An Iliopsoas Impingement Lesion in the Absence of Painful Internal Snapping May Not Require Iliopsoas Fractional Lengthening

Abstract

Background: Iliopsoas impingement (IPI) has been associated with a distinct lesion on the anterior labrum. Iliopsoas fractional lengthening (IFL) can treat IPI in instances of painful internal snapping (PIS) and mechanical groin pain. Purpose: To report minimum 2-year outcomes of patients without PIS who had an IPI lesion diagnosed intraoperatively that did not undergo IFL (+IPI –PIS –IFL) as compared with a matched group of patients with PIS and an IPI lesion that was treated with IFL (+IPI +PIS +IFL). Study Design: Cohort study; Level of evidence, 3. Methods: Data on all patients who underwent primary hip arthroscopy between May 2009 and June 2017 were retrospectively reviewed. Patients were included if they underwent hip arthroscopy for femoroacetabular impingement–related pathology, an IPI lesion was diagnosed intraoperatively, and they had minimum 2-year postoperative scores for the following: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), iHOT-12 (International Hip Outcome Tool–12), patient satisfaction, and visual analog score (VAS) for pain. Patients were propensity score matched based on the following criteria: age, body mass index, follow-up time, sex, labral treatment, femoroplasty, and acetabuloplasty. Results: A total of 412 hips were eligible for the current study, of which 336 (81.6%) had 2-year follow-up. The matching process established 37 hips in the +IPI –PIS –IFL group and 87 hips in the +IPI +PIS +IFL group. Both groups experienced significant improvements from presurgery to latest follow-up for all recorded patient-reported outcomes (PROs). The +IPI –PIS –IFL group compared favorably with the +IPI +PIS +IFL group for mHHS (86.0 vs 86.1; P = .53), NAHS (83.0 vs 84.7; P = .40), and HOS-SSS (78.1 vs 76.5; P = .87). Additionally, iHOT-12, VAS, patient satisfaction, and rates of achieving the minimal clinically important difference for mHHS, NAHS, and HOS-SSS were similar between groups at the latest follow-up. Conclusion: Patients without PIS who were diagnosed with an IPI lesion intraoperatively and did not undergo IFL had similar and favorable improvements in PROs, VAS, and satisfaction to a matched cohort with PIS who had IFL performed. Thus, an IPI lesion in the absence of PIS may not require IFL.

The role of iliopsoas fractional lengthening in hip arthroscopy: a systematic review

“…(2021) and Meghpara et al . (2020) have highlighted the importance of careful patient selection and judicious use of IFL [ 4 , 10 ]. Matsuda et al .…”

“…Meghpara et al . found that IFL did not significantly improve PRO for patients without painful internal snapping, further emphasizing the need for careful patient selection and consideration of alternative treatment options [ 4 ]. Thus, iliopsoas tenotomy and IFL should not be routinely used without clear internal snapping hip pathology present pre-operatively.…”

“…Surgeons often run into the question of whether to combine iliopsoas releases with their arthroscopic labral repairs when a patient has a concomitant internal snapping hip pathology. In addition, iliopsoas impingement may be found during arthroscopy and there is no consensus of whether to treat the impingement in addition to the original labral pathology [ 4 ].…”

Editorial Commentary: Indiscriminate Iliopsoas Tenotomy May Cause Complications–With Tight Indications and Transbursal Lengthening, We May Avoid Them

“…It has also been our experience that an iliopsoas impingement lesion in the absence of painful internal snapping does not require IFL. 6 Although performing an IFL using the transbursal approach is feasible, in our experience, there are key technical pearls to diminish the risk of complications and obtain favorable outcomes. 8 In the setting of FAIS and labral tear, labral restoration and accurate bony morphology correction are important.…”

“…1 It is a cautionary tale that certain studies have demonstrated early postoperative weakness and iliopsoas atrophy on radiological imaging. Furthermore, the data in outcomes after hip arthroscopy in patients with painful snapping without IFL are scarce, 6 which makes the current study presented by Matsuda et al 3 very valuable. The first line for the treatment of iliopsoas pathology should be conservative treatment.…”