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  • Title: Does endoscopic piriformis tenotomy provide safe and complete tendon release? A cadaver study.
    Author: Coulomb R, Khelifi A, Bertrand M, Mares O, May O, Marchand P, Kouyoumdjian P.
    Journal: Orthop Traumatol Surg Res; 2018 Dec; 104(8):1193-1197. PubMed ID: 29852320.
    Abstract:
    BACKGROUND: Endoscopic piriformis release (EPR) is among the available treatments for piriformis syndrome. This procedure typically involves dividing the muscle near the sciatic nerve in the sub-gluteal space, which contains numerous blood vessels and nerves. The objectives of this prospective cadaver study were: 1) to assess the reproducibility and quality of endoscopic piriformis tenotomy near the greater trochanter; 2) to detect iatrogenic injuries to the lateral hip rotators, nerves, and vessels; 3) and to define the surgical safety margins relative to the sciatic nerve and inferior gluteal bundle. HYPOTHESIS: EPR at the greater trochanter ensures full release of the muscle with a limited risk of neuro-vascular injury. MATERIAL AND METHODS: EPR was performed via two portals on 10 cadaver hips preserved in zinc chloride and placed in the prone position. A third, ancillary portal was required in 7 cases. The area was then dissected with the Kocher-Langenbeck approach to allow an assessment of the tenotomy, detect iatrogenic injuries, and measure the distances separating the tenotomy site from the sciatic nerve and inferior gluteal artery. RESULTS: Complete tenotomy was achieved in 9 (90%) cases. The tendon adhered to the capsule in 2 (20%) cases and showed acquired avulsion in 1 case. No injuries to the sciatic nerve or inferior gluteal artery occurred. Mean distances from the tenotomy site were 5.21±0.59cm (range, 4.5-6.6cm) for the sciatic nerve and 7.1±0.89cm (range, 5.4-8.5cm) for the inferior gluteal artery. DISCUSSION: EPR by a tenotomy at the greater trochanter without sciatic nerve release provides full release of the muscle with satisfactory safety margins and a short learning curve. LEVEL OF EVIDENCE: III, prospective cadaver case-control study.
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