Iliopsoas Impingement: A Newly Identified Cause of Labral Pathology in the Hip

Abstract

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.

Current concepts in the diagnosis and management of extra-articular hip impingement syndromes

“…Arthroscopic resection of an impinging AIIS has also been reported by some experienced hip arthroscopists [21,23,25,27], and studies have shown good short-term outcomes up to two years follow-up for a return to sporting activity, increased ROM, Harris hip score and visual analogue scale [21,23,27]. To date, post-surgical rehabilitation has not been objectively studied and its role in the post-operative period is poorly detailed in the literature [18], while two to four weeks of protected weight bearing with crutches and ROM exercises until basic muscle strength is regained are recommended [28]. The post-operative administration of non-steroidal antiinflammatory agents for prophylaxis against heterotopic ossification for the first three to four weeks after surgery is also advised [23].…”

“…In other words, iliopsoas impingement causes a distinct pattern of anterior labral damage that does not extend into the anterosuperior portion of the labrum (e.g., 1 to 2-o'clock position for right hips). It is an emerging diagnosis of anterior hip pain that has been linked to acetabular labral tears [28,35], and also to impingement on the osteophytic acetabular rim in a patient with degenerative hip arthritis [36].…”

“…Iliopsoas impingement is more common in young females and individuals involved in regular sporting activities [18,28,37]. The average age of the patients is 25-35 years (range, 15-57 years) [28,35].…”

“…The average age of the patients is 25-35 years (range, 15-57 years) [28,35]. The strong female preponderance might be explained by a narrower iliopsoas tendon in females (10.2 mm) compared with females without iliopsoas impingement (11.0 mm) and males with iliopsoas impingement (11.9 mm) [35].…”

“…Clinical examination may reveal non-specific focal tenderness over the iliopsoas tendon at the anterior joint line, positive hip impingement test (Flexion, Adduction, Internal Rotation test), and pain or apprehension with a resisted straight leg raise test [28,37]. Iliopsoas snapping may be elicted by flexion, abduction and external rotation of the hip and then bringing the leg into extension [42][43][44].…”