Ischioplasty and Secondary Proximal Hamstring Repair for Ischiofemoral Impingement Syndrome: A Solution to a Deep-Seated Pain.

Background: Ischiofemoral impingement (IFI) syndrome is the narrowing of the space between the lateral aspect of the ischium and the medial aspect of the lesser trochanter. IFI is a frequently unrecognized generator of vague or posterior hip pain that is commonly preceded by trauma or previous hip surgery. IFI can also be a result of atypical pelvic/proximal femur anatomy, adductor/abductor imbalances, or ischial tuberosity enthesopathies. Management typically consists of conservative treatments, including activity modification, anti-inflammatories, physical therapy, and corticosteroid injections. Endoscopic decompression of the ischiofemoral space has been shown to be an effective surgical intervention in treating IFI. Indications: Indications for endoscopic ischioplasty and secondary repair of the proximal hamstring origin include symptomatic IFI that has failed extensive conservative treatment measures. Technique Description: The width of the ischium is measured. The sciatic nerve is identified and protected. The proximal hamstring origin is exposed, and an arthroscopic burr is used to perform an osteoplasty of the lateral ischium. An endoscopic repair of the proximal hamstring is performed on the decorticated ischial tuberosity. Results: Limited clinical studies exist that report outcomes after ischioplasty for IFI. Many studies reporting outcomes after endoscopic treatment of IFI focus on iliopsoas release and lesser trochanter osteoplasty. The endoscopic treatment of IFI has been demonstrated to provide effective results after 2 years of follow-up in appropriately selected patients. Specifically, lesser trochanter osteoplasty has also shown satisfactory outcomes with symptom relief and good functional results in patients with IFI. Discussion/Conclusion: Endoscopic ischioplasty in the setting of IFI, while concomitantly performing a secondary repair of the proximal hamstring origin, allows for the enlargement of the ischiofemoral space. This approach spares the need to perform a lesser trochanter osteoplasty, which disrupts the insertion of the iliopsoas. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.