Does endoscopic piriformis tenotomy provide safe and complete tendon release? A cadaver study

Area of Science:

• Orthopedic surgery
• Minimally invasive procedures
• Anatomical studies

Background:

• Piriformis syndrome is treated with endoscopic piriformis release (EPR).
• EPR involves dividing the piriformis muscle near the sciatic nerve.
• The sub-gluteal space contains critical neurovascular structures.

Purpose of the Study:

• Assess reproducibility and quality of endoscopic piriformis tenotomy near the greater trochanter.
• Detect iatrogenic injuries to lateral hip rotators, nerves, and vessels.
• Define surgical safety margins relative to the sciatic nerve and inferior gluteal bundle.

Main Methods:

• Prospective cadaver study on 10 hips in the prone position.
• Endoscopic piriformis release (EPR) performed via two portals (a third in 7 cases).
• Post-procedure dissection using Kocher-Langenbeck approach for assessment.

Main Results:

• Complete tenotomy achieved in 90% of cases.
• No sciatic nerve or inferior gluteal artery injuries observed.
• Mean safety margins: 5.21cm from sciatic nerve, 7.1cm from inferior gluteal artery.

Conclusions:

• Endoscopic piriformis tenotomy at the greater trochanter provides complete muscle release.
• The procedure demonstrates satisfactory safety margins and a short learning curve.
• EPR without sciatic nerve release is a viable treatment option.