Labral tears typically occur anterosuperiorly in association with femoroacetabular impingement or dysplasia. Less commonly, labral pathology may occur in an atypical direct anterior location adjacent to the iliopsoas tendon in the absence of bony abnormalities. We hypothesize that this pattern of injury is related to compression or traction on the anterior capsulo-labral complex by the iliopsoas tendon where it crosses the acetabular rim. In a retrospective review of prospectively collected data, we identified 25 patients that underwent isolated, primary, unilateral iliopsoas release and presented for at least 1 year follow-up (mean 21 months). Pre-operative demographics, clinical presentation, intra-operative findings, and outcome questionnaires were analyzed. The injury was treated with a tenotomy of the iliopsoas tendon at the level of the joint line and either labral debridement or repair. Mean post-operative outcome scores were 87.17, 92.46, and 78.8 for the modified Harris Hip Score, activities of daily living Hip Outcome Score, and sports-related score, respectively. The atypical labral injury identified in this study appears to represent a distinct pathological entity, psoas impingement, with an etiology which has not been previously described.

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With short-term follow-up, endoscopic repair of gluteus medius tendon tears of the hip appears to provide pain relief and return of strength in select patients who have failed conservative measures. Further long-term follow-up is warranted to confirm the clinical effectiveness of this procedure.

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Background The objective of this study was to determine whether the tear size of a supraspinatus tendon correlated with synovial inflammation and tendon degeneration in patients that underwent shoulder arthroscopy for rotator cuff repair. We hypothesized that increased synovial inflammation would correlate with greater tear size of the supraspinatus tendon at the time of surgery. Materials and Methods Tissue from the synovium, bursa, torn supraspinatus tendon and subscapularis tendon were obtained from patients during shoulder arthroscopy in order to evaluate the mRNA expression of pro-inflammatory cytokines, tissue remodeling and angiogenesis factors in the tendon, bursa, and synovium. Additional tissue was fixed to determine histological changes including inflammation, vascular ingrowths, and collagen organization. Results Increased expression of IL-1β, IL-6, COX-2, MMP-9, and VEGF was found in the synovium of patients with full-thickness tears versus partial-thickness tears (p<0.05). In the supraspinatus tendon, increased expression of MMP-1, -9, and -13 and VEGF was found in the full-thickness group. The upregulation of these genes in the full-thickness group was consistent with enhanced synovium inflammation, greater vascular ingrowth and the loss of collagen organization in both supraspinatus and subscapularis tendons as determined by histology. Conclusion Increased synovium inflammation and tissue degeneration correlates with the tear size of the supraspinatus tendon. A better understanding of the relationship between synovial inflammation and the progression of tendon degeneration can help design novel and effective treatments to limit the advance of rotator cuff diseases and to improve their clinical outcomes. Level of evidence Basic Science, Molecular and Cell Biology Study