Arthroscopic treatment of the snapping iliopsoas tendon through the central compartment of the hip

Abstract

We undertook a prospective pilot study to determine whether arthroscopic surgery through the central compartment of the hip was effective in the management of a snapping iliopsoas tendon. Seven patients were assessed pre-operatively and at three, six, 12 and 24 months after operation. This included the assessment of pain on a visual analogue scale (VAS) and function using the modified Harris hip score. All the patients had resolution of snapping post-operatively and this persisted at follow-up at two years. The mean VAS score for pain fell from 7.7 (6 to 10) pre-operatively to 4.3 (0 to 10) by three months (p = 0.051), and to 3.6 (1 to 8) (p = 0.015), 2.4 (0 to 8) (p = 0.011) and 2.4 (0 to 8) (p = 0.011) by six, 12 and 24 months, respectively. The mean modified Harris hip score increased from 56.1 (13.2 to 84.7) pre-operatively to 88.4 (57.2 to 100) at one year (p = 0.018) and to 87.9 (49.5 to 100) at two years (p = 0.02). There were no complications and no weakness occurred in the musculature around the hip. Our findings suggest that this treatment is effective and would support the undertaking of a larger study comparing this procedure with other methods of treatment.

The anatomy and relevance of the iliopsoas in the young adult with hip pain: Role of arthroscopic intervention

“…The exact location of tendon release is still a matter of debate, with all of the three sites of release showing equivalent results. 9,52 We postulate that this should be according to surgeons' preference and experience.…”

Hip arthroscopy for extra-articular hip disease

“…The iliopsoas tendon can be released either at its insertion into the lesser trochanter or via a transcapsular technique at the level of the hip joint [35,49,50]. These procedures can be successfully done either from the lateral decubitus position [42,49] or from the supine position [35,44,[51][52][53]. Iliopsoas release is preceded by diagnostic hip arthroscopy and treatment of concurrent femoroacetabular impingement (FAI) lesions, chondral damage, and labral tears if indicated [35,42,[49][50][51][52][53].…”

“…These procedures can be successfully done either from the lateral decubitus position [42,49] or from the supine position [35,44,[51][52][53]. Iliopsoas release is preceded by diagnostic hip arthroscopy and treatment of concurrent femoroacetabular impingement (FAI) lesions, chondral damage, and labral tears if indicated [35,42,[49][50][51][52][53]. By releasing at the lesser trochanter, a number of authors have reported completely relieving snapping in patients and that, after initial hip flexion weakness, strength is ultimately restored and patients return to their preoperative level of activity and work [42,52], including competitive athletics [51].…”

“…By releasing at the lesser trochanter, a number of authors have reported completely relieving snapping in patients and that, after initial hip flexion weakness, strength is ultimately restored and patients return to their preoperative level of activity and work [42,52], including competitive athletics [51]. Results have also been promising with the transcapsular approach [49,53], which is the senior author's preferred approach when this is to be performed, although currently, in our practice, the indications for psoas release are extremely limited. In a prospective randomized study of 19 patients comparing the two techniques, Ilizaliturri et al found that at an average follow-up of 20 months, all patients treated by either technique were relieved of their snapping without complications, and there were no differences in their Western Ontario and McMaster Universities osteoarthritis scores [49].…”

Arthroscopy of the Hip, The Snapping Hip

“…5). 7,9,10,15,16 When bony impingement (typically pincer or anterior inferior iliac spine prominence), labral pathology, and psoas impingement or internal snapping hip are seen together, the term "triple impingement" has been used. 17 One retrospective review of failed hip arthroscopies noted that 7 out of 24 failures were related to tight iliopsoas and associated labral tearing.…”