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Hwang A, Martinez M, Cora Jones CM, Giordano B. Multifid Iliopsoas Tendons Are More Common in Patients With Painful Snapping Iliopsoas Tendons. Arthrosc Sports Med Rehabil 2023; 5:100780. [PMID: 37546385 PMCID: PMC10400859 DOI: 10.1016/j.asmr.2023.100780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/16/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose To retrospectively determine the prevalence of multifid tendons in a population of patients who underwent iliopsoas release for painful snapping iliopsoas tendons. Methods Patients who underwent iliopsoas release for painful snapping iliopsoas tendons were retrospectively identified from a database of patients who had undergone arthroscopic hip surgery performed by a single surgeon between 2011 and 2020. Patients who had incomplete data or who underwent prior fracture fixation, joint arthroplasty, pelvic surgery, or other interventions for snapping hip were excluded. Magnetic resonance imaging (MRI) and operative reports were reviewed and compared with those of an age-matched control group of patients who had undergone hip or pelvic MRI examinations in the past year for different indications. Results This study included 91 patients (78 female and 13 male patients; mean age, 23.3 years) who were treated operatively for painful snapping hip and 78 controls (54 female and 24 male patients; mean age, 28.4 years) who received hip or pelvic MRI for other indications. Among the patients who underwent iliopsoas release, there were 5 unifid iliopsoas tendons (5.5%) compared with 86 multifid iliopsoas tendons (94.5%) when classified with MRI whereas operative examination showed 19 unifid tendons (20.9%) compared with 72 multifid tendons (79.1%, P < .001). When the MRI scans of the operative group were compared with the MRI scans of the control group, the patients who underwent surgery for painful snapping hip had a higher rate of multifid tendons (94.5% of operative hips compared with 69.2% of control right hips [P < .001] and 74.4% of control left hips [P < .001]). However, when the operative reports were used to classify the iliopsoas tendon, there was no significance between the operative and control groups (79.1% of operative hips had multifid tendons compared with 69.2% of control right hips [P = .141] and 74.4% of control left hips [P = .464]). Conclusions For patients with symptomatic snapping hip undergoing iliopsoas lengthening, multifid iliopsoas tendons are more prevalent than in a control population. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Alan Hwang
- Address correspondence to Alan Hwang, M.D., Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, U.S.A.
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Sugrañes J, Jackson GR, Warrier AA, Allahabadi S, Chahla J. Snapping Hip Syndrome: Pathoanatomy, Diagnosis, Nonoperative Therapy, and Current Concepts in Operative Management. JBJS Rev 2023; 11:01874474-202306000-00004. [PMID: 37289915 DOI: 10.2106/jbjs.rvw.23.00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
» Asymptomatic snapping hip affects 5% to 10% of the population; when pain becomes the primary symptom, it is classified as snapping hip syndrome (SHS).» The snap can be felt on the lateral side of the hip (external snapping hip), often attributed to an iliotibial band interaction with the greater trochanter, or on the medial side (internal snapping hip), often attributed to the iliopsoas tendon snapping on the lesser trochanter.» History and physical examination maneuvers can help distinguish the etiology, and imaging may help confirm diagnosis and rule out other pathologies.» A nonoperative strategy is used initially; in the event of failure, several surgical procedures are discussed in this review along with their pertinent analyses and key points.» Both open and arthroscopic procedures are based on the lengthening of the snapping structures. While open and endoscopic procedures both treat external SHS, endoscopic procedures typically have lower complication rates and better outcomes when treating internal SHS. This distinction does not appear to be as noticeable in the external SHS.
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Affiliation(s)
- Joan Sugrañes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- Department of Orthopaedic Surgery, Hospital de La Santa Creu I Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Alec A Warrier
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Sachin Allahabadi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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3
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Coulomb R, Nougarede B, Maury E, Marchand P, Mares O, Kouyoumdjian P. Arthroscopic iliopsoas tenotomies: a systematic review of surgical technique and outcomes. Hip Int 2022; 32:4-11. [PMID: 33226846 DOI: 10.1177/1120700020970519] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the technique, results and complications of arthroscopic iliopsoas tenotomies either on native hips or total hip arthroplasty (THA). METHODS A systematic review was performed using 3 databases: PubMed, EMBASE and the Cochrane library from January 2000 to December 2018 in accordance with the PRISMA procedure. The literature search, data extraction and quality assessment were conducted by 2 independent reviewers. Surgical technique, clinical outcomes, recurrences and complication rate were evaluated. RESULTS Out of 115 articles reviewed, 20 articles concerned native hips and 8 articles THA. 3 levels of release were described. For native hips, the recurrence rate was higher for central compartment than peripheral or lesser trochanter releases. Complication rates were similar for hip arthroscopy but remained low in all series. Loss of strength was evaluated mainly using the MRC muscle scale. Most studies noted strength recovery. MRI analysis of muscle atrophy was greater for lesser trochanter than for central compartment release but unrelated to loss of strength. The complication rate was low for tenotomy after THA, heterotopic ossification being the most common complication. CONCLUSIONS Central compartment releases lead to the highest rate of recurrence due to incomplete release. Peripheral releases have a potential risk of vascular injury. The lesser trochanteric approach has the disadvantage of not having direct access to the joint. The main difficulty with THA lies in the diagnosis of cup/iliopsoas impingement. Diagnostic tests with infiltration should be made before iliopsoas release to prevent its failure. Cup protrusion of over 8mm is a potential indication for acetabular revision.
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Affiliation(s)
- Remy Coulomb
- Nîmes University Hospital (CHU Nimes), Nîmes, France
| | | | - Etienne Maury
- Nîmes University Hospital (CHU Nimes), Nîmes, France
| | | | - Olivier Mares
- Nîmes University Hospital (CHU Nimes), Nîmes, France
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4
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Longstaffe R, Hendrikx S, Naudie D, Willits K, Degen RM. Iliopsoas Release: A Systematic Review of Clinical Efficacy and Associated Complications. Clin J Sport Med 2021; 31:522-529. [PMID: 32032164 DOI: 10.1097/jsm.0000000000000784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/10/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To perform a systematic review of the findings of iliopsoas release as it relates to resolution of snapping, improvement of groin pain, and associated complications. DESIGN Systematic review. DATA SOURCES Four electronic databases PubMed/MEDLINE, EMBASE, CINAHL, and Web of Science were searched, identifying all literature pertaining to surgical treatment of a snapping hip/coxa saltans, iliopsoas impingement, or iliopsoas tendinitis. A total of 818 studies were identified. Two reviewers independently screened the titles, abstracts, and full-text articles for eligibility. ELIGIBILITY CRITERIA All studies published in English that reported on iliopsoas release for snapping hip/coxa saltans, iliopsoas impingement, or iliopsoas tendinitis reporting outcomes or associated complications were eligible. RESULTS A total of 48 articles were included in this review. Three surgical indications were identified for iliopsoas release, internal snapping hip, labral tear secondary to iliopsoas impingement, and iliopsoas tendinopathy after total hip arthroplasty. Arthroscopic techniques seemed to be superior to open techniques with regards to reoccurrence of snapping (5.1% vs 21.7%) and groin pain relief (89.1% vs 85.6%) with fewer complications (4.2% vs 21.1%) overall. CONCLUSIONS Both open and arthroscopic iliopsoas releases have been shown to be successful treatment options regardless of the surgical indications identified in this review. Arthroscopic release demonstrated a decreased failure rate, fewer complications, and improved outcomes when compared with open procedures.
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Affiliation(s)
- Robert Longstaffe
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, London, ON, Canada
| | - Shawn Hendrikx
- Western Libraries, Western University, London, ON, Canada ; and
| | - Douglas Naudie
- University Hospital, London Health Sciences Centre, Department of Surgery, London, ON, Canada
| | - Kevin Willits
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, London, ON, Canada
| | - Ryan M Degen
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, London, ON, Canada
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5
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Maldonado DR, Diulus SC, Annin S, Shapira J, Rosinsky PJ, Kyin C, Lall AC, Domb BG. Borderline Dysplastic Female Patients With Painful Internal Snapping Improve Clinical Outcomes At Minimum 2-Year Follow-Up Following Hip Arthroscopy With Femoroplasty, Labral Repair, Iliopsoas Fractional Lengthening, and Capsular Plication: A Propensity-Matched Controlled Comparison. Arthroscopy 2021; 37:2473-2484. [PMID: 33771688 DOI: 10.1016/j.arthro.2021.03.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSES To report minimum 2-year follow-up patient-reported outcome scores (PROs) in borderline dysplastic female patients who underwent primary hip arthroscopy with femoroplasty, labral repair, iliopsoas fractional lengthening, and plication of the capsule (FLIP procedure) for cam-type femoroacetabular impingement syndrome (FAIS), labral tear, and painful internal snapping and to compare these PROs to a propensity-matched borderline dysplastic control group without painful internal snapping. METHODS Data were retrospectively reviewed for patients who underwent primary hip arthroscopy for cam-type FAIS and labral tear between September 2008 and May 2017. Females with borderline dysplasia (lateral center-edge angle of ≥18° to ≤25°) and painful internal snapping, who underwent the FLIP procedure, with minimum 2-year PROs for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, patient satisfaction, and visual analog scale (VAS) for pain were included. The group was matched 1:1 to a control group without painful internal snapping for age, sex, body-mass index (BMI), and surgical procedures. The minimal clinically important difference (MCID) was calculated. P-value was set at .05. RESULTS Seventy-four hips were included. The mean was 26.82 ± 10.49 years and 23.62 ± 4.56 kg/m2 for age and BMI, respectively. Improvement was reported for all PROs and VAS (P < .0001). Twenty-nine patients were matched. At minimum 2-year follow-up, the FLIP procedure demonstrated comparable improvement in PROs and rate of achievement of MCID to the control group. CONCLUSION After primary hip arthroscopy and FLIP procedure, females with borderline dysplasia and painful internal snapping demonstrated significant improvement in PROs at minimum 2 years' follow-up. When compared to a propensity-matched control group without painful internal snapping, the improvement between groups was comparable. LEVEL OF EVIDENCE III; Case-Control study.
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Affiliation(s)
| | | | - Shawn Annin
- American Hip Institute Research Foundation, Chicago
| | | | | | - Cynthia Kyin
- American Hip Institute Research Foundation, Chicago
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago; American Hip Institute, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute, Chicago; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A..
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6
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Matsuda D, Kivlan BR, Nho SJ, Wolff AB, Salvo JP, Christoforetti JJ, Martin RL, Carreira DS. Tenotomy for Iliopsoas Pathology is Infrequently Performed and Associated with Poorer Outcomes in Hips Undergoing Arthroscopy for Femoroacetabular Impingement. Arthroscopy 2021; 37:2140-2148. [PMID: 33631254 DOI: 10.1016/j.arthro.2021.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this article was to report prevalence of iliopsoas pathology in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI), incidence of rendered tenotomy, and outcomes of hips with iliopsoas involvement compared with those with primary FAI. METHODS A cohort study from a hip arthroscopy study group using a prospectively-collected multicenter database was performed. Patients who underwent isolated hip arthroscopy for FAI from January 2016 to March 2017 were assigned to the Iliopsoas group (defined as preoperative diagnosis of coxa saltans internus, intraoperative anteroinferior labral bruising or tear, and preoperative positive psoas injection) or control group. The prevalence of iliopsoas pathology, radiographic and intraoperative findings, and rendered procedures between groups were compared. Mean 2-year (minimum 1.8 year) outcomes of iliopsoas groups with and without rendered tenotomy and a control group were compared. RESULTS There were 1393 subjects, of which 92 (7%) comprised the iliopsoas study group with 1301 subjects control subjects. Sixteen subjects in the iliopsoas group received tenotomy (17% of iliopsoas group, 1% of all subjects), whereas 76 subjects (83% of iliopsoas group) with iliopsoas involvement did not. There was significant effect on postoperative International Hip Outcome Tool-12 (iHOT-12) scores based on iliopsoas involvement and treatment, F(2,1390) = 3.74, P = .02. Compared with the control group (M = 73, standard deviation [SD] = 24), the non-tenotomized iliopsoas group (M = 69, SD = 32) had similar postoperative scores (P = .46), whereas the tenotomized iliopsoas group (M = 57, SD = 28) averaged lower postoperative scores (P = .03). In the tenotomy group, 25% achieved the iHOT-12 substantial clinical benefit and patient acceptable symptomatic state value for normal function and 100% satisfaction, compared to 49% and 41% for the without tenotomy and control groups. CONCLUSIONS Tenotomy in patients with iliopsoas pathology undergoing arthroscopic surgery for FAI is infrequently performed and is associated with poorer outcomes. Co-afflicted patients treated without tenotomy have similar successful outcomes to patients with primary FAI. Indiscriminate tenotomy for iliopsoas pathology in this setting should be cautiously considered. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Dean Matsuda
- Premier Hip Arthroscopy, Marina del Rey, California.
| | - Benjamin R Kivlan
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania
| | - Shane J Nho
- Department of Orthopedic Surgery, Division of Sports Medicine, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois
| | - Andrew B Wolff
- Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, District of Columbia
| | - John P Salvo
- Rothman Institute, Philadelphia, Pennsylvania; Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - John J Christoforetti
- Center for Athletic Hip Injury, Allegheny Health Network, Pittsburgh, Pennsylvania; Department of Orthopaedic Surgery, Drexel University School of Medicine, Pittsburgh, Pennsylvania
| | - RobRoy L Martin
- American Hip Institute, Pittsburgh, Pennsylvania; Department of Physical Therapy, Rangos School of Health Sciences, Pittsburgh, Pennsylvania
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7
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Christopher ZK, Hassebrock JD, Anastasi MB, Economopoulos KJ. Hip Flexor Injuries in the Athlete. Clin Sports Med 2021; 40:301-310. [PMID: 33673888 DOI: 10.1016/j.csm.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Athletic injuries to the hip flexors and iliopsoas have been described in populations across all levels of competitive sports. Overall estimates of hip flexor pathology have ranged from 5% to 28% of injuries among high-risk sport specific groups. Although most of these injuries are successfully treated with conservative management, and high rates of return to play are observed, significant rehabilitation time can be involved. As the understanding of hip pathology with imaging modalities such as MRI has advanced, greater importance has been placed on accurately diagnosing hip flexor injuries and initiating rehabilitation protocols early to minimize time loss from sport.
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Affiliation(s)
- Zachary K Christopher
- Mayo Clinic Arizona, Orthopedics, Sports Medicine Department, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Jeffrey D Hassebrock
- Mayo Clinic Arizona, Orthopedics, Sports Medicine Department, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Matthew B Anastasi
- Mayo Clinic Arizona, Orthopedics, Sports Medicine Department, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Kostas J Economopoulos
- Mayo Clinic Arizona, Orthopedics, Sports Medicine Department, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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8
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Gómez-Hoyos J, Márquez WH, Gallo JA, Khoury A, Bernal-Sierra S, Martin HD. Iliopsoas Muscle/Tendon Proportions at Three Levels of Described Arthroscopic Tenotomy: An Anatomic Study in Fresh Cadaveric Specimens. Arthrosc Sports Med Rehabil 2020; 3:e297-e303. [PMID: 34027435 PMCID: PMC8129034 DOI: 10.1016/j.asmr.2020.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/21/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To calculate the iliopsoas muscle/tendon ratio at 3 levels of arthroscopic iliopsoas tenotomy sites in fresh cadaveric specimens. Methods An anatomic study design was performed using 16 iliopsoas musculotendinous units from the level of the hip joint to their insertion on the lesser trochanter. All specimens came from 16 fresh cadaveric specimens (10 male, 6 female), with a median age of 41 years (range 31-55.25 years). Circumferential measurements of the composite musculotendinous unit and the iliopsoas tendon were then made at the lesser trochanter insertion, the site of transcapsular tenotomy, and the site of tenotomy at the level of the labrum. Anatomical variance of the iliopsoas tendon at the insertion on the lesser trochanter and muscular extension below the lesser trochanter level also were described. The difference between the median circumference of the iliopsoas musculotendinous units or the isolated tendons at the 3 levels was calculated. Results The median circumference of the iliopsoas musculotendinous unit at the level of the labrum, orbicularis zone (transcapsular tenotomy site), and the lesser trochanter was 140.9 mm (range 137.9-148.9), 136.7 mm (range 132.9-140), and 99.5 mm (range 96.5-104.8), respectively. The median circumference of the iliopsoas tendon at these same levels was 25.6 mm (range 22.7-33.7), 28.9 mm (range 25.1-32.2), and 30.9 mm (range 27.9-36.1), respectively. Accordingly, the proportions of the iliopsoas muscle/tendon at the level of the labrum, the transcapsular tenotomy site, and the lesser trochanter insertion were 18% tendon/82% muscle, 21% tendon/79% muscle, and 31% tendon/69% muscle, respectively. Conclusions The proportions of the iliopsoas muscle/tendon at the level of the labrum, the transcapsular tenotomy site and the lesser trochanter insertion were 18% tendon/82% muscle, 21% tendon/79% muscle, and 31% tendon/69% muscle, respectively. The distal muscular projection below the tendinous insertion on the lesser trochanter may maintain the functional connection of the iliopsoas between origin and insertion even after releasing the tendon. Clinical relevance This finding may have implications for a new understanding of arthroscopic tenotomy of the iliopsoas around the hip, as previously described muscle/tendon proportions were not calculated in fresh cadavers.
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Affiliation(s)
- Juan Gómez-Hoyos
- Hip Preservation Center, Baylor Scott and White Research Institute, Dallas, Texas, U.S.A.,Orthopaedic Unit, Clínica del Campestre/Clínica Las Américas, Antioquia, Colombia.,School of Medicine, University of Antioquia, Antioquia, Colombia
| | - William H Márquez
- Orthopaedic Unit, Clínica del Campestre/Clínica Las Américas, Antioquia, Colombia.,School of Medicine, University of Antioquia, Antioquia, Colombia
| | - Jaime A Gallo
- School of Medicine, University of Antioquia, Antioquia, Colombia
| | - Antony Khoury
- Hip Preservation Center, Baylor Scott and White Research Institute, Dallas, Texas, U.S.A.,Department of Bioengineering, University of Texas Arlington, Arlington, Texas, U.S.A
| | | | - Hal D Martin
- Hip Preservation Center, Baylor Scott and White Research Institute, Dallas, Texas, U.S.A
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Meghpara MB, Bheem R, Diulus SC, Rosinsky PJ, Shapira J, Maldonado DR, Lall AC, Domb BG. An Iliopsoas Impingement Lesion in the Absence of Painful Internal Snapping May Not Require Iliopsoas Fractional Lengthening. Am J Sports Med 2020; 48:2747-2754. [PMID: 32776856 DOI: 10.1177/0363546520944147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Iliopsoas impingement (IPI) has been associated with a distinct lesion on the anterior labrum. Iliopsoas fractional lengthening (IFL) can treat IPI in instances of painful internal snapping (PIS) and mechanical groin pain. PURPOSE To report minimum 2-year outcomes of patients without PIS who had an IPI lesion diagnosed intraoperatively that did not undergo IFL (+IPI -PIS -IFL) as compared with a matched group of patients with PIS and an IPI lesion that was treated with IFL (+IPI +PIS +IFL). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data on all patients who underwent primary hip arthroscopy between May 2009 and June 2017 were retrospectively reviewed. Patients were included if they underwent hip arthroscopy for femoroacetabular impingement-related pathology, an IPI lesion was diagnosed intraoperatively, and they had minimum 2-year postoperative scores for the following: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), iHOT-12 (International Hip Outcome Tool-12), patient satisfaction, and visual analog score (VAS) for pain. Patients were propensity score matched based on the following criteria: age, body mass index, follow-up time, sex, labral treatment, femoroplasty, and acetabuloplasty. RESULTS A total of 412 hips were eligible for the current study, of which 336 (81.6%) had 2-year follow-up. The matching process established 37 hips in the +IPI -PIS -IFL group and 87 hips in the +IPI +PIS +IFL group. Both groups experienced significant improvements from presurgery to latest follow-up for all recorded patient-reported outcomes (PROs). The +IPI -PIS -IFL group compared favorably with the +IPI +PIS +IFL group for mHHS (86.0 vs 86.1; P = .53), NAHS (83.0 vs 84.7; P = .40), and HOS-SSS (78.1 vs 76.5; P = .87). Additionally, iHOT-12, VAS, patient satisfaction, and rates of achieving the minimal clinically important difference for mHHS, NAHS, and HOS-SSS were similar between groups at the latest follow-up. CONCLUSION Patients without PIS who were diagnosed with an IPI lesion intraoperatively and did not undergo IFL had similar and favorable improvements in PROs, VAS, and satisfaction to a matched cohort with PIS who had IFL performed. Thus, an IPI lesion in the absence of PIS may not require IFL.
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Affiliation(s)
- Mitchell B Meghpara
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | - Rishika Bheem
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Samantha C Diulus
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Philip J Rosinsky
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Des Plaines, Illinois, USA.,American Hip Institute, Des Plaines, Illinois, USA
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10
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Chen AW, Steffes MJ, Laseter JR, Maldonado DR, Ortiz-Declet V, Perets I, Domb BG. How has arthroscopic management of the iliopsoas evolved, and why? A survey of high-volume arthroscopic hip surgeons. J Hip Preserv Surg 2020; 7:322-328. [PMID: 33163218 PMCID: PMC7605777 DOI: 10.1093/jhps/hnaa023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/07/2020] [Accepted: 04/18/2020] [Indexed: 12/02/2022] Open
Abstract
The rapid growth of hip preservation has left surgeons following trends based on limited, or even anecdotal, evidence in certain circumstances. A consensus as well as high-level research on how best to manage the iliopsoas is lacking. Arthroscopic treatment of the iliopsoas may be an example of how treatment patterns and trends can shift with limited evidence-based medicine. A cross-sectional survey of 16 high-volume hip preservation surgeons was conducted to gather perspectives and opinions on how and why the arthroscopic management of the iliopsoas has evolved. All participants completed the survey in person and anonymously. Of the surveyed surgeons, the mean career hip preservation volume was 1031.25 cases (250 to >3000) with an average annual volume of 162.08 cases (75–400). Of the surveyed surgeons’ caseload, 16.1% involved an iliopsoas tenotomy or fractional lengthening mostly commonly (75%) for recalcitrant internal snapping. Labral repair/reconstruction is performed concomitantly 87.5% of the time. Seventy-five percent of surgeons indicated a decrease in frequency of iliopsoas tenotomy over the course of their practice most commonly (56.3%) because of hip flexion weakness; however, 0% of the surgeons could cite literature evidence to support their practices. Perceived poor outcomes in individual practices was the most common (56.3%) source of this complication. Surgeons were less inclined to perform tenotomy on patients with borderline dysplasia (75%) or ligamentous laxity (56.3%).
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Affiliation(s)
- Austin W Chen
- Boulder Centre for Orthopaedics, 4740 Pearl Pkwy #200A, Boulder, CO 80301, USA
| | - Matthew J Steffes
- University of Illinois at Chicago, 1200 W Harrison St., Chicago, IL 60607, USA
| | - Joseph R Laseter
- Case Western Reserve University, 9501 Euclid Ave, Cleveland, OH 44106, USA
| | - David R Maldonado
- American Hip Institute Research Foundation, 999 E Touhy Ave. Ste. 450, Des Plaines, IL 66018, USA
| | | | - Itay Perets
- Hasassah Hebrew University Hospital, Jersalem, Israel
| | - Benjamin G Domb
- American Hip Institute Research Foundation, 999 E Touhy Ave. Ste. 450, Des Plaines, IL 66018, USA
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11
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Johnson WO, Sellon JL, Moore BJ, Levy BA, Lachman N, Finnoff JT. Ultrasound-Guided Iliopsoas Tendon Release: A Cadaveric Investigation. PM R 2020; 13:397-404. [PMID: 32506581 DOI: 10.1002/pmrj.12430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The iliopsoas is a common source of anterior hip pain. Refractory cases may require surgical intervention, with reported complication rates ranging from 3% to 50%. Development of a minimally invasive, outpatient method of iliopsoas tendon release is desirable and may reduce costs, lower complications, and improve recovery time. OBJECTIVE To describe and evaluate the safety and reproducibility of an ultrasound-guided (USG) iliopsoas tendon release using a spinal needle in a cadaveric model. DESIGN Prospective, cadaveric laboratory investigation. SETTING Academic Institution Procedural Skills Laboratory. PARTICIPANTS Five unembalmed cadaveric specimens (three female, two male), 69 to 93 years of age (mean 83.2 years), with a mean body mass index (BMI) of 24.5 kg/m2 (range 19.2 to 30.3 kg/m2 ). INTERVENTIONS Two operators each performed five USG iliopsoas tendon releases. Three additional investigators dissected the pelves to assess completeness of tendon release and damage to adjacent structures. MAIN OUTCOME MEASURES Successful transection, completeness (%) of the tendon transection, damage to adjacent structures, and procedural time. RESULTS Nine of 10 releases achieved the target release of ≥75% tendon transection. One procedure achieved 50% tendon release. No injury to adjacent structures was identified. The mean duration of the procedure was 6.19 minutes. CONCLUSIONS USG iliopsoas tendon release can be performed in a cadaveric model, consistently achieve the desired percentage of tendon release, does not result in injury to adjacent neurovascular structures, and takes approximately 6 minutes to perform. Although results cannot be generalized to a clinical setting, due to the minimally invasive nature of the procedure, it is likely that this procedure can be performed safely in an outpatient setting under local anesthesia, will cost less, and will facilitate a more rapid recovery when compared to standard surgical procedures. Further research is warranted for clinical application.
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Affiliation(s)
- Wade O Johnson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic Health System, Mankato, MN
| | - Jacob L Sellon
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Brittany J Moore
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Nirusha Lachman
- Department of Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Rochester, MN
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Audenaert EA, Khanduja V, Claes P, Malviya A, Steenackers G. Mechanics of Psoas Tendon Snapping. A Virtual Population Study. Front Bioeng Biotechnol 2020; 8:264. [PMID: 32292780 PMCID: PMC7118580 DOI: 10.3389/fbioe.2020.00264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/13/2020] [Indexed: 12/24/2022] Open
Abstract
Internal snapping of the psoas tendon is a frequently reported condition, especially in young adolescents involved in sports. It is defined as an increased tendon excursion over bony or soft tissue prominence causing local irritation and inflammation of the tendon leading to groin pain and often is accompanied by an audible snap. Due to the lack of detailed dynamic visualization means, the exact mechanism of the condition remains poorly understood and different theories have been postulated related to the etiology and its location about the hip. In the present study we simulated psoas tendon behavior in a virtual population of 40,000 anatomies and compared tendon movement during combined abduction, flexion and external rotation and back to neutral extension and adduction. At risk phenotyopes for tendon snapping were defined as the morphologies presenting with excess tendon movement. There were little differences in tendon movement between the male and female models. In both populations, abnormal tendon excursion correlated with changes in mainly the femoral anatomy (male r = 0.72, p < 0.001, female r = 0.66, p < 0.001): increased anteversion and valgus as well as a decreasing femoral offset and ischiofemoral distance. The observed combination of shape components correlating with excess tendon movement in essence presented with a medial positioning of the minor trochanter. This finding suggest that psoas snapping and ischiofemoral impingement are possibly two presentations of a similar underlying rotational dysplasia of the femur.
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Affiliation(s)
- Emmanuel A Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom.,Op3Mech Research Group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Vikas Khanduja
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Peter Claes
- Medical Imaging Research Center (MIRC), University Hospitals Leuven, Leuven, Belgium.,Department of Electrical Engineering/Processing Speech and Images, KU Leuven, Leuven, Belgium.,Department of Human Genetics, KU Leuven, Leuven, Belgium.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Ajay Malviya
- Department of Orthopedic Surgery and Traumatology, Northumbria National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom.,Department of Regenerative Medicine, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gunther Steenackers
- Op3Mech Research Group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
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13
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Bakhsh W, Childs S, Kenney R, Schiffman S, Giordano B. Iliopsoas snapping hip: improving the diagnostic value of magnetic resonance imaging with a novel parameter. Skeletal Radiol 2019; 48:889-896. [PMID: 30280202 DOI: 10.1007/s00256-018-3083-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/08/2018] [Accepted: 09/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To illustrate an advanced imaging parameter that describes the course of the iliopsoas tendon, and evaluate its correlations with iliopsoas internal hip snapping syndrome. METHODS This retrospective cohort study reviewed hip MRI images of all patients seen by a single surgeon between January 2015 and March 2016. The comparison group included all patients with clinical internal hip snapping, versus the control group that did not. MRI images were processed using minimum intensity projection. Measurements obtained of the pelvis and course of the iliopsoas tendon included: pelvic incidence, coronal angle, and sagittal opening angle (SOA). Comparison of measurements between the groups was performed with Mann-Whitney U analysis and receiver operator curve (ROC) plotting, with a significance cutoff of p = 0.05. RESULTS The control group (n = 85) and comparison group (n = 48) demonstrated no difference in age or gender. Pelvic incidence was similar [51.3 (± 10.7) degrees control versus 52.2 (± 7.7) degrees comparison (p = 0.36)], as was coronal angle [13.9 (± 4.6) degrees control versus 14.8 (±4.8) degrees comparison (p = 0.15)]. There was a significant difference in SOA [137.0 (± 5.9) degrees control versus 141.9 (± 6.5) degrees comparison (p < 0.01)]. ROC analysis revealed SOA threshold of 140 degrees for clinical IP hip snapping (p < 0.01), with odds ratio 5.2 (2.4-11.3) for SOA > 140 degrees. CONCLUSIONS Iliopsoas hip snapping is often part of a more complex disease process. While challenging to diagnose, advanced imaging parameters, like the sagittal opening angle, relate with clinical pathology. The SOA offers diagnostic value, with a threshold of greater than 140 degrees significantly correlating with clinical presentation.
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Affiliation(s)
- Wajeeh Bakhsh
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Sean Childs
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Raymond Kenney
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Scott Schiffman
- Department of Radiology, University of Rochester Medical Center, Rochester, NY, USA
| | - Brian Giordano
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Editorial Commentary: Iliopsoas Fractional Lengthening: Treating a Disease or a Symptom? Arthroscopy 2019; 35:1441-1444. [PMID: 31054723 DOI: 10.1016/j.arthro.2019.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
Arthroscopic iliopsoas fractional lengthening requires careful patient selection, specifically reproducible symptoms, confirmatory physical examination, suggestive imaging findings, and evaluation for microinstability. Resolution of hip snapping is expected in about 80% of cases, but there is a possibility of weakness and pain, presumably from microinstability from the loss of a dynamic anterior hip stabilizer.
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15
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Perets I, Chaharbakhshi EO, Mansor Y, Ashberg LJ, Mu BH, Battaglia MR, Lall AC, Domb BG. Midterm Outcomes of Iliopsoas Fractional Lengthening for Internal Snapping as a Part of Hip Arthroscopy for Femoroacetabular Impingement and Labral Tear: A Matched Control Study. Arthroscopy 2019; 35:1432-1440. [PMID: 31000391 DOI: 10.1016/j.arthro.2018.11.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To report minimum 5-year outcomes and rate of painful snapping resolution for patients who underwent iliopsoas fractional lengthening (IFL) as a part of hip arthroscopy for femoroacetabular impingement (FAI) and labral tear. In addition, to match this group to a group of patients who underwent hip arthroscopy for FAI and labral tear without internal snapping. METHODS Patients were eligible for inclusion if they underwent hip arthroscopy for treatment of FAI and labral tear with concomitant IFL for painful snapping and had preoperative baseline scores for modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Subscale, and visual analog scale for pain. The exclusion criteria for this study were preoperative Tönnis grade >0, active workers' compensation claims, or previous ipsilateral hip conditions. These patients were matched to a control group of patients who did not have snapping or undergo IFL but who otherwise satisfied the same inclusion and exclusion criteria. RESULTS There were 57 eligible cases (80.3% follow-up). Mean follow-up time was 69.3 months (from 60.0 to 91.9). All patient-reported outcomes measures demonstrated statistically significant improvements between preoperative and latest follow-up scores for the following measures (P < .001): modified Harris Hip Score (from 64.3 to 84.9), Nonarthritic Hip Score (from 61.7 to 85.2), Hip Outcome Score-Sports Subscale (from 47.0 to 75.0), and visual analog scale (from 6.5 to 2.2). Mean satisfaction was 8.1 out of 10. Painful snapping was resolved in 80.7% of cases. Ten hips (17.5%) required secondary arthroscopy at a mean of 30.5 months. Three hips (5.3%) required total hip arthroplasty at a mean of 57.5 months. One case (1.8%) had minor postoperative complications. There were no statistically significant differences between the groups in outcomes, complications, and secondary surgeries. CONCLUSIONS IFL as part of hip arthroscopy for treatment of FAI and labral tears demonstrated similar favorable improvement, complication rates, and secondary surgeries, when compared with a control group that did not undergo IFL. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Itay Perets
- American Hip Institute, Westmont, Illinois, U.S.A.; Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Edwin O Chaharbakhshi
- American Hip Institute, Westmont, Illinois, U.S.A.; Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, U.S.A
| | - Yosif Mansor
- Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel
| | | | - Brian H Mu
- American Hip Institute, Westmont, Illinois, U.S.A.; Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, U.S.A
| | | | - Ajay C Lall
- American Hip Institute, Westmont, Illinois, U.S.A
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16
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Chandrasekaran S, Close MR, Walsh JP, Chaharbakhshi EO, Lodhia P, Mohr MR, Domb BG. Arthroscopic Technique for Iliopsoas Fractional Lengthening for Symptomatic Internal Snapping of the Hip, Iliopsoas Impingement Lesion, or Both. Arthrosc Tech 2018; 7:e915-e919. [PMID: 30258772 PMCID: PMC6153307 DOI: 10.1016/j.eats.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 04/25/2018] [Indexed: 02/03/2023] Open
Abstract
Pathology of the iliopsoas may cause painful internal snapping of the hip or labral damage from soft impingement. Favorable outcomes have been reported after arthroscopic release or fractional lengthening of the iliopsoas. In patients with risk factors for instability, restoration of other soft-tissue constraints such as the labrum and capsule should be performed if iliopsoas fractional lengthening is undertaken. The purpose of this article is to detail the step-by-step surgical technique of arthroscopic iliopsoas fractional lengthening, in addition to the indications, pearls, and pitfalls of the technique.
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Affiliation(s)
| | | | | | - Edwin O. Chaharbakhshi
- American Hip Institute, Chicago, Illinois, U.S.A.,Stritch School of Medicine, Chicago, Illinois, U.S.A
| | - Parth Lodhia
- American Hip Institute, Chicago, Illinois, U.S.A
| | | | - Benjamin G. Domb
- American Hip Institute, Chicago, Illinois, U.S.A.,Address correspondence to Benjamin G. Domb, M.D., 1010 Executive Court, Suite 250, Westmont, IL 60559, U.S.A.
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17
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Perets I, Hartigan DE, Chaharbakhshi EO, Ashberg L, Mu B, Domb BG. Clinical Outcomes and Return to Sport in Competitive Athletes Undergoing Arthroscopic Iliopsoas Fractional Lengthening Compared With a Matched Control Group Without Iliopsoas Fractional Lengthening. Arthroscopy 2018; 34:456-463. [PMID: 29108784 DOI: 10.1016/j.arthro.2017.08.292] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the minimum 2-year outcomes and return to sports in competitive athletes after arthroscopic iliopsoas fractional lengthening (IFL) and treatment for femoroacetabular impingement (FAI) to competitive athletes treated for FAI who did not undergo IFL. METHODS Data were prospectively collected and retrospectively reviewed between November 2009 and April 2014. Included patients were high school, collegiate, or professional athletes who underwent arthroscopic IFL, treatment for FAI, and preoperative modified Harris Hip Score, Non-Arthritic Athletic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale. Exclusion criteria were patients younger than 16 years, Tönnis grade >1, microfracture, abductor pathology, and previous hip conditions. A subgroup of athletes were matched to athletes who did not undergo IFL by age ± 5 years, sex, and body mass index ± 5. RESULTS There were 75 athletes eligible for inclusion, 60 (80.0%) of whom had minimum 2-year follow-up. All patient-reported outcome (PRO) scores demonstrated significant improvements at latest follow-up (P < .001). Mean satisfaction was 7.9. No patients converted to arthroplasty. Painful snapping was resolved in 55 athletes (91.7%). Nine athletes (15.0%) had nonpainful snapping at follow-up. Thirty-nine (65%) returned to their sport. Forty (66.7%) maintained or improved their competitive abilities. There was one case (1.6%) of temporary postoperative numbness. There were no complaints of weakness in hip flexion. Forty-one IFL athletes were matched to 41 controls. No differences were detected in demographics, follow-up time, intraoperative findings, procedures, mean magnitudes of improvement, or return to sports. CONCLUSIONS In competitive athletes, IFL during hip arthroscopy is safe and demonstrates favorable improvements in PROs and VAS, high satisfaction, and high rate of symptom resolution at a minimum of 2 years postoperatively. Most patients were able to return to sports and maintain or improve their competitive levels. These results were similar to a control group of athletes not requiring IFL. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Itay Perets
- American Hip Institute, Westmont, Illinois, U.S.A
| | | | - Edwin O Chaharbakhshi
- American Hip Institute, Westmont, Illinois, U.S.A.; Stritch School of Medicine, Maywood, Illinois, U.S.A
| | - Lyall Ashberg
- Atlantis Orthopaedics, Palm Beach Gardens, Florida, U.S.A
| | - Brian Mu
- American Hip Institute, Westmont, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute, Westmont, Illinois, U.S.A.; Hinsdale Orthopaedics, Westmont, Illinois, U.S.A..
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18
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Alapati S, Wadhwa V, Komarraju A, Guidry C, Pandey T. Magnetic Resonance Imaging of Nonneoplastic Musculoskeletal Pathologies in the Pelvis. Semin Ultrasound CT MR 2017; 38:291-308. [PMID: 28705373 DOI: 10.1053/j.sult.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Musculoskeletal pathologies in the pelvis encompass a wide variety of lesions including femoroacetabular impingement, athletic pubalgia, ischiofemoral impingement, and apophyseal avulsion injuries. Magnetic resonance imaging is the noninvasive imaging modality of choice for the diagnosis and management of these lesions. In this article, the authors discuss the nonneoplastic musculoskeletal lesions in the pelvis, with illustrations and relevant case examples.
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Affiliation(s)
- Sindhura Alapati
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Aparna Komarraju
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Carey Guidry
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Tarun Pandey
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
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19
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Obituary: A Personal Remembrance of William C. Allen (1934-2016). Clin Orthop Relat Res 2017; 475:1508-1511. [PMID: 28236081 PMCID: PMC5384935 DOI: 10.1007/s11999-017-5281-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/03/2017] [Indexed: 01/31/2023]
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Abstract
The snapping hip (SH) syndrome is characterised by an audible snapping, often accompanied by pain, which usually occurs with the flexion and extension of the hip during exercise or ordinary daily activities.The causes of SH can be classified as external, internal and intraarticular. The prevalence of asymptomatic SH in the population is unknown and the incidence of symptomatic cases is not well-defined. The painless snapping in the hip is common in the general population; the symptomatic SH with debilitating pain and weakness is often seen in those who take part in activities such as ballet and running hurdles.The clinician's goal is to determine the cause and treat patients who have symptomatic SH so that they may return to their activities or to athletic peak performance.Most patients with SH can be treated conservatively. However, surgery may be indicated if the condition becomes chronically symptomatic. Arthroscopy may prove useful in the treatment of intraarticular lesions that are causing discomfort. Various techniques have been described with different grades of success. The aim is to achieve the least invasive procedure with the lowest potential complications that corrects the painful snapping, according to the patient's characteristics.The purpose of this systematic review is to clarify the results of the surgical treatment of SH, after the failure of the conservative treatment.
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21
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Nakano N, Lisenda L, Khanduja V. Pseudoaneurysm of a branch of the femoral circumflex artery as a complication of revision arthroscopic release of the iliopsoas tendon. SICOT J 2017; 3:26. [PMID: 28322718 PMCID: PMC5360095 DOI: 10.1051/sicotj/2017012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023] Open
Abstract
Treatment of painful internal snapping hip via arthroscopic release of the iliopsoas tendon is becoming the preferred option over open techniques because of the benefits of minimal dissection and fewer complications. However, complications do occur with arthroscopic techniques as well. We present the case of a 33-year-old woman who presented with painful internal snapping of her right hip and underwent arthroscopic release of the iliopsoas tendon. Following the procedure she continued to complain of pain in her groin and was therefore investigated further with a magnetic resonance imaging (MRI) which revealed a swelling near the femoral circumflex vessels. A computed tomography (CT) angiogram revealed a 15 mm pseudoaneurysm of the femoral circumflex artery, which was successfully treated by selective catheterisation and embolisation. Hip arthroscopists should be sufficiently familiar with the vascular anatomy around the hip and keep this complication in mind when releasing the iliopsoas tendon arthroscopically especially in revision cases with adhesions.
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Affiliation(s)
- Naoki Nakano
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Laughter Lisenda
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
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22
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Hwang DS, Noh CK. Comprehensive Review of Advancements in Hip Arthroscopy. Hip Pelvis 2017; 29:15-23. [PMID: 28316958 PMCID: PMC5352721 DOI: 10.5371/hp.2017.29.1.15] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/24/2022] Open
Abstract
Hip arthroscopy is currently being leveraged in the diagnosis and treatment of a wide range of hip joint problems. In fact, great advancements in hip arthroscopy have resulted in an ever-expanding number of indications to which it is being applied. Minimally invasive hip arthroscopy allows for quicker initiation of rehabilitation and has attracted much attention as the field becomes increasingly focused on surgeries designed to preserve joints. This review aims to summarize the recent advances, applications, and impact of hip arthroscopy.
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Affiliation(s)
- Deuk-Soo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chang-Kyun Noh
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
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23
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Abstract
Snapping hip, or coxa saltans is a palpable or auditory snapping with movement of the hip joint. Extra-articular snapping is divided into external and internal types, and is caused laterally by the iliotibial band and anteriorly by the iliopsoas tendon. Snapping of the iliopsoas usually requires contraction of the hip flexors and may be difficult to distinguish from intra-articular coxa saltans. Ultrasound can be a useful modality to dynamically detect tendon translation during hip movement to support the diagnosis of extra-articular snapping. Coxa saltans is typically treated with conservative measures including anti-inflammatories, stretching, and avoidance of inciting activities. Recalcitrant cases are treated with surgery to lengthen the iliopsoas or the iliotibial band.
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25
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Brandenburg JB, Kapron AL, Wylie JD, Wilkinson BG, Maak TG, Gonzalez CD, Aoki SK. The Functional and Structural Outcomes of Arthroscopic Iliopsoas Release. Am J Sports Med 2016; 44:1286-91. [PMID: 26872894 DOI: 10.1177/0363546515626173] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic release of the iliopsoas tendon may alleviate pain associated with internal snapping hip, but previous reports of physical function, hip strength, and muscle atrophy after surgery are mixed. HYPOTHESIS The hips of patients who underwent arthroscopic iliopsoas release would demonstrate significantly reduced hip flexion strength and iliopsoas muscle volume when compared with their contralateral hips and the hips of patients who underwent hip arthroscopy without psoas release. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Eighteen patients who underwent hip arthroscopy with iliopsoas release for symptomatic internal snapping hip and concomitant femoroacetabular impingement (FAI) and/or chondrolabral damage (release group) and 18 patients who underwent arthroscopy for FAI and/or chondrolabral damage without iliopsoas release (control group) were evaluated at a mean of 21 months (range, 16-30 months) postoperatively. Magnetic resonance images were performed and segmented to calculate iliopsoas volume. Isometric hip flexion strength was evaluated in the supine and seated positions with a custom testing apparatus. Differences between groups and differences between the operative and nonoperative limbs within groups were compared with unpaired and paired t tests, respectively. RESULTS In the release group, the iliopsoas muscle of the surgical limb was significantly smaller (288 ± 98 vs 384 ± 113 cm(3), P < .001) and weaker in the seated position (13 ± 4.7 vs 17 ± 5.8 kg, P < .001) than the contralateral limb. Compared with the control group, the release group demonstrated a greater percentage decrease in iliopsoas volume on magnetic resonance imaging (-25% ± 9.1% vs -0.6% ± 4.6%, P < .001) and seated hip flexion strength (-19% ± 16% vs -3.9% ± 20%, P = .018) between the operative and contralateral limbs. There were no significant differences in supine strength between limbs or groups (all P > .168). CONCLUSION Arthroscopic iliopsoas release results in iliopsoas atrophy with a 25% volume loss and a 19% reduction in seated hip flexion strength.
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Affiliation(s)
| | - Ashley L Kapron
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - James D Wylie
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | | | - Travis G Maak
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | | | - Stephen K Aoki
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Chun YS, Rhyu KH, Cho KY, Cho YJ, Lee CS, Han CS. Osteochondroma Arising from Anterior Inferior Iliac Spine as a Cause of Snapping Hip. Clin Orthop Surg 2016; 8:123-6. [PMID: 26929811 PMCID: PMC4761596 DOI: 10.4055/cios.2016.8.1.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 12/16/2014] [Indexed: 11/14/2022] Open
Abstract
Snapping hip syndrome is a relatively common problem that can be easily managed with conservative treatment. This syndrome can be divided into external, internal and intra-articular types. Internal snapping hip syndrome is the rarest amongst these and its etiology is not well understood. We report a unique case of osteochondroma arising from the anterior inferior iliac spine (AIIS), which caused the internal snapping hip syndrome with hip pain and restriction of activity. This rare case of snapping hip syndrome from the AIIS was treated surgically and the symptoms completely disappeared after excision of the tumor.
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Affiliation(s)
- Young Soo Chun
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kee Hyung Rhyu
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kye-Youl Cho
- Department of Orthopaedic Surgery, Icheon Hospital, Gyeonggi Provincial Medical Center, Icheon, Korea
| | - Young Joo Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Chung Seok Lee
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Chung Soo Han
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Hwang DS, Hwang JM, Kim PS, Rhee SM, Park SH, Kang SY, Ha YC. Arthroscopic Treatment of Symptomatic Internal Snapping Hip with Combined Pathologies. Clin Orthop Surg 2015. [PMID: 26217460 PMCID: PMC4515454 DOI: 10.4055/cios.2015.7.2.158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Arthroscopic iliopsoas tendon release was introduced in 2000. The purpose of this study was to evaluate clinical outcomes of arthroscopic iliopsoas tendon release for painful internal snapping hip with concomitant hip pathologies. Methods Between January 2009 and December 2011, we performed arthroscopic iliopsoas tendon release and related surgeries in 25 patients (20 men and 5 women; mean age, 32 years; range, 17 to 53 years) with combined intraarticular hip pathologies. The patients were followed for a minimum of 2 years postoperatively. Clinical and radiological evaluations were performed. Results Snapping sounds had disappeared by the 2-year follow-up in 24 of the 25 patients. All patients who had presented with loss of flexion strength postoperatively showed recovery at postoperative week 6 to 10. Harris hip score improved from 65 points (range, 46 to 86 points) preoperatively to 84 points (range, 67 to 98 points) postoperatively (p < 0.001). Seven hips (28%) had an excellent score, 15 hips (60%) a good score, 2 hips (8%) a fair score, and one hip (4%) a poor score (p < 0.001). The Tonnis grade of osteoarthritis did not change in any of the patients at the last follow-up. Conclusions Patients with painful internal snapping hip have combined hip pathologies. Therefore, the surgeon should keep in mind that painful internal snapping hips are frequently combined with concomitant intraarticular pathologies.
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Affiliation(s)
- Duck-Soo Hwang
- Department of Orthopaedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jung-Mo Hwang
- Department of Orthopaedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pil-Sung Kim
- Department of Orthopaedic Surgery, Bumin Seoul Hospital, Seoul, Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung-Hwan Park
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Yong Kang
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Yoon JY, Kwak HS, Yoon KS, Chang JS, Yoon PW. Arthroscopic Treatment for External Snapping Hip. Hip Pelvis 2014; 26:173-7. [PMID: 27536576 PMCID: PMC4971143 DOI: 10.5371/hp.2014.26.3.173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/06/2014] [Accepted: 09/01/2014] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcome of arthroscopic treatment for recalcitrant external snapping hip. MATERIALS AND METHODS Between September 2011 and June 2013, we evaluated 7 patients (10 cases) with snapping hip who were refractory to conservative treatments for at least 3 months. Two patients (4 cases) were impossible to adduct both knees in 90°of hip flexion. Surgery was done in lateral decubitus position, under spinal anesthesia. We made 2 arthroscopic portals to operate the patients, and used cross-cutting with flap resection technique to treat the lesion. We performed additional gluteal sling release in those 2 patients (4 cases) with adduction difficulty. Average follow-up length was 19 months (range, 12-33 months). Clinical improvement was evaluated with visual analog scale (VAS), modified Harris hip score (mHHS), and also investigated for presence of limping or other complications as well. RESULTS The VAS decreased from 6.8 (range, 6-9) preoperatively to 0.2 (range, 0-2) postoperatively, and the mHHS improved from 68.2 to 94.8 after surgery. None of the patients complained of post-operative wound problem or surgical complications. CONCLUSION The clinical outcome of arthroscopic treatment for recalcitrant external snapping hip was encouraging and all patients were also satisfied with the cosmetic results.
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Affiliation(s)
- Jae Youn Yoon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Suk Kwak
- Department of Orthopedic Surgery, Joint and Spine Center, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, Joint and Spine Center, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Suk Chang
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Whan Yoon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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El Bitar YF, Stake CE, Dunne KF, Botser IB, Domb BG. Arthroscopic Iliopsoas Fractional Lengthening for Internal Snapping of the Hip: Clinical Outcomes With a Minimum 2-Year Follow-up. Am J Sports Med 2014; 42:1696-703. [PMID: 24769407 DOI: 10.1177/0363546514531037] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Internal snapping of the hip is caused by the iliopsoas (IP) tendon sliding over the iliopectineal eminence or the femoral head. In many cases that require hip arthroscopic surgery, there is coexistent painful internal snapping. In such cases, fractional lengthening of the IP tendon has been suggested as an adjunctive procedure. PURPOSE To examine the outcomes and effectiveness of arthroscopic IP tendon fractional lengthening as a solution to coexistent internal hip snapping in patients undergoing hip arthroscopic surgery for a labral tear and/or femoroacetabular impingement. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between June 2010 and June 2011, data were prospectively collected for all patients with internal snapping of the hip who underwent primary arthroscopic IP tendon fractional lengthening, with a minimum 2-year follow-up. All patients were interviewed by telephone with specific questions regarding the resolution or persistence of snapping. Patients were assessed preoperatively and postoperatively using the following patient-reported outcome (PRO) measures: Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activity of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and modified Harris Hip Score (mHHS). Pain was recorded on a visual analog scale (VAS), and satisfaction was measured on a scale from 0 to 10. RESULTS A total of 55 patients were included, with all PROs showing statistically significant improvement postoperatively (NAHS: 57.6 ± 20.6 preoperatively vs. 80.2 ± 19.2 at 2 years; HOS-ADL: 60.9 ± 21.4 preoperatively vs. 81.8 ± 20.6 at 2 years; HOS-SSS: 43.4 ± 24.6 preoperatively vs. 70.0 ± 26.7 at 2 years; and mHHS: 62.3 ± 16.4 preoperatively vs. 80.5 ± 18.3 at 2 years) (P < .001 for all). Forty-five patients (81.8%) reported good/excellent satisfaction (≥7). Overall, 45 patients (81.8%) reported resolution of painful snapping. Patients who had resolution of snapping had statistically significant superior outcomes compared with those with persistent snapping using the change in the NAHS value (25.8 ± 16.1 vs. 8.0 ± 22.5, respectively; P = .005), change in the HOS-ADL value (23.6 ± 18.0 vs. 8.5 ± 15.2, respectively; P = .017), change in the HOS-SSS value (30.7 ± 26.9 vs. 8.7 ± 23.6, respectively; P = .021), and change in the mHHS value (23.3 ± 20.1 vs. 4.4 ± 9.9, respectively; P = .005). CONCLUSION A majority of patients reported resolution of painful snapping and improvement in symptoms. Nonetheless, the rate of persistence of internal snapping at a minimum 2 years postoperatively was higher than that reported in previous studies.
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Affiliation(s)
| | - Christine E Stake
- Hinsdale Orthopaedics/American Hip Institute, Westmont, Illinois, USA
| | - Kevin F Dunne
- Hinsdale Orthopaedics/American Hip Institute, Westmont, Illinois, USA
| | - Itamar B Botser
- Hinsdale Orthopaedics/American Hip Institute, Westmont, Illinois, USA
| | - Benjamin G Domb
- Hinsdale Orthopaedics/American Hip Institute, Westmont, Illinois, USA
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MRI of the Hip: Important Injuries of the Adult Athlete. CURRENT RADIOLOGY REPORTS 2014. [DOI: 10.1007/s40134-014-0051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
OBJECTIVE To assess medium- and long-term outcomes of psoas tendinopathy to psoas tenotomy and image-guided steroid injections. DESIGN This is a 14-year retrospective case-control study to identify the efficacy of psoas tenotomy and image-guided steroid injections. SETTING This study was undertaken in a secondary care setting. PATIENTS Patients with confirmed psoas tendinopathy were followed up by postal questionnaire, which included a nonarthritic hip score (NAHS) and a study patient satisfaction questionnaire. INTERVENTIONS Patients underwent image-guided steroid injections. Depending on the analgesic or symptomatic relief, some patients proceeded to psoas tenotomy. MAIN OUTCOME MEASURES Response to steroid injection. Pain relief and symptomatic relief after the surgery. RESULTS Twenty-three patients were reviewed with a 70% follow-up over a time of 49 months for surgery (range, 13-144 months) and 77 months for injection (range, 14-160 months). Eight patients had a lasting response to injection and required no further intervention, and 15 patients proceeded to psoas tenotomy using a medial Ludloff approach. The average NAHS scores after the surgery and injection were 66.15 and 76.08, respectively. Ten patients reported pain relief after their tenotomy, and 5 patients reported no change in pain. All 8 patients, who only underwent injection, reported lasting pain relief. CONCLUSIONS Local steroid injections can provide long-term relief for patients presenting with psoas tendinopathy. For those patients with only temporary relief from injection, psoas tenotomy can provide good long-term pain relief.
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Philippon MJ, Devitt BM, Campbell KJ, Michalski MP, Espinoza C, Wijdicks CA, Laprade RF. Anatomic variance of the iliopsoas tendon. Am J Sports Med 2014; 42:807-11. [PMID: 24451113 DOI: 10.1177/0363546513518414] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The iliopsoas tendon has been implicated as a generator of hip pain and a cause of labral injury due to impingement. Arthroscopic release of the iliopsoas tendon has become a preferred treatment for internal snapping hips. Traditionally, the iliopsoas tendon has been considered the conjoint tendon of the psoas major and iliacus muscles, although anatomic variance has been reported. HYPOTHESIS The iliopsoas tendon consists of 2 discrete tendons in the majority of cases, arising from both the psoas major and iliacus muscles. STUDY DESIGN Descriptive laboratory study. METHODS Fifty-three nonmatched, fresh-frozen, cadaveric hemipelvis specimens (average age, 62 years; range, 47-70 years; 29 male and 24 female) were used in this study. The iliopsoas muscle was exposed via a Smith-Petersen approach. A transverse incision across the entire iliopsoas musculotendinous unit was made at the level of the hip joint. Each distinctly identifiable tendon was recorded, and the distance from the lesser trochanter was recorded. RESULTS The prevalence of a single-, double-, and triple-banded iliopsoas tendon was 28.3%, 64.2%, and 7.5%, respectively. The psoas major tendon was consistently the most medial tendinous structure, and the primary iliacus tendon was found immediately lateral to the psoas major tendon within the belly of the iliacus muscle. When present, an accessory iliacus tendon was located adjacent to the primary iliacus tendon, lateral to the primary iliacus tendon. CONCLUSION Once considered a rare anatomic variant, the finding of ≥2 distinct tendinous components to the iliacus and psoas major muscle groups is an important discovery. It is essential to be cognizant of the possibility that more than 1 tendon may exist to ensure complete release during endoscopy. CLINICAL SIGNIFICANCE Arthroscopic release of the iliopsoas tendon is a well-accepted surgical treatment for iliopsoas impingement. The most widely used site for tendon release is at the level of the anterior hip joint. The findings of this novel cadaveric anatomy study suggest that surgeons should be mindful that more than 1 tendon may be present and require release for curative treatment.
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Affiliation(s)
- Marc J Philippon
- Marc J. Philippon, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, USA.
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Dauffenbach J, Pingree MJ, Wisniewski SJ, Murthy N, Smith J. Distribution pattern of sonographically guided iliopsoas injections: cadaveric investigation using coned beam computed tomography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:405-414. [PMID: 24567451 DOI: 10.7863/ultra.33.3.405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To investigate the distribution pattern of sonographically guided iliopsoas (IP) injections in an unembalmed cadaveric model. METHODS A single experienced operator completed 10 sonographically guided IP injections in 5 unembalmed cadaveric pelvic specimens (4 male and 1 female; ages 55-95 years; body mass indices, 15.5-27.5 kg/m(2)) using a previously described in-plane, lateral-to-medial approach short axis to the tendon. Each injection consisted of 7 mL of a 20% dilution of contrast material injected between the IP tendon and the acetabular rim using a 22-gauge, 87.5-mm (3½-in) needle. To facilitate interpretation of contrast patterns, 2 additional injections were performed on single hips: sonographically guided 14 mL contrast-latex IP injection and sonographically guided superficial IP "peritendinous" injection with 7 mL of contrast-latex. Immediately before and after each injection, fluoroscopic images were obtained with a fixed C-arm equipped with coned beam computed tomography. After each injection, radiographic images were evaluated by a board-certified, fellowship-trained musculoskeletal radiologist to determine injectate distribution. Specimens receiving contrast-latex injections were dissected 48 hours after injection to determine the anatomic location of the injectate. RESULTS Nine of 10 IP injections (90%) produced characteristic "U-shaped" flow patterns covering 50% to nearly 100% of the IP tendon circumference and resembling previously published IP bursograms. One injection was excluded because the majority of the latex was within the pectineus muscle, likely due to technical factors. Latex flowed an average of 5.3 cm (range, 0.3-7.9 cm) cephalad and 5.2 cm (range, 1.0-7.5 cm) caudad to the acetabular rim. The large-volume (14-mL) IP injection produced a similar flow pattern to the 7 mL injections, whereas the superficial peritendinous injection produced a contrast pattern consistent with intramuscular flow. Subsequent dissection confirmed bursal flow for the 14-mL injection, whereas the superficial peritendinous injection placed latex within the superficial portion of the IP muscle (ie, intramuscular). CONCLUSIONS Sonographically guided IP injections using an in-plane, lateral-to-medial technique place injectate into the IP bursa between the IP tendon and the acetabular rim. Within the limits of this cadaveric investigation, this sonographically guided 7-mL IP "bursa" injection may provide a minimum of 50% circumferential IP tendon coverage and approximately 5 cm of cephalad and caudad flow. There does not appear to be a peritendinous space deep to the IP tendon at the acetabular rim that is both outside the bursa and amenable to sonographically guided injection. Injections into the superficial aspect of the IP using 7-mL volumes may not deliver injectate deep to the IP tendon and therefore may represent a fundamentally different injection.
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Affiliation(s)
- Jason Dauffenbach
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, W14, Mayo Building, 200 First St SW, Rochester, MN 55905 USA.
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Abstract
Femoroacetabular impingement (FAI) in the adolescent patient is becoming increasingly recognized. A number of morphologic variants can lead to abnormal abutment of the femoral neck against the acetabular rim. Unrecognized FAI can lead to the development of secondary hip disorders including osteoarthritis. FAI is both a clinical and radiographic diagnosis and requires a thorough and complete understanding to diagnose appropriately. A precise history and comprehensive physical examination is paramount. Radiographs and advanced imaging techniques help to confirm the diagnosis.
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Abstract
Hip injuries in young athletes are being diagnosed with increasing frequency. Improvements in diagnostic imaging and surgical technologies have helped facilitate the diagnosis of intra- and extra-articular derangements that were previously untreated in this age group. Athletic injuries of the hip in the young athlete encompass both osseous and soft-tissue etiologies, which can be the result of a single traumatic event or repetitive microtrauma or may be associated with an underlying pediatric hip disorder. Without accurate diagnosis and management, these injuries may result in debilitating consequences. This article will review the more common causes of hip and groin pain in the adolescent athlete, as well as advances in diagnostic and therapeutic interventions.
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Abstract
Background: Coxa saltans refers to a constellation of diagnoses that cause snapping of the hip and is a major cause of anterior hip pain in dancers. When the internal type is accompanied by weakness or pain, it is referred to as iliopsoas syndrome. Iliopsoas syndrome is the result of repetitive active hip flexion in abduction and can be confused with other hip pathology, most commonly of labral etiology. Purpose: To report the incidence, clinical findings, treatment protocol, and results of treatment for iliopsoas syndrome in a population of dancers. Study Design: Retrospective case series; Level of evidence, 4. Methods: A retrospective database review of 653 consecutive patients evaluated for musculoskeletal complaints over a 3-year period was completed. The diagnosis of iliopsoas syndrome was made based on anterior hip or groin pain, weakness with resisted hip flexion in abduction, or symptomatic clicking or snapping with a positive iliopsoas test. Patients identified with iliopsoas syndrome were further stratified according to age at time of onset, insidious versus acute onset, duration of symptoms, side of injury, presence of rest pain, pain with activities of daily living, and associated lower back pain. All patients diagnosed with iliopsoas syndrome underwent physical therapy, including hip flexor stretching and strengthening, pelvic mobilization, and modification of dance technique or exposure as required. Results: A total of 49 dancers were diagnosed and treated for iliopsoas syndrome. Within this injured population of 653 patients, the incidence in female dancers was 9.2%, significantly higher than that in male dancers (3.2%). The mean age at the time of injury was 24.6 years. The incidence of iliopsoas syndrome in dancers younger than 18 years was 12.8%, compared with 7% in dancers older than 18 years. Student dancers had the highest incidence (14%), followed by amateur dancers (7.5%), while professional dancers had the lowest incidence (4.6%). All patients responded to conservative treatment, and no patients required corticosteroid injections or surgical intervention. Conclusion: This is the largest series reported to date of iliopsoas syndrome in the dance population, treated noninvasively. This study supports that conservative treatment with nonsteroidal anti-inflammatory medication, activity modification, and a physical therapy regimen specific to the iliopsoas should be the primary treatment for patients with iliopsoas syndrome. Clinical Relevance: This study supports current literature and conservative treatment of iliopsoas syndrome diagnosis. Furthermore, this study gives specific information regarding incidence of iliopsoas syndrome in dance populations and provides a test for diagnosis and an algorithm for treatment.
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Affiliation(s)
- Catherine Laible
- Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, New York, USA
| | - David Swanson
- Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, New York, USA
| | - Garret Garofolo
- Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, New York, USA
| | - Donald J Rose
- Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, New York, USA
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Márquez Arabia WH, Gómez-Hoyos J, Llano Serna JF, Aguilera Bohorquez B, Nossa Barrera JM, Márquez Arabia JJ, Clavijo Rodríguez MP, Gallo Villegas JA. Regrowth of the psoas tendon after arthroscopic tenotomy: a magnetic resonance imaging study. Arthroscopy 2013; 29:1308-13. [PMID: 23906271 DOI: 10.1016/j.arthro.2013.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 04/20/2013] [Accepted: 05/06/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether the psoas tendon regenerates after arthroscopic tenotomy through the central compartment of the hip in patients with internal snapping hip. METHODS Twenty-seven patients with a snapping hip, aged 18 to 54 years (mean, 37.47 years), underwent arthroscopic tenotomy through the central compartment of the hip; all patients had symptomatic femoroacetabular impingement as well. The degree of regeneration was evaluated by preoperative and postoperative measurements of the tendon perimeter with a magnetic resonance imaging protocol in patients with more than 6 months' follow-up. In addition, function was assessed preoperatively and postoperatively with the Western Ontario and McMaster Universities Osteoarthritis Index score. Postoperative active flexion force was graded clinically between 1 and 5 with the Medical Research Council score. RESULTS Eight patients had less than 6 months' follow-up, and they were excluded. The remaining 19 patients were evaluated after a mean follow-up period of 23.16 months (SD, 12.95 months). Tendon regeneration occurred in all patients. Compared with preoperative measurement, the psoas tendon circumference had recovered by 84.3% on average (55.44 ± 5.68 mm v 46.71 ± 6.05 mm, P < .001). Pain improved in all patients, and the mean Western Ontario and McMaster Universities Osteoarthritis Index score fell from 49 ± 15.9 points to 10.74 ± 11.35 points (P < .001). Muscle force recovered completely in all cases. CONCLUSIONS There is a process of tissular repair after psoas tenotomy, and the findings on magnetic resonance imaging suggest that tendon tissue regrowth occurs. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Aprato A, Jayasekera N, Bajwa A, Villar RN. Peri-articular diseases of the hip: emerging frontiers in arthroscopic and endoscopic treatments. J Orthop Traumatol 2013; 15:1-11. [PMID: 23893307 PMCID: PMC3948506 DOI: 10.1007/s10195-013-0253-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 07/09/2013] [Indexed: 01/15/2023] Open
Abstract
The precise diagnosis of both intra and extra-capsular disease of the hip is now possible because of commonly available advanced diagnostic imaging techniques. An increasing number of reports in the orthopedic literature describe new endoscopic and arthroscopic techniques to address peri-articular pathology of the hip. The purpose of this paper is to review current techniques in the management of extra-articular hip conditions.
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Affiliation(s)
- A Aprato
- The Richard Villar Practice, Spire Cambridge Lea Hospital, Impington, Cambridge, CB24 9EL, UK,
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Lindner D, Stake CE, El Bitar YF, Jackson TJ, Domb BG. Endoscopic iliopsoas tenotomy for iliopsoas impingement on a collared femoral prosthesis. Arthrosc Tech 2013; 2:e205-8. [PMID: 24265984 PMCID: PMC3834627 DOI: 10.1016/j.eats.2013.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 02/13/2013] [Indexed: 02/03/2023] Open
Abstract
Groin pain after total hip replacement is an uncommon event and may be the result of several causes, including iliopsoas impingement. We describe the case of a 51-year-old woman who was diagnosed with iliopsoas impingement after total hip replacement with a collared femoral stem. She did not improve despite extensive conservative treatment. She was treated by endoscopic iliopsoas tenotomy, and the surgical technique is described herein. Her preoperative groin pain and popping disappeared completely at 3 months postoperatively.
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Affiliation(s)
- Dror Lindner
- American Hip Institute, Chicago, Illinois, U.S.A
| | - Christine E. Stake
- American Hip Institute, Chicago, Illinois, U.S.A.,Hinsdale Orthopaedics, Hinsdale, Illinois, U.S.A
| | | | | | - Benjamin G. Domb
- American Hip Institute, Chicago, Illinois, U.S.A.,Hinsdale Orthopaedics, Hinsdale, Illinois, U.S.A.,Stritch School of Medicine, Loyola University, Chicago, Illinois, U.S.A.,Address correspondence to Benjamin G. Domb, M.D., Hinsdale Orthopaedics, 1010 Executive Ct, Ste 250, Westmont, IL 60559, U.S.A.
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Bureau NJ. Sonographic evaluation of snapping hip syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:895-900. [PMID: 23716509 DOI: 10.7863/ultra.32.6.895] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Sound Judgment Series consists of invited articles highlighting the clinical value of using ultrasound first in specific clinical diagnoses where ultrasound has shown comparative or superior value. The series is meant to serve as an educational tool for medical and sonography students and clinical practitioners and may help integrate ultrasound into clinical practice.
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Affiliation(s)
- Nathalie J Bureau
- FRCPC, Department of Radiology, University of Montreal Medical Center, 1058 Saint-Denis St, Montreal, QC H2X 3J4, Canada.
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Iliopsoas tendon reformation after psoas tendon release. Case Rep Orthop 2013; 2013:361087. [PMID: 23662230 PMCID: PMC3639708 DOI: 10.1155/2013/361087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/28/2013] [Indexed: 11/17/2022] Open
Abstract
Internal snapping hip syndrome, or psoas tendonitis, is a recognised cause of nonarthritic hip pain. The majority of patients are treated conservatively; however, occasionally patients require surgical intervention. The two surgical options for iliopsoas tendinopathy are step lengthening of the iliopsoas tendon or releasing the tendon at the lesser trochanter. Although unusual, refractory snapping usually occurs soon after tenotomy. We report a case of a 47-year-old active female with internal snapping and pain following an open psoas tenotomy. Postoperatively she was symptom free for 13 years. An MRI arthrogram revealed reformation of a pseudo iliopsoas tendon reinserting into the lesser trochanter. The pain and snapping resolved after repeat iliopsoas tendon release. Reformation of tendons is an uncommon sequela of tenotomies. However the lack of long-term studies makes it difficult to calculate prevalence rates. Tendon reformation should be included in the differential diagnosis of failed tenotomy procedures after a period of symptom relief.
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Thorey F, Budde S, Ettinger M, Albrecht UV, Ezechieli M. Accessibility of extra-articular pathologies of iliopsoas tendon and bursitis of greater trochanter in hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 2012; 20:2348-52. [PMID: 22825390 DOI: 10.1007/s00167-012-2137-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 07/09/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Different pathologies leading to psoas tendon pain and chronic bursitis of the greater trochanter are well known. The purpose of the study was to underline the accessibility of the psoas tendon at lesser trochanter, reproduce the results and measure the distances to anatomical landmarks. METHODS Twelve hips of six human cadavers underwent hip arthroscopy. The accessibility of the iliopsoas tendon at the lesser trochanter and the bursa at the greater trochanter was documented with the camera. In addition to the usual access portals, alternative ventral ports were analysed concerning accessibility of the lesser trochanter. Afterwards, arthroscopy needles were placed along the extra-articular portals followed by dissection. The distances of the portals in relation to important anatomical landmarks were analysed. RESULTS The accessibility to the iliopsoas tendon at the lesser trochanter and to the bursa at the greater trochanter throughout the conventional portals was reproducible. Sufficient distances to the important anatomical landmarks could be shown. The mean distance of the distal ventro-lateral and the wide distal ventro-lateral portal to the nervous cutaneous femoris lateralis was 26.8 ± 5.4 mm and 32.2 ± 3.9 mm. The mean distance from the more ventral located portals to the nervous arteria and vena femoralis was 28.3 ± 2.1 mm. CONCLUSION This is the first study known to us that describes in detail the accessibility of the extra-articular structures underlined by anatomical preparation. In addition, it was demonstrated that a more ventrally located portal had sufficient distance to the important neurovascular structures of the ventral femur and can also be used in addendum if necessary.
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Affiliation(s)
- Fritz Thorey
- Center for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany.
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Griffiths EJ, Khanduja V. Hip arthroscopy: evolution, current practice and future developments. INTERNATIONAL ORTHOPAEDICS 2012; 36:1115-21. [PMID: 22371112 DOI: 10.1007/s00264-011-1459-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 11/30/2011] [Indexed: 10/28/2022]
Abstract
Arthroscopic examination and treatment is an ever-increasing part of modern orthopaedic practice in this age of minimally invasive surgery. Arthroscopic procedures have been widespread in surgery of the knee and the shoulder for many years; however, the hip until relatively recently, has been largely neglected. Even now hip arthroscopy is not widely available; this may be due to the complexity of the procedure, the requirement of specialist equipment and a reportedly long learning curve. On the other hand, it has gone through a period of rapid growth over the last decade and is being performed in large numbers routinely in some centres around the world. Hip arthroscopy now provides excellent visualisation of not only the articular surfaces of the hip joint but also of the peritrochanteric or extra-articular space around the hip. Pathology of both the femoral head and the acetabulum along with the soft tissues of the hip, namely the ligamentum teres, the acetabular labrum, the synovial folds and synovium, is readily diagnosed. Modern techniques provide therapeutic options for a myriad of conditions and allow modulation of pathological processes early. Additionally hip arthroscopy is a relatively safe procedure with few complications and contraindications. However, the key to good outcomes is in the careful selection of patients and meticulous surgical technique. The aim of this review is to bring the reader up to date with an overview of the evolution of arthroscopy of the hip, review the current practice and explore possible future developments.
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Affiliation(s)
- Emmet J Griffiths
- Department of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK
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Ilizaliturri VM, Camacho-Galindo J, Evia Ramirez AN, Gonzalez Ibarra YL, McMillan S, Busconi BD. Soft tissue pathology around the hip. Clin Sports Med 2011; 30:391-415. [PMID: 21419963 DOI: 10.1016/j.csm.2010.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Snapping hip syndromes have been treated with open surgery for many years. Recently, endoscopic techniques have been developed for treatment of snapping hip syndromes with results that are at least comparable if not better than those reported for open procedures. The greater trochanteric pain syndrome is well known by orthopedic surgeons. However, deep understanding of the pathologic conditions generating pain in the greater trochanteric region and endoscopic access to it has only recently been described. Although evidence regarding endoscopic techniques for the treatment of the greater trochanteric pain syndrome is mainly anecdotal, early published reports are encouraging.
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Affiliation(s)
- Victor M Ilizaliturri
- National Rehabilitation Institute of Mexico, Universidad Nacional Autónoma de México, Avenue México Xochimilco 289, Col. Arenal de Guadalupe, Mexico City, Mexico.
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Masala S, Fiori R, Bartolucci DA, Mammucari M, Angelopoulos G, Massari F, Simonetti G. Diagnostic and therapeutic joint injections. Semin Intervent Radiol 2011; 27:160-71. [PMID: 21629405 DOI: 10.1055/s-0030-1253514] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Joint injection is a useful tool in the diagnosis of intra-articular pathology that may improve diagnostic performance of computed tomography (CT) and magnetic resonance (MR) imaging. Historically, conventional arthrography under fluoroscopy was the first method to be used to image indirectly the intra-articular soft tissues, but with the advent of CT, CT arthrography offered better soft tissue depiction. The development of conventional MR allowed even better visualization of soft tissues, and in the early 1990s, MR arthrography surpassed CT arthrography in popularity. Joint injections may also be performed for therapeutic reasons with different drugs, such as corticosteroids, anesthetics, or hyaluronic acid, which have been shown to provide pain relief in various circumstances. In this article, the technical principles for joint injection of the shoulder, knee, elbow, hip, ankle, and wrist, used for therapeutic or diagnostic reasons, are discussed. Indications, expected benefits, and risks are also analyzed.
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Affiliation(s)
- Salvatore Masala
- Department of Diagnostic Imaging, Interventional Radiology, Radiotherapy, and Nuclear Medicine, Policlinico Tor Vergata, Rome, Italy
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Nam KW, Yoo JJ, Koo KH, Yoon KS, Kim HJ. A modified Z-plasty technique for severe tightness of the gluteus maximus. Scand J Med Sci Sports 2011; 21:85-9. [PMID: 19883391 DOI: 10.1111/j.1600-0838.2009.01011.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The majority of reports concern external snapping hips caused by the iliotibial band. Comparatively, little information is available regarding snapping hips caused by a gluteus maximus. Here we show that hip problems caused by a tight gluteus maximus can be treated using a modified Z-plasty technique. Fourteen hips in seven patients were diagnosed as snapping hips caused by a tight gluteus maximus. The main functional impairment is that when the hips were flexed, legs were abducted widely and could not be adducted. All had functional impairments irresponsive to conservative treatments besides snapping, whether painful or not, and all patients underwent surgery using a modified Z-plasty technique on the iliotibial band. All patients were followed up and the mean follow-up was 7 years. All patients had complete resolution of functional impairments, snapping, and pain after surgery. No patient needed revision surgery, and there were no complications, such as, abductor weakness, or irritation over the greater trochanter. We suggest that the intrinsic tendon contracture can cause serious functional impairment in patients with snapping due to a tight gluteus maximus. In this context, a modified Z-plasty technique offers a good surgical approach.
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Affiliation(s)
- K W Nam
- Department of Orthopaedic Surgery, School of Medicine, Jeju National University, Jejusi, South Korea
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Ilizaliturri VM, Camacho-Galindo J. Endoscopic Release of the Iliopsoas Tendon and Iliotibial Band. OPER TECHN SPORT MED 2011. [DOI: 10.1053/j.otsm.2010.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shu B, Safran MR. Case report: Bifid iliopsoas tendon causing refractory internal snapping hip. Clin Orthop Relat Res 2011; 469:289-93. [PMID: 20593254 PMCID: PMC3008906 DOI: 10.1007/s11999-010-1452-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 06/16/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of painful internal snapping hip (coxa saltans) via arthroscopic lengthening or release of the iliopsoas tendon is becoming preferred over open techniques because of the benefits of minimal dissection, the ability to address concomitant intraarticular disorders, and a low complication rate. Persistent snapping after release is uncommon, especially when performed arthroscopically. Reported causes include incomplete release, intraarticular disorders, and incorrect diagnosis. Anatomic variants are not discussed in the orthopaedic literature. CASE DESCRIPTION We report a case of an 18-year-old softball player with internal snapping hip treated with arthroscopic iliopsoas release in the peripheral compartment. Postoperatively, the athlete continued to have painful snapping. Repeat arthroscopy with a larger capsulotomy revealed a bifid iliopsoas tendon causing refractory internal snapping hip, which resolved after revision arthroscopic release. LITERATURE REVIEW Bifid iliopsoas tendon as a cause of persistent snapping of the hip has not been reported in the orthopaedic literature. Prior sonographic and anatomic studies suggest the bifid iliopsoas tendon exists but is uncommon. PURPOSE AND CLINICAL RELEVANCE Recognition that a bifid iliopsoas tendon may be the source of painful internal snapping hip is important to prevent clinical failure of surgical management of the internal snapping hip. The differential diagnosis of failed iliopsoas lengthening surgery should include the consideration of an incompletely lengthened tendon attributable to bifid iliopsoas tendon anatomy. Prevention of this complication includes making a large enough capsulotomy to identify the tendon and to ensure it is not bifid.
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Affiliation(s)
- Beatrice Shu
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, M/C 6342, Redwood City, CA 94063 USA
| | - Marc R. Safran
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, M/C 6342, Redwood City, CA 94063 USA
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