Clinical Outcomes of Arthroscopic Annular Release Around the Greater Trochanter in Severe Gluteal Muscle Contracture Cases: A Technical Note and Case Series.

OBJECTIVE: Severe gluteal muscle contracture often requires surgical release, yet conventional open procedures are associated with extensive soft tissue trauma, significant postoperative pain, and prolonged rehabilitation. This study aimed to introduce an arthroscopic annular release technique for severe gluteal muscle contracture and evaluate its clinical outcomes. METHODS: A retrospective review was conducted using data from patients with severe gluteal muscle contracture who underwent arthroscopic treatment between September 2019 and October 2022. Inclusion criteria were patients presented positive preoperative signs, including squatting and crouching impairment, difficulty in crossing the legs, a positive Ober's sign, with or without clicking sounds during hip rotation. The annular release treatment was done around the greater trochanter, which has a sparse distribution of muscle and neuromuscular tissues. Arthroscopic observation and intraoperative physical examination were used to assess the adequacy of the release. Additionally, clinical assessments included the Gluteal Muscle Contracture Disability Scale (GDS), Visual Analogue Scale (VAS), and pain frequency, which were evaluated pre- and postoperatively. A paired Student's t-test was applied to compare the GDS, VAS, and pain frequency scores before and after surgery. RESULTS: A total of 22 patients were included in the final analysis, with an average follow-up of 2 years. All operations were successfully completed, with no intraoperative conversion to alternative surgical methods. After surgery, most patients achieved satisfactory postoperative outcomes; isolated limitations persisted in one patient who reported persistent squatting difficulty, and two patients continued to have trouble crossing their legs. The GDS score was 43.8 ± 13.3 preoperatively and 72.7 ± 9.6 at the final follow-up, showing a statistically significant improvement (p < 0.01). The VAS score was 1.8 ± 2.0 preoperatively and 0.9 ± 1.3 postoperatively, with a significant difference observed (p = 0.015). Pain frequency was 2.4 ± 2.7 preoperatively and 0.8 ± 1.2 at final follow-up, with a statistically significant improvement (p < 0.01). No neurologic injuries or other complications were observed during the follow-up period. CONCLUSION: Arthroscopic annular release around the greater trochanter showed adequate contracture band exposure and favorable clinical outcomes in this retrospective case series. It may be a feasible minimally invasive option for severe gluteal muscle contracture.