Piriformis Tenotomy and Sciatic Neurolysis via a Mini-open Approach: A Technique Guide
Piriformis syndrome is a common, treatable cause of deep gluteal pain. Treatment often starts with conservative measures such as nonsteroidal anti-inflammatories, muscle relaxants, physical therapy, and injections, but some patients progress to needing surgical intervention. Several surgical techniques are currently used to treat piriformis syndrome, with an endoscopic approach gaining popularity because of its less invasive nature and, therefore, esthetic and symptomatic benefits. However, an open approach remains more effective in releasing severely adherent sciatic nerves, in addition to being less technically demanding. This article aims to describe a reproducible mini-open surgical technique for piriformis tenotomy with sciatic neurolysis, thereby providing patients with the esthetic and symptomatic benefits of a traditional endoscopic approach while maintaining the efficiency of a traditional open approach.
Gluteus Maximus and Tensor Fascia Lata Tendon Transfers Without Bony Fixation: Operative Technique
Hip abductor insufficiency due to an irreparable or severely atrophied gluteal cuff is a potentially debilitating cause of lateral hip pain. Gluteus maximus and tensor fascia lata tendon transfers have been utilized to relieve lateral hip pain and improve abductor strength. Classical surgical techniques relying on bony fixation have shown promising results for patients, but this approach is problematic in the setting of poor bone quality. This Technical Note describes our surgical approach for performing these tendon transfers with fixation to the proximal vastus lateralis fascia, a reliable method regardless of bone quality.
Suprainguinal Lateral Femoral Cutaneous Neurectomy for Recurrent Meralgia Paresthetica: A Technique Guide
Meralgia paresthetica (MP) is a neuropathy caused by injury or compression of the lateral femoral cutaneous nerve (LFCN), presenting as numbness, tingling, or burning pain in the lateral thigh. While surgical decompression has traditionally been a common surgical treatment for MP, recently, fully transecting the LFCN is increasingly becoming the first-line surgical management as more favorable outcomes are reported. Although infrainguinal neurectomy is the primary surgical approach, recurrent or persistent symptoms due to neuroma formation or proximal variations in branching patterns can necessitate revision surgery via a suprainguinal approach. This technical note details our preferred suprainguinal LFCN neurectomy technique for the treatment of recurrent MP.
Lateral Femoral Cutaneous Neurectomy With Nerve End Implantation for Meralgia Paresthetica: A Technique Guide
Meralgia paresthetica is an uncommon but painful neuropathy causing anterolateral thigh pain. Compression or injury of the lateral femoral cutaneous nerve (LFCN) leads to pain and/or numbness in its distribution throughout the thigh. Historically, surgical decompression of the LFCN just below the inguinal ligament was most commonly utilized for first-line surgical management, but recently, fully transecting the LFCN is becoming increasingly popular as more favorable outcomes are reported. This Technical Note describes our surgical approach to neurectomy and nerve end implantation for the treatment of meralgia paresthetica.
Adductor Lengthening and Rectus Abdominis Repair via a 2-Incision Approach for Treatment of Core Muscle Injuries: A Technique Guide
Core muscle injuries are a common source of groin pain in athletes. An understanding of the pathoanatomy and clinical workup for this condition will assist in correctly identifying core muscle injuries from other causes of groin pain. In cases refractory to nonoperative management, surgical intervention may be indicated. In this Technical Note, we describe a comprehensive approach for the clinical evaluation of core muscle injuries, indications for operative intervention, and a surgical technique for adductor lengthening and rectus abdominis repair via a 2-incision approach.
