Arthroscopic Treatment of Iliopsoas Snapping in Patients With Radiographic Acetabular Dysplasia Using Iliopsoas Fractional Lengthening and Capsular Plication

Hartigan, David E.; Perets, Itay; Close, Mary R.; Walsh, John P.; Chaharbakhshi, Edwin O.; Mohr, Mitchell R.; Domb, Benjamin G.

doi:10.1016/j.arthro.2018.01.027

Cited by 18 publications

(24 citation statements)

References 47 publications

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“…[26][27][28][29][30][31] Furthermore, most relevant clinical outcomes studies in the past did not study directly the implication of iliopsoas tenotomy on hip instability. 3,9 Iliopsoas lengthening is performed for symptomatic internal snapping hip syndrome and has been shown to have excellent outcomes as long as the cam/pincer morphology is corrected, the labrum is preserved, the capsule is plicated, and femoral version is normal or low. 9 Internal snapping hip syndrome causes a painful snapping of the hip that involves the iliopsoas tendon snapping over the femoral head and the hip capsule when the hip is extended, adducted and internally rotated.…”

Section: Discussionmentioning

confidence: 99%

“…3,9 Iliopsoas lengthening is performed for symptomatic internal snapping hip syndrome and has been shown to have excellent outcomes as long as the cam/pincer morphology is corrected, the labrum is preserved, the capsule is plicated, and femoral version is normal or low. 9 Internal snapping hip syndrome causes a painful snapping of the hip that involves the iliopsoas tendon snapping over the femoral head and the hip capsule when the hip is extended, adducted and internally rotated. 32,33 About 10% of the general population is estimated to have an internal snapping hip; however, the majority of these individuals are found to be asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8] Nevertheless, some studies have shown that excellent outcomes can be achieved in patients undergoing arthroscopic iliopsoas lengthening for symptomatic internal snapping hip syndrome, as long as cam/pincer morphology is corrected, the labrum is preserved, the capsule is managed according to underlying pathology, and femoral version is normal or low. [9][10][11][12][13] The purpose of this study was to perform a systematic review of biomechanical and clinical studies to determine whether the iliopsoas is a femoral head stabilizer. The authors hypothesized that the iliopsoas is an anterior femoral head stabilizer.…”

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confidence: 99%

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Is the Iliopsoas a Femoral Head Stabilizer? A Systematic Review

Hirase

Mallett

Barter

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To perform a systematic review of biomechanical and clinical studies to determine whether the iliopsoas is a femoral head stabilizer. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Inclusion criteria were any human clinical (Levels I-IV evidence) or laboratory studies that investigated the role of the iliopsoas as a stabilizer of the hip. Exclusion criteria included studies that investigated patients undergoing spine surgery or those with a total hip arthroplasty or hip hemiarthroplasty. Study methodologic quality for clinical-outcomes studies were analyzed using the Modified Coleman Methodology Score. Because of the heterogeneity in the participants and interventions, no quantitative assimilative meta-analysis was performed. Results Eight articles were analyzed (3 biomechanical [35 cadavers and 18 healthy subjects]; 5 clinical outcomes studies [537 subjects, 207 arthroscopic iliopsoas tenotomies]). Two in vivo biomechanical studies identified the iliopsoas as an anterior hip stabilizer. One cadaveric study identified the iliopsoas as a femoral head stabilizer at 0 o -15 o of hip flexion. Two clinical studies demonstrated the role of the iliopsoas as a dynamic hip stabilizer, particularly in patients with increased femoral version (greater than 15˚-25˚). Two studies reported cases of atraumatic anterior hip dislocations after arthroscopic iliopsoas tenotomies. Conclusions Evidence from biomechanical and clinical studies may suggest that the iliopsoas is a dynamic anterior femoral head stabilizer. Level of Evidence Level IV, systematic review of Level III and IV plus biomechanical studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Is the Iliopsoas a Femoral Head Stabilizer? A Systematic Review

Hirase

Mallett

Barter

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…• Use the shaver to expose the junction between the capsule and the labrum. The surgeon should aim to remove only synovial tissue, but no capsular tissue, particularly in patients with borderline dysplasia and/or laxity [17][18][19][20] .…”

Section: Contraindicationsmentioning

confidence: 99%

“…• Restoring capsular anatomy is critical for achieving a good outcome 15,17,18,25 ; therefore, appropriate capsular preservation and management are even more important in patients indicated for IFL, as the condition often is seen with ligamentous laxity or borderline acetabular dysplasia 20 .…”

Section: Contraindicationsmentioning

confidence: 99%

Arthroscopic Iliopsoas Fractional Lengthening

Maldonado

Lall

Battaglia

et al. 2018

JBJS Essential Surgical Techniques

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Background: Iliopsoas fractional lengthening (IFL) is performed on patients with symptomatic internal snapping. This condition is defined as painful and sometimes audible snapping of the iliopsoas (IP) tendon over the femoral head or iliopectineal line. Arthroscopic IFL is performed if the snapping is unresponsive to conservative treatment 1,2. Description: Hip arthroscopy is performed with the patient in the supine position on a traction table. The portals used to access the joint capsule include standard anterolateral, mid-anterior, and distal anterolateral accessory (DALA) portals 3. With a 70°arthroscope, diagnostic arthroscopy is conducted to assess the quality of labral tissue, acetabular and femoral cartilage surfaces, and the ligamentum teres. When indicated, supplementary procedures, such as acetabuloplasty, labral repair, or labral reconstruction 4 , are performed prior to IFL. With traction still applied, IFL is then performed from the central compartment at the level of the joint line. Exposure of the IP tendon is achieved with the use of a curved blade to extend the capsulotomy medially over the 3 o'clock position (right hip). Once the tendon can be appropriately visualized, a progressive and complete transverse cut is made in the tendinous portion, taking care to avoid the muscular portion. During this process, the anterolateral and mid-anterior portals serve as visualization and working portals, respectively 5. Alternatives: Prior to arthroscopic IFL for painful internal snapping, nonsurgical options 6,7 may include (1) physical therapy programs, (2) activity modification, (3) nonsteroidal anti-inflammatory drugs (NSAIDs), or (4) ultrasound-guided cortisone injections. Disclosure: The authors indicated that no external funding was received for any aspect of this work. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (http://links.lww.com/JBJSEST/A229).

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Coxa Saltans: Iliopsoas Snapping and Tendonitis

Ilizaliturri¹,

Suárez-Ahedo²

2021

Hip Arthroscopy and Hip Joint Preservation Surgery

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Arthroscopic Treatment of Iliopsoas Snapping in Patients With Radiographic Acetabular Dysplasia Using Iliopsoas Fractional Lengthening and Capsular Plication

Cited by 18 publications

References 47 publications

Is the Iliopsoas a Femoral Head Stabilizer? A Systematic Review

Is the Iliopsoas a Femoral Head Stabilizer? A Systematic Review

Arthroscopic Iliopsoas Fractional Lengthening

Coxa Saltans: Iliopsoas Snapping and Tendonitis

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