Arthroscopic Iliopsoas Tendon Release in the Treatment of Internal Snapping Hip (SS-44)

Abstract

Introduction: Internal hip snapping produced by the iliopsoas tendon moving over the iliopectineal eminence or over the femoral head can cause significant pain in the hip joint. The purpose of this study was to examine the outcomes and effectiveness of arthroscopic iliopsoas tendon lengthening as a solution to internal hip snapping. Methods: Data was prospectively collected between 2009-2011 on all patients undergoing arthroscopic iliopsoas lengthening for a diagnosis of painful internal snapping hip. The exclusion criteria were revision surgeries and previous hip conditions such as LCPD, SCFE or AVN. The surgical approach used to lengthen the iliopsoas tendon involved releasing the tendinous portion at the joint level, while leaving the anterior muscular portion intact. Surgical outcome was measured according to the improvement in four hip specific scores (modified Harris Hip Score, NonArthritic Hip Score, and the two Hip Outcome Score subscales: the Sport Specific and the Activities of Daily Living), visual analog pain score (VAS), and satisfaction with surgery on a scale of 0 10. Results: A total of 28 cases met our inclusion/exclusion criteria. At the time of surgery, patient age ranged from 14 to 51, with an average age of 25. At an average follow-up of 15.4 months, 20 of the 28 cases resulted in a complete resolution of hip snapping. On average, patients showed an improvement of more than 19 points in all four hip specific scores. The pain level reduced by 3.2 points on average. All patients but six reported to have ‘good’ to ‘excellent’ (7 to 10 out of 10) level of satisfaction. One report of weakness in flexion was noted two weeks after the tendon lengthening and was found to be resolved at the three month clinical follow-up visit. Conclusion: Arthroscopic fractional lengthening of the iliopsoas tendon at the level of the joint in patients showing pre-operative internal hip snapping resulted in limited recurrence of the snapping post-operatively, no cases of unresolved weakness in flexion, as well as an overall good to excellent satisfaction and clinical improvement. Hip Arthroscopy in the Older patient (SS-45) MICHAEL MULDOON, M.D., PRESENTING AUTHOR CHRISTOPHER R. GOODING M.D. F.R.C.S.(TR&ORTH) GLENNIS MULDOON RICHARD SANTORE, M.D.