IT Band Tenotomy for Bursitis

What is IT Band Tenotomy for Bursitis?

Iliotibial (IT) band tenotomy for bursitis is a surgical procedure used to relieve pain and inflammation associated with iliotibial band syndrome (ITBS) or trochanteric bursitis (greater trochanteric pain syndrome). It involves making controlled incisions or lengthening the iliotibial band to reduce tension and friction over the greater trochanter of the hip.

Trochanteric bursitis, also known as greater trochanteric bursitis or hip bursitis, is a painful condition caused by inflammation of the trochanteric bursa that overlies the greater trochanter (bony prominence at the outer side of the hip). A bursa is a small sac filled with fluid that acts as a cushion and allows frictionless movement between the muscles and bone. Trochanteric bursitis results in pain on the outer portion of the hip that usually increases with prolonged walking or climbing stairs.

Iliotibial band syndrome is an overuse injury resulting from the inflammation of the iliotibial band. The iliotibial band is a tough group of fibers that begins at the iliac crest of the hip and runs along the outside of the thigh, to get attached to the outer side of the shin bone just below the knee joint. Its function is to coordinate with the thigh muscles and provide stability to the knee joint. Iliotibial band syndrome occurs when the iliotibial band and the lower outside portion of the thigh bone at the knee joint rub against each other. It commonly occurs in athletes, cyclists, and runners.

Indications for IT Band Tenotomy for Bursitis

IT band tenotomy for bursitis is typically recommended for:

• Refractory Greater Trochanteric Bursitis: Chronic hip pain that does not respond to conservative treatments such as physical therapy, corticosteroid injections, or NSAIDs.
• Iliotibial Band Syndrome (ITBS): Persistent lateral hip pain due to excessive tension and rubbing of the IT band over the greater trochanter.
• Hip Abductor Tendinopathy or Gluteal Tendon Tears: Conditions that often coexist with bursitis and IT band tightness.

Procedure for IT Band Tenotomy for Bursitis

During an IT band tenotomy for bursitis, the surgeon partially releases or lengthens the iliotibial band to reduce tension and friction over the greater trochanter, relieving pain from trochanteric bursitis and IT band syndrome.

In general, the procedure is performed under regional anesthesia (spinal or epidural) or general anesthesia and involves the following steps:

• The patient is positioned in a lateral decubitus (lying on your side) or supine (lying flat on your back) position with the affected hip accessible.
• The hip and the lateral thigh are sterilized and draped for the procedure.
• If done arthroscopically, small incisions (about 1 cm each) are made for the arthroscope and instruments. An arthroscope is a small, fiber-optic instrument consisting of a lens, light source, and video camera. The camera displays images of the inside of the joint onto a monitor, allowing your surgeon to assess any damage and perform a repair.
• If an open surgery, a small incision is made on the lateral thigh near the greater trochanter (the bony prominence on the outer hip).
• The iliotibial band is identified.
• The surgeon performs a partial thickness incision in the IT band to release tightness.
• Z-lengthening technique or controlled incisions may be used to lengthen the IT band while maintaining its function.
• In some cases, a window or fenestration is created in the IT band to reduce pressure on the underlying trochanteric bursa and gluteal tendons.
• If necessary, your surgeon may also perform bursal and tendon debridement.
  • If the trochanteric bursa is inflamed, it may be partially or fully removed (bursectomy).
  • If gluteal tendinopathy or partial tears are present, tendon repair may be done.
• The incisions are closed with sutures or staples, and a sterile dressing is applied.

Postoperative Care and Recovery

Postoperative care for IT band tenotomy for bursitis focuses on pain management, mobility restoration, and gradual return to activity. Patients may experience mild discomfort and swelling, which can be managed with NSAIDs, ice therapy, and elevation. Weight-bearing is usually allowed immediately or within a few days, depending on the extent of the procedure, and crutches may be recommended temporarily for mobility. Physical therapy begins early with gentle stretching and strengthening exercises to restore hip function and prevent stiffness. Most patients can return to light activities within 2–4 weeks, while full recovery, including a return to sports or high-impact activities, typically takes 3–6 months. Compliance with rehabilitation exercises and avoiding excessive strain on the hip are crucial for optimal healing. Sutures or staples (if used) are typically removed in 10-14 days.

Risks and Complications

Risks and complications associated with IT band tenotomy for bursitis include:

• Persistent pain or recurrence
• Weakness or instability
• Scar tissue formation
• Infection
• Bleeding or hematoma
• Delayed healing
• Nerve injury
• Blood clots or deep vein thrombosis (DVT)