Central Compartment Release Versus Lesser Trochanter Release of the Iliopsoas Tendon for the Treatment of Internal Snapping Hip: A Comparative Study

2014 ◽  
Vol 30 (7) ◽  
pp. 790-795 ◽  
Author(s):  
Victor M. Ilizaliturri ◽  
Martín Buganza-Tepole ◽  
Anell Olivos-Meza ◽  
Marco Acuna ◽  
Eduardo Acosta-Rodriguez
Keyword(s):  
Comparative Study ◽  
Central Compartment ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Snapping Hip

scholarly journals Iliopsoas Tendon Reformation after Psoas Tendon Release

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
K. Garala ◽  
R. A. Power
Keyword(s):  
Surgical Intervention ◽  
Symptom Relief ◽  
Prevalence Rates ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Snapping Hip ◽  
Surgical Options ◽  
Snapping Hip Syndrome ◽  
Long Term Studies

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.

scholarly journals Endoscopic Lesser Trochanter Resection With Refixation of the Iliopsoas Tendon for Treatment of Ischiofemoral Impingement

2018 ◽  
Vol 7 (4) ◽  
pp. e321-e325 ◽  
Author(s):  
Rafael Corrales ◽  
Iñaki Mediavilla ◽  
Eric Margalet ◽  
Mikel Aramberri ◽  
Jorge A. Murillo-González ◽  
...  
Keyword(s):  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Ischiofemoral Impingement

The Surgical Treatment of Internal Snapping Hip

2002 ◽  
Vol 30 (4) ◽  
pp. 607-613 ◽  
Author(s):  
Gary S. Gruen ◽  
Thomas N. Scioscia ◽  
Jason E. Lowenstein
Keyword(s):  
Retrospective Cohort ◽  
Nonoperative Treatment ◽  
Iliopsoas Tendon ◽  
Ilioinguinal Approach ◽  
Nonoperative Therapy ◽  
Snapping Hip ◽  
Tendon Lengthening ◽  
Competitive Athletes ◽  
Viable Approach ◽  
Surgical Option

Background Internal snapping hip is an underdiagnosed cause of hip pain that sidelines many recreational and competitive athletes. It originates from a taut iliopsoas tendon that snaps across bony prominences when the hip is extended from a flexed position. When nonoperative treatment methods fail, fractional tendon-lengthening procedures may be used. Hypothesis Surgical tendon lengthening through a true ilioinguinal approach, which has not been previously reported, will achieve good results in patients with internal snapping hip. Study Design Retrospective cohort study. Methods In 30 patients with symptoms in their anterior hip, internal snapping hip was diagnosed by history and physical examination. All patients were initially treated nonoperatively; 19 (63%) improved and did not require further intervention. Eleven patients (12 hips) whose symptoms were recalcitrant to physical therapy were offered the surgical option of iliopsoas tendon lengthening. The procedure was performed via an ilioinguinal intrapelvic approach. Patients were followed up for an average of 3 years. Results All 11 surgically treated patients (100%) had complete postoperative mitigation of their snapping hip. Nine (82%) reported excellent pain relief. Moreover, nine patients thought that they had greatly benefited from the tendon lengthening and would repeat the surgery. Conclusion Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy.

scholarly journals Arthroscopic treatment of internal snapping hip

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0017
Author(s):  
Gonzalo J. Magi ◽  
Juan Pablo Carucci ◽  
Sebastián Bergués
Keyword(s):  
Recurrence Rate ◽  
Clinical Results ◽  
Arthroscopic Treatment ◽  
Harris Hip Score ◽  
Iliopsoas Muscle ◽  
Average Score ◽  
Iliopsoas Tendon ◽  
Snapping Hip ◽  
Endoscopic Release

Introduction: Internal snapping hip syndrome (ISHS) is caused by the iliopsoas tendon snapping over either the iliopectineal ridge or the anterior femoral head. Excellent results are achieved only with activity modification, rest, and stretching the iliopsoas muscle. The literature favors iliopsoas tendon release if conservative therapy fails. There is little evidence about the gold standard of this condition. Objective: Describe clinical results, complicactions and recurrence rate of arthroscopic treatment of ISHS. Methods: We included all patients who failed conservative treatment and were treated with arthroscopy for ISHS between March 2012 and March 2018. Patients with less than 2 years of follow up and previous surgery on the hip were excluded. We performed Ilizariturri´s technique with a transcapsular endoscopic release in central compartment. We registered modified Harris hip score (MHHS), Hip outcome score activity of daily living (EHOSDL), patients satisfaction, recurrence rate and complications. Results: Eight patients were included. Average follow up was 36 months (range 24-60 months). MMHS improved from preoperative average score of 70 (range 62-72) to postoperative average of 93 (range 92 to 96). Average EHOSDL improvement was 30% (from 55% preoperative to 85% postoperative). All patients had excellent results. Average patient satisfaction was 8 (range 7-9). We had no recurrence or complications. Conclusion: Arthroscopic treatment of ISHS allowed us to obtain very good clinical results with no complications or recurrences with a minimum 2 years follow up.

scholarly journals Biomechanical Comparison of Anterograde and Retrograde Lesser Trochanter Avulsion Repair

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989228
Author(s):  
Alexander Otto ◽  
Joshua B. Baldino ◽  
Alyssa M. DiCosmo ◽  
Katherine Coyner ◽  
Jeremiah D. Johnson ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Suture Anchors ◽  
Retrograde Approach ◽  
Avulsion Fractures ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Cortical Button ◽  
Load To Failure ◽  
Biomechanical Comparison ◽  
Lesser Trochanter Avulsion

Background: Lesser trochanter avulsions are rare injuries in adolescents. Severe cases with relevant fragment displacement can be treated surgically. However, no standard approach is available in the literature. Operative techniques are presently limited to anterograde fixations. A new retrograde approach to reduce operative difficulty and postoperative morbidity has been proposed. So far, no biomechanical comparison of these techniques is available. Hypothesis: Retrograde repair of the lesser trochanter with a titanium cortical button will produce superior stability under load to failure and similar displacement under cyclic loading compared with anterograde fixation with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Sixteen paired hemipelvic cadaveric specimens (mean age, 62.5 ± 10.7 years) were dissected to isolate the lesser trochanter and iliopsoas muscle. After repair of a simulated lesser trochanter avulsion, specimens were tested under cyclic loading between 10 and 125 N at 1 Hz for 1500 cycles before finally being loaded to failure at a rate of 120 mm/min in a material testing machine. Motion tracking was used to assess displacement at the superior and inferior aspects of the iliopsoas tendon under cyclic loading. Results: Load to failure was significantly greater for the retrograde repair compared with the anterograde repair (1075.24 ± 179.39 vs 321.85 ± 62.45 N; P = .012). Mean displacement at the superior repair aspect (retrograde vs anterograde: 3.29 ± 1.84 vs 4.39 ± 4.50 mm; P = .779) and mean displacement at the inferior aspect (3.54 ± 2.13 vs 4.22 ± 4.48 mm; P = .779) of the iliopsoas tendon did not significantly differ by the type of repair. Mode of failure was tendon tearing by the sutures for each retrograde repair and anchor pullout for each anterograde repair. Conclusion: Surgical repair of lesser trochanter avulsion fractures with retrograde fixation using a titanium cortical button demonstrated superior load to failure and similar displacement under cyclic loading compared with anterograde fixation using suture anchors. Clinical Relevance: The retrograde approach provides a biomechanically validated alternative to other surgical techniques for this injury.

Arthroscopic iliopsoas tenotomies: a systematic review of surgical technique and outcomes

2020 ◽  
pp. 112070002097051
Author(s):  
Remy Coulomb ◽  
Bastien Nougarede ◽  
Etienne Maury ◽  
Philippe Marchand ◽  
Olivier Mares ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Technique ◽  
Complication Rate ◽  
Data Extraction ◽  
Central Compartment ◽  
Direct Access ◽  
Cochrane Library ◽  
Complication Rates ◽  
Lesser Trochanter ◽  
Loss Of Strength

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.

scholarly journals Multiple iliopsoas tendons: a cadaveric study and treatment implications for internal snapping hip syndrome

2021 ◽  
Author(s):  
Benjamin Lin ◽  
Jonathan Bartlett ◽  
Thomas D. Lloyd ◽  
Dimitris Challoumas ◽  
Cecilia Brassett ◽  
...  
Keyword(s):  
Average Length ◽  
Average Distance ◽  
Femoral Shaft ◽  
Cadaveric Study ◽  
Total Width ◽  
Anterior Surface ◽  
Anatomical Variant ◽  
Iliopsoas Tendon ◽  
Lesser Trochanter ◽  
Psoas Major

Abstract Purpose This cadaveric study aimed at describing the anatomical variations of the iliopsoas complex. Methods The iliopsoas complex was dissected unilaterally in 28 formalin-embalmed cadavers—13 males and 15 females with a mean age of 85.6 years. The number, courses and widths of the iliacus and psoas major tendons were determined. Patients with previous hip surgery were excluded. The following measurements were taken from the mid-inguinal point: the distance to the point of union of the psoas major and iliacus tendon; and the distance to the most distal insertion of iliopsoas. Results The presence of single, double and triple tendon insertions of iliopsoas were found in 12, 12 and 4 of the 28 specimens, respectively. When present, double and triple tendons inserted separately onto the lesser trochanter. The average length of the iliopsoas tendon from the mid-inguinal point to the most distal attachment at the lesser trochanter was 122.3 ± 13.0 mm. The iliacus muscle bulk merged with psoas major at an average distance of 24.9 ± 17.9 mm proximal to the mid-inguinal point. In all cases, the lateral-most fibres of iliacus yielded a non-tendinous, muscular insertion on to the anterior surface of the lesser trochanter and the femoral shaft, rather than joining onto the main iliopsoas tendon(s). The average total width of the psoas major tendon decreased with an increasing number of tendons: 14.6 ± 2.2 mm (single tendon), 8.2 ± 3.0 mm (2 tendons present) and 5.9 ± 1.1 mm (3 tendons present) (P < 0.001). Conclusions The results of this study suggest that multiple tendinous insertions of iliopsoas are present as an anatomical variant in more than 50% of the population. The non-tendinous muscular insertion of the iliopsoas on to the anterior surface of the lesser trochanter and femoral shaft found represents a novel anatomical variant not previously described. Level of evidence Level V

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