical techniques published to date include both open and endoscopic partial or complete resection of the lesser trochanter. Because of the anterior attachment of the iliopsoas tendon on the lesser trochanter, release of the tendon is a necessity during anterior approaches or complete lesser trochanter resections. Additionally, anterior-based procedures place anterior-based structures like the medial femoral circumflex and perforating branches of the femoral artery at risk during approach. In addition, proximal hamstring degeneration and tears are common with IFI. We present a posterior-based endoscopic approach for the treatment of IFI which allows access to the entire area of pathology including the LT, proximal hamstring, ischium, quadratus femoris muscle, and avoidance of the MFCA.