Effectiveness analysis of arthroscopic outside-in release for gluteal muscle contracture in supine position_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIA Di ¹ , RAN Qiguo ¹ , SUN Fei ² , ZHANG Kun ¹ ,  LI Yanlin ¹

1. Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;
2. Department of Orthopedics, Luliang County Hospital of Traditional Chinese Medicine, Qujing Yunnan, 655600, P. R. China;

Corresponding?author：

LI Yanlin, Email: liyanlin@kmmu.edu.cn

Keywords：

Arthroscopy; gluteal muscle contracture; surgical position; outside-in technique

DOI：

10.7507/1002-1892.202504110

Video：

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Objective To compare the effectiveness of arthroscopic outside-in release for gluteal muscle contracture (GMC) in supine position versus lateral decubitus position. Methods The clinical data of 34 GMC patients meeting selection criteria between January 2022 and May 2023 were retrospectively analyzed. Arthroscopic contracture band release was performed in the lateral decubitus position (lateral group, n=14) or the supine position (supine group, n=20). No significant difference (P>0.05) was observed between groups in baseline data, including gender, age, body mass index, preoperative GMC functional quantitative score, modified Harris hip score (mHHS), visual analogue scale (VAS) pain score, and hip flexion/adduction range of motion (ROM). The total operation time, release procedure time, non-release procedure time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared. Functional outcomes (GMC functional quantitative score, mHHS score, VAS score, hip flexion/adduction ROM) were evaluated preoperatively and at 3, 12, and 24 months postoperatively. Results All incisions healed by first intention without major vascular or neurological complications. In the lateral group, 3 patients developed patchy bruising on bilateral buttocks and posterior thighs at 3 days after operation, which resolved after 2 weeks of ice packs and ultrasonic therapy. The supine group demonstrated significantly shorter total operation time, non-release procedure time, hospital stay, and reduced intraoperative blood loss versus the lateral group (P<0.05). No significant difference was found in release procedure time (P>0.05). All patients were followed up 24 months. Both groups showed significant improvements (P<0.05) in mHHS score, GMC functional quantitative score, VAS score, and hip adduction/flexion ROM at all postoperative timepoints compared to preoperative values, with no significant intergroup differences (P>0.05). Conclusion Both surgical positions effectively improve hip function in GMC patients. However, the supine position offers significant advantages over the lateral decubitus position in operation time, anesthesia management, intraoperative blood loss control, and reduced hospital stay.

Citation： JIA Di, RAN Qiguo, SUN Fei, ZHANG Kun, LI Yanlin. Effectiveness analysis of arthroscopic outside-in release for gluteal muscle contracture in supine position. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(7): 848-854. doi: 10.7507/1002-1892.202504110 Copy

1.	Jiang X, Zhang H, Ren Y, et al. The pattern of collagen production may contribute to the gluteal muscle contracture pathogenic process. J Orthop Surg Res, 2023, 18(1): 579. doi: 10.3389/fcell.2020.00694.
2.	Su Q, Zhang Y, Zhang Y, et al. Multivariate analysis of associations between patellofemoral instability and gluteal muscle contracture: A radiological analysis. J Pers Med, 2022, 12(2): 242. doi: 10.3390/jpm12020242.
3.	Zhao W, Li Z, Ma S, et al. Identification of pro-fibrotic cellular subpopulations in fascia of gluteal muscle contracture using single-cell RNA sequencing. J Transl Med, 2025, 23(1): 192. doi: 10.1186/s12967-024-05889-y.
4.	吳毅東, 于康康, 安明揚, 等. 平臥位關節鏡下由內向外髂脛束松解術治療雙側臀肌攣縮癥的療效觀察. 中華醫學雜志, 2023, 103(21): 1611-1616.
5.	Hu J, Zhu J, Zhou Z, et al. Clinical outcomes of arthroscopic surgery in patients with gluteal muscle contracture: Single-institution results from a high-volume cohort. Med Sci Monit, 2024, 30: e942945. doi: 10.12659/MSM.942945.
6.	余剛, 王明英, 趙其純. 關節鏡下 L 形松解治療雙側臀肌攣縮癥. 臨床骨科雜志, 2022, 25(4): 502-506.
7.	吳毅東, 于康康, 安明揚, 等. 對平臥位關節鏡下由內向外松解骼脛束治療雙側臀肌攣縮癥的療效觀察. 骨科臨床與研究雜志, 2022, 7(4): 198-202.
8.	唐翔宇, 劉玉杰, 李春寶, 等. 臀肌攣縮癥功能量化評分表的信效度檢驗. 中國矯形外科雜志, 2017, 25(4): 336-339.
9.	Giai Via R, Elzeiny A, Pantè S, et al. Can we encourage the endoscopic treatment for external snapping hip (ESH)? A systematic review of current concepts. Eur J Orthop Surg Traumatol, 2024, 34(6): 2835-2844.
10.	Zhang S, Dong C, Li Z, et al. Endoscopic iliotibial band release during hip arthroscopy for femoroacetabular impingement syndrome and external snapping hip had better patient-reported outcomes: A retrospective comparative study. Arthroscopy, 2021, 37(6): 1845-1852.
11.	Jiang Y, Li T, Wang L, et al. Comparison of open surgery versus endoscopic-assisted release for gluteal muscle contracture: a systematic review and meta-analysis. J Orthop Surg Res, 2024, 19(1): 39. doi: 10.1186/s13018-023-04452-7.
12.	Maldonado DR, Glein RM, Lee MS, et al. Patients with concomitant painful external snapping hip and femoroacetabular impingement syndromes reported complete snapping resolution with release of the gluteus maximus and iliotibial band, and comparable minimum 2-year outcomes to a propensity-matched control group. Arthroscopy, 2022, 38(6): 1890-1899.
13.	劉玉杰, 王志剛, 李眾利, 等. 臀肌攣縮的分型與關節鏡微創治療. 軍醫進修學院學報, 2010, 31(10): 947-948.
14.	王浩, 劉誠, 郭孝軍, 等. 關節鏡治療臀肌攣縮與開放手術療效比較. 實用骨科雜志, 2022, 28(1): 73-76.
15.	祝閩, 吳鵬, 朱佳壯, 等. 外側型彈響髖不同治療方式的臨床研究. 實用骨科雜志, 2021, 27(8): 736-740.
16.	張薦, 王斌, 趙洪波, 等. 類“Pie-crusting”輔助關節鏡與開放手術治療小兒Ⅲ度臀肌攣縮癥療效對比. 中國骨與關節雜志, 2025, 14(3): 228-232.
17.	賀翔, 高嘉鍇, 王陶然, 等. 創傷性臀肌攣縮癥臨床研究進展. 創傷與急危重病醫學, 2024, 12(3): 186-190.
18.	Browning RB, Fenn TW, Allahabadi S, et al. Open and endoscopic gluteus medius and/or minimus repair achieves clinical success regardless of tear grade: High-grade fatty infiltration portends worse outcomes. Arthroscopy, 2025, 41(4): 966-977.
19.	Gao J, Chai N, Wang T, et al. A new technique of percutaneous minimally invasive surgery assisted by magnetic resonance neurography. Bone Jt Open, 2024, 5(9): 776-784.
20.	Malinowski K, Mostowy M, Kim DW, et al. Gluteal complex is important in external snapping hip: intraoperative identification of syndrome origin and endoscopic stepwise release-a case series. Int Orthop, 2024, 48(2): 401-408.
21.	Gao SG, Liu WJ, Yang M, et al. Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals: a retrospective analysis of 118 consecutive cases. BMC Musculoskelet Disord, 2021, 22(1): 28. doi: 10.1186/s12891-020-03885-z.
22.	Lim EJ, Kim JW, Doh CH, et al. Clinical outcomes following incomplete arthroscopic iliotibial band release for external snapping hip syndrome: An observational study. Orthop Surg, 2024, 16(5): 1153-1159.

1. Jiang X, Zhang H, Ren Y, et al. The pattern of collagen production may contribute to the gluteal muscle contracture pathogenic process. J Orthop Surg Res, 2023, 18(1): 579. doi: 10.3389/fcell.2020.00694.
2. Su Q, Zhang Y, Zhang Y, et al. Multivariate analysis of associations between patellofemoral instability and gluteal muscle contracture: A radiological analysis. J Pers Med, 2022, 12(2): 242. doi: 10.3390/jpm12020242.
3. Zhao W, Li Z, Ma S, et al. Identification of pro-fibrotic cellular subpopulations in fascia of gluteal muscle contracture using single-cell RNA sequencing. J Transl Med, 2025, 23(1): 192. doi: 10.1186/s12967-024-05889-y.
4. 吳毅東, 于康康, 安明揚, 等. 平臥位關節鏡下由內向外髂脛束松解術治療雙側臀肌攣縮癥的療效觀察. 中華醫學雜志, 2023, 103(21): 1611-1616.
5. Hu J, Zhu J, Zhou Z, et al. Clinical outcomes of arthroscopic surgery in patients with gluteal muscle contracture: Single-institution results from a high-volume cohort. Med Sci Monit, 2024, 30: e942945. doi: 10.12659/MSM.942945.
6. 余剛, 王明英, 趙其純. 關節鏡下 L 形松解治療雙側臀肌攣縮癥. 臨床骨科雜志, 2022, 25(4): 502-506.
7. 吳毅東, 于康康, 安明揚, 等. 對平臥位關節鏡下由內向外松解骼脛束治療雙側臀肌攣縮癥的療效觀察. 骨科臨床與研究雜志, 2022, 7(4): 198-202.
8. 唐翔宇, 劉玉杰, 李春寶, 等. 臀肌攣縮癥功能量化評分表的信效度檢驗. 中國矯形外科雜志, 2017, 25(4): 336-339.
9. Giai Via R, Elzeiny A, Pantè S, et al. Can we encourage the endoscopic treatment for external snapping hip (ESH)? A systematic review of current concepts. Eur J Orthop Surg Traumatol, 2024, 34(6): 2835-2844.
10. Zhang S, Dong C, Li Z, et al. Endoscopic iliotibial band release during hip arthroscopy for femoroacetabular impingement syndrome and external snapping hip had better patient-reported outcomes: A retrospective comparative study. Arthroscopy, 2021, 37(6): 1845-1852.
11. Jiang Y, Li T, Wang L, et al. Comparison of open surgery versus endoscopic-assisted release for gluteal muscle contracture: a systematic review and meta-analysis. J Orthop Surg Res, 2024, 19(1): 39. doi: 10.1186/s13018-023-04452-7.
12. Maldonado DR, Glein RM, Lee MS, et al. Patients with concomitant painful external snapping hip and femoroacetabular impingement syndromes reported complete snapping resolution with release of the gluteus maximus and iliotibial band, and comparable minimum 2-year outcomes to a propensity-matched control group. Arthroscopy, 2022, 38(6): 1890-1899.
13. 劉玉杰, 王志剛, 李眾利, 等. 臀肌攣縮的分型與關節鏡微創治療. 軍醫進修學院學報, 2010, 31(10): 947-948.
14. 王浩, 劉誠, 郭孝軍, 等. 關節鏡治療臀肌攣縮與開放手術療效比較. 實用骨科雜志, 2022, 28(1): 73-76.
15. 祝閩, 吳鵬, 朱佳壯, 等. 外側型彈響髖不同治療方式的臨床研究. 實用骨科雜志, 2021, 27(8): 736-740.
16. 張薦, 王斌, 趙洪波, 等. 類“Pie-crusting”輔助關節鏡與開放手術治療小兒Ⅲ度臀肌攣縮癥療效對比. 中國骨與關節雜志, 2025, 14(3): 228-232.
17. 賀翔, 高嘉鍇, 王陶然, 等. 創傷性臀肌攣縮癥臨床研究進展. 創傷與急危重病醫學, 2024, 12(3): 186-190.
18. Browning RB, Fenn TW, Allahabadi S, et al. Open and endoscopic gluteus medius and/or minimus repair achieves clinical success regardless of tear grade: High-grade fatty infiltration portends worse outcomes. Arthroscopy, 2025, 41(4): 966-977.
19. Gao J, Chai N, Wang T, et al. A new technique of percutaneous minimally invasive surgery assisted by magnetic resonance neurography. Bone Jt Open, 2024, 5(9): 776-784.
20. Malinowski K, Mostowy M, Kim DW, et al. Gluteal complex is important in external snapping hip: intraoperative identification of syndrome origin and endoscopic stepwise release-a case series. Int Orthop, 2024, 48(2): 401-408.
21. Gao SG, Liu WJ, Yang M, et al. Clinical results of arthroscopic tight fibrous band release for adult moderate-to-severe gluteal fibrosis using anterior and posterior portals: a retrospective analysis of 118 consecutive cases. BMC Musculoskelet Disord, 2021, 22(1): 28. doi: 10.1186/s12891-020-03885-z.
22. Lim EJ, Kim JW, Doh CH, et al. Clinical outcomes following incomplete arthroscopic iliotibial band release for external snapping hip syndrome: An observational study. Orthop Surg, 2024, 16(5): 1153-1159.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of arthroscopic outside-in release for gluteal muscle contracture in supine position

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