Iliopectineal Eminence Research Articles

Low back pain associated with internal snapping hip syndrome in a competitive cyclist

Low back pain is a common complaint among cyclists. Here we present the case of a competitive master cyclist with low back pain and whose symptoms ultimately resolved when he...

Anatomic study of internal fixation of acetabular anterior column plate technique

To study the best entry points, direction and length of screw in acetabular anterior column plate technique, and to prevent the serious complications of screw penetrating the joint surface. Twenty male cadaveric adult semi-pelvic specimen were taken, and the distance from anterior acetabular margin, posterior acetabular margin to anterior inferior iliac spine, iliopubic eminence and pubic tubercle were measured respectively. Determine and make serial cross-sections of the acetabular anterior column, measure the safe angle of screw entry on all entry points of each cross-section, and put all data into software SPSS 10.0 for statistics process. The distance from anterior acetabular margin to anterior inferior iliac spine, iliopubic eminence and pubic tubercle was (25.4 +/- 1.4) mm, (11.8 +/- 0.7) mm and (37.4 +/- 1.5) mm respectively, the distance from posterior acetabular margin to anterior inferior iliac spine, iliopubic eminence was (15.5 +/- 0.9) mm and (29.1 +/- 1.6) mm respectively. On each cross-section, the maximum of the safe entry angle of inclination in 0.5 cm, 1.0 cm and 1.5 cm entry point lateral to the linea terminalis of pelvis was (8.2 +/- 2.2) degrees , (14.9 +/- 3.4) degrees and (26.1 +/- 4.5) degrees respectively. When plate for internal fixation on acetabular region of anterior column is used, there are three ways to avoid screw penetrating the joint surface. The first way is using short screw in any direction; the second way is using long screw close to the linea terminalis of pelvis, the direction of the screw is parallel to the quadrilateral plate; the third way is using different entry angle and length according to different entry point.

Inguinal hernia and the iliopectineal line. Deficiency of the insertion of the conjoint tendon as a factor in the aetiology, with an account of an operation for its correction and a report of 200 cases

Inguinal hernia and the iliopectineal line. Deficiency of the insertion of the conjoint tendon as a factor in the aetiology, with an account of an operation for its correction and a report of 200 cases

THE CLASSIC: Complete Replacement Arthroplasty of the Hip by the Ring Prosthesis

THE CLASSIC: Complete Replacement Arthroplasty of the Hip by the Ring Prosthesis

Internal Snapping Hip Syndrome: Treatment by Endoscopic Release of the Iliopsoas Tendon

The internal snapping hip syndrome is caused by slippage of the iliopsoas tendon over the iliopectineal eminence or the femoral head. Open surgical techniques have been successfully used to treat this condition. More recently, endoscopic techniques have become available to address this problem. The purpose of this study was to investigate an endoscopic technique for release of the iliopsoas tendon and its short-term results. Consecutive case series. Six patients (7 hips) with an average age of 38.5 years had an endoscopic release of the iliopsoas tendon for internal snapping hip syndrome. Hip arthroscopy was performed in every patient. Special inferior portals were used for psoas bursoscopy. The iliopsoas tendon was identified and released at the level of the lesser trochanter in all cases. Intra-articular concomitant injuries were identified and treated in 4 cases. No snapping symptoms were present in any patient after surgery nor at the last follow-up at, on average, 21 months. Significant loss of flexion strength was present after surgery but had improved by 8 weeks. In our hands, the endoscopic technique for iliopsoas tendon release was effective and reproducible and our results compare well with results of open procedures in the short term. Level IV.

An Overview of Hip Injuries in Running

Running has steadily gained in worldwide popularity and is the primary exercise modality for many individuals of all ages. Its low cost, versatility, convenience and related health benefits appeal to men and women of broad cultural, ethnic and economic backgrounds. With more children and adults participating in recreational and competitive running, the incidence of injuries has steadily increased. Most running-related injuries affecting the lower extremities are due to preventable training errors, and some may necessitate medical evaluation or a significant reduction in training. Hip injuries in runners are due to interactions of intrinsic and extrinsic factors that adversely affect the complex regional anatomy. Acute or chronic hip pain presents a diagnostic and therapeutic challenge because the vague, nonspecific symptoms and signs may originate from local, regional or distant foci. Muscle strains and tendonitis are the most common aetiologies of hip pain and typically result from sudden acceleration/deceleration manoeuvres, direction changes or eccentric contractions. Apophysitis and avulsion fractures may affect younger runners and produce localised pain at muscle attachment sites. Iliotibial band syndrome is a common cause of lateral hip and knee symptoms characterised by sharp or burning pain that is exacerbated by activity. Bursitis, due to repetitive activity or acute trauma, may affect the trochanteric, ischial or iliopectineal bursae. Hip osteoarthritis may also produce persistent pain that worsens with running. Stress fractures are potentially serious conditions that affect women more frequently than men. Snapping hip syndrome is a benign condition that results from tight connective tissues' passing repeatedly over the greater trochanter, anterior hip capsule, lesser trochanter, femoral head or iliopectineal eminence. Acetabular labral tears, sports hernias and nerve entrapment syndromes are also potential causes of persistent hip pain in runners. Treatment of hip pain in running should focus not only on addressing the symptoms but also identifying the underlying conditions that precipitated the injury. Injury prevention and comprehensive rehabilitation are essential, since prior hip injuries increase the risk of subsequent ones. Coaches, trainers and medical personal who care for runners should advocate running regimens, surfaces, shoes, technique and individualised conditioning programmes that minimise the risk of initial or recurrent hip injuries.

Arthroscopic release of the “snapping ilio-psoas tendon” (SS-90)

Snapping ilio-psoas tendon is a rare condition caused by a sudden slip of the ilio-psoas tendon over the iliopectineal eminence, it is underdiagnosed and may be related to sport activity or hip pathology. Open surgical lengthening and release have been used with success to treat this condition. The purpose or this study is to report the short-term results of an endoscopic ilio-psoas tendon release technique. Methods: Between January 2002 and August 2003 we treated 12 patients for symptomatic anterior snapping hip, 6 patients (7 hips) did not respond to physical therapy, surgical treatment was indicated, all were female with an average age of 38.5 years (26 to 44). The diagnosis was related to sports in 2 cases, developmental dysplasia of the hip in 2 (no previous surgery) and 1 had no positive history. Four hips were left and 3 right. Endoscopic psoas release was performed after hip joint arthroscopy by the lateral approach, traction was used for acetabular and superior femoral head visualization trough 3 standard portals. The inferior hip capsule and the psoas bursa were examined without traction. The inferior hip capsule was visualized trough an anterior inferior portal (with fluoro control); no working portal was necessary for any case at this point. To access the psoas bursa the leg was externally rotated to visualize the lesser trochanter at the image intensifier. The arthroscopic cannula was introduced in the anterior inferior portal and directed to the lesser trochanter (fluoro control), the ilio-psoas tendon was identified arthroscopically and a further inferior portal was made triangulating toward the lesser trochanter. A slotted cannula was placed at the most inferior portal and the ilio-psoas tendon was released with electrocautery. Full range of motion and weight bearing were allowed after surgery except for one case that had microfractures done. Results: We were able to identify and release the ilio-psoas tendon in every case, associated injuries were identified and treated in 4 cases, these included Outerbridge II lesions on the acetabulum in 1 case. Two cases with inverted labrums one with exposed subchondral bone at the anterior acetabular rim and one case with hypertrophy of ligamentum teres. All the patients were relieved of symptoms and pain immediately after surgery but they were unable to do a straight leg raise or climb steps until 6 to 8 weeks. Discussion: Open ilio-psoas tendon release is a well-known procedure, loss of flexion strength in the hip can be significant and may not be suited for the young sports-active patient, open tendon lengthening is a good option but may be insufficient and snapping symptoms may not be fully relieved. We present an endoscopic technique which is safe and reproducible and seems to be effective in the treatment of the symptoms of the snapping ilio-psoas tendon. Loss of flexion strength was present in all cases and recovered to a functional level in 8 weeks. Longer follow-up and larger series are needed to fully evaluate this procedure.

Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip.

Anterior hip snapping is a rare clinical observation. The physiopathological hypothesis currently held is a sudden slip of the iliopsoas tendon over the iliopectineal eminence. For symptomatic cases, a surgical technique is proposed. The aim of this work is to describe the anatomy of the femoral portion of the iliopsoas, which is the target of surgery. We have studied, through dissection of embalmed cadavers, the different components of the musculotendinous complex forming the femoral portion of the muscle and the gliding apparatus associated with it. The psoas major tendon exhibited a characteristic rotation. The iliacus tendon, more lateral, received the most medial iliacus muscular fibers, then fused with the main tendon. The most lateral fibers, starting in particular from the ventral portion of the iliac crest, ended up without any tendon on the anterior surface of the lesser trochanter and in the infratrochanteric region. The most inferior muscular fibers of the iliacus, starting from the arcuate line, joined the principal tendon of the psoas major passing around it by its ventromedial surface. An ilio-infratrochanteric muscular bundle was observed, in a deeper position, under the iliopsoas tendon; it arose from the interspinous incisure and on the anterior inferior iliac spine, ran along the anterolateral edge of the iliacus and inserted without any tendon onto the anterior surface of the lesser trochanter of the femur and in the infratrochanteric area. The iliopectineal bursa was studied on horizontal cross sections of a frozen pelvis and on 5 of the non-frozen preparations after dividing the iliopsoas tendon. The iliopectineal bursa had the shape of a 5 to 6-cm high and 3-cm wide cavity; in its upper part, it was divided into 2 compartments: a medial compartment for the main tendon and a lateral compartment for the accessory tendon.

The function of the psoas major muscle: passive kinetics and morphological studies using donated cadavers

This study was carried out to analyze the phasic heterogeneity in the function of the psoas major muscle (PMM) depending on the flexion angle at the hip joint. The study design was a passive kinetic experiment using 25 osteoligamentous specimens with the PMM tendon. We measured the flexion angle of the hip joint where the PMM tendon loses contact with the femoral head and pelvic surface. Ten osteoligamentous specimens were used for additional measurements of the tensile force and pressure exerted on the PMM and/or at the bone-tendon interface when the PMM tendon was gently pulled in line with the PMM origin in the supine position. The tension loading the PMM tendon was measured at seven different angled positions of hip joint flexion (0°, 15°, 30°, 45°, 60°, 75°, and 90°), using a load cell attached to a traction appliance. The pressure was measured at each of eight sites along the long axis of the PMM, using a pressure sensor. The PMM tendon lost contact with the femoral head at angled positions of 14° (average) hip flexion, and lost contact with the iliopectineal eminence at positions of 54° (average). The tension was stronger at angled positions of 0°–30° at the hip joint. The pressure on the femoral head and pelvic surface were stronger at positions of 0°–30° at the hip joint. The pressure on the femoral head was strongest at a hip flexion of 0°. The tensile force markedly decreased at 45°–60° flexion at the hip joint, while the pressure on the femoral head gradually reduced to zero in the same phases. We concluded that the PMM works phasically: (1) as an erector of the lumbar vertebral column, as well as a stabilizer of the femoral head in the acetabulum at 0°–15° flexion at the hip joint; (2) less as a stabilizer, in contrast to maintaining its erector action, at 15°–45°; and (3) as an effective flexor of the lower extremity, at 45°–60°.

The incidence of protrusio acetabuli in Marfan's syndrome and its relationship to bone mineral density.

Twenty-one patients with Marfan's syndrome participated in a study to assess the incidence of and radiographic measurements significant for protrusio acetabuli. Our data show that the incidence of protrusio acetabuli in Marfan's syndrome is 31%. The most sensitive radiographic parameter to determine protrusio acetabuli is crossing of the acetabular line by the iliopectineal line. The presence of protrusio in Marfan's syndrome was not related to the bone mineral content of the hip and pelvis. Protrusio acetabuli in Marfan syndrome's also did not correlate with clinical symptoms. Based on our results, the presence of protrusio acetabuli alone is not an indication for early surgical intervention.

空手選手に発生した比較的稀な内側型弾発股の１例

The external variety of snapping hip is well known, but the internal variety is rare and poorly understood. We experienced a case of an internal variety of snapping hip in a young KARATE athlete. Iliopsoas bursography demonstrated that an iliopsoas tendon jerk on the iliopectineal eminence or the anterior capsule of the femoral head. It was effectively treated by partial release of the iliopsoas tendon.

Multivariate analysis of the sexual dimorphism of the hip bone in a modern human population and in early hominids

A large sample of hip bones of known sex coming from one modern population is studied morphologically and by multivariate analysis to investigate sexual dimorphism patterns. A principal component analysis of raw data shows that a large amount of the hip bone sexual dimorphism is accounted for by size differences, but that sex-linked shape variation is also very conspicuous and cannot be considered an allometric consequence of differences in body size between the sexes. The PCA of transformed ("shape") variables indicates that the female hip bones are different in those traits associated with a relatively larger pelvic inlet (longer pubic bones, a greater degree of curvature of the iliopectineal line, and more posterior position of the auricular surface), as well as a broader sciatic notch. The analysis of nonmetric traits also shows marked sexual dimorphism in the position of the sacroiliac joint in the iliac bone, in the shape of the sciatic notch, in pubic morphology, and in the presence of the pre-auricular sulcus in females. When the australopithecine AL 288-1 and Sts 14 hip bones are included in the multivariate analysis, they appear as "ultra-females." In particular these early hominids exhibit extraordinarily long pubic bones and iliopectineal lines, which cannot be explained by allometry.

Surgical correction of the snapping iliopsoas tendon

Eighteen patients with 20 symptomatic hips underwent lengthening of the iliopsoas tendon for persistent painful snapping of this "internal" variety of snapping hip. We referred to the pathologic, painful snapping of the iliopsoas in the deep anterior groin as the "internal" snapping hip. This is in contrast to the more common and better-known "external" snapping that involves the greater trochanter and its overlying soft tissues. The results of our iliopsoas lengthening procedure are presented here. Lengthening of the iliopsoas tendon was accomplished by step cutting of the tendinous portion of the iliopsoas. The pathoanatomy of this poorly understood symptom complex was described in 1984 paper from this institution and is reviewed here. Iliopsoas bursography demonstrated a sudden jerking movement of the iliopsoas tendon between the anterior inferior iliac spine and iliopectineal eminence, synchronous with the patient's pain and often accompanied by an audible snap. The average preoperative duration of symptoms was 2.9 years, and the average length of postoperative followup was 25 months. All patients, except one, had a marked reduction in the frequency of snapping after tendon lengthening, and 14 of 20 hips had no snapping postoperatively. Of the six patients who had recurrence of snapping, all but one stated that this occurred much less frequently and was much less painful compared to the preoperative state. Two hips required reoperation. Postoperatively, only three patients complained of subjective weakness, and most patients were unlimited in physical activity with return to activities such as competitive football, pole vaulting, and long-distance running.(ABSTRACT TRUNCATED AT 250 WORDS)

The snapping hip syndrome.

The snapping hip syndrome is a symptom complex characterized by hip pain and an audible snapping of the hip with exercise typically seen in young individuals. "External" and "internal" etiologies have been described, although the "internal" etiology is poorly understood. A clinical, radiographic, and anatomical study of eight patients with this disorder, secondary to an internal etiology, was undertaken to aid in the diagnosis and surgical treatment. Iliopsoas bursography with cineradiography revealed subluxation of the iliopsoas tendon to be an apparent cause of the snapping hip. The anatomy of the hip in relationship to the iliopsoas tendon is defined with the anterior inferior iliac spine, iliopectineal eminence, and lesser trochanter assuming a significant role in the syndrome. An operative approach involving a partial release and lengthening of the iliopsoas tendon, with minimal resection of a lesser trochanteric bony ridge, if involved, is described.

The Snapping Iliopsoas Tendon

Herein we describe a previously seldom recognized variety of snapping hip, which is caused by snapping of the iliopsoas tendon over the iliopectineal eminence when the femur is moved from the flexed position at the hip and extended through 45 degrees of flexion. The finding is demonstrated with the patient supine and gently resisting gravity with the iliopsoas muscle, thus placing it under tension. At approximately 45 degrees of flexion, the iliopsoas tendon in two patients was confirmed radiographically to snap abruptly, coincident with an audible sound over the iliopectineal eminence of the pelvis. We believe that this occurs relatively frequently and is generally asymptomatic.

Calcification in Cooper's ligament.

CALCIFICATION IN COOPER’S LIGAMENTJOHN R. STEINFELD, M.D., K. E. SCHUIT, PH.D. and THEODORE E. KEATS, M.D.Audio Available | Share

Successful Treatment of Umbilical Hernia in a Dog by Ligature

The aim of this study was to evaluate the transposition distance in in vitro canine medial patellar luxation (MPL) models of different severity grades using a single radiograph of the stifle joint. Each MPL grade model was generated with manipulation and evaluated by palpating the stability of the patella. An anterior-posterior radiograph of the entire hind limb with extended hip and stifle joints, including the iliopubic eminence, was used for all measurements. The quadriceps angles and the percentage of the transposition distance to the maximum width of the proximal tibia were measured. Our results demonstrated that when the tibial tuberosity transposition procedure is performed in a clinical setting, the required distance to correct the abnormal direction of the extensor mechanism in the canine stifle joint was greater in severe grade MPL than in mild grade MPL.