Labral Pathology Associated With Psoas Impingement (SS-60)

Abstract

Hip pain in patients with normal bony anatomy and atypical direct anterior labral pathology may be related to compression of the psoas tendon across the anterior capsulo-labral complex. Labral tears typically occur anterosuperiorly in association with femoroacetabular impingement or dysplasia. Less commonly, labral pathology may occur in an atypical direct anterior location in the absence of bony abnormalities. We hypothesize that this pattern of injury is related to compression of the anterior capsulo-labral complex by the psoas tendon where it crosses the acetabular rim and describe a unique constellation of intra-articular findings reproducibly demonstrated at the time of arthroscopy. A prospective evaluation of 482 consecutive hip arthroscopies performed by the senior author identified 32 patients with labral tears in the absence of bony pathology and preoperative findings suggestive of psoas involvement. Preoperative, intra-operative, and post-operative data were analyzed. There were 26 females and 6 males with an average age of 21.2. X-rays demonstrated no bony abnormalities, and all had MRI evidence of labral injury. Intraoperatively, anterior labral injury was present and was associated with a tight iliopsoas tendon resulting in compression of the anterior capsulo-labral complex against the acetabular rim. The injury was treated with either labral debridement (29) or repair (3) and partial psoas release at the site of compression. At early follow-up all patients reported significant subjective improvement in their preoperative symptoms. The findings in this study suggest that hip pain in patients with normal bony anatomy and atypical anterior labral pathology may be related to compression of the psoas tendon across the anterior capsulo-labral complex. In the short term, labral debridement or repair, combined with partial psoas release leads to pain relief and restoration of activities.