Psoas impingement causing labrum tear: a series from three tertiary hip arthroscopy centers.
ABSTRACT The term hip impingement is usually associated with psoas impingement after arthroplasty or femoroacetabular impingement (FAI). A recently, less commonly described mechanism of impingement and labrum pathology is the psoas tendon applying pressure to the acetabular labrum more medial to the typical FAI labrum lesion. Much is still unkown about the anatomy, pathology, and treatment of this entity.
This paper describes the successful arthroscopic treatment of a series of patients with a recently recognized cause of hip pain in the young athletic population without significant bony pathology or coxa saltans. Awareness of this entity is important to allow appropriate treatment of the labrum and psoas tendon.
Seven hundred hip arthroscopies by three surgeons at different centers were retrospectively reviewed. Athletes with labrum tears from the two to three o'clock position were evaluated for inclusion in the study. Patients with osteoarthritis, crossover sign, coxa profunda, CAM lesion, acute trauma, or coxa saltans were excluded. All authors were the primary surgeons and are fellowship-trained hip arthroscopists working in tertiary hip arthroscopy centers. Pre- and postoperative Harris Hip scores were obtained. Patients underwent diagnostic and therapeutic hip arthroscopy. The psoas tendon was released in all patients at the level of the capsule via a transcapsular approach. Labrum repairs were performed when deemed beneficial by the operative surgeon.
Twenty-two patients (26 hips, 4 bilateral) were identified with a labrum tear apparently caused by psoas impingement and had no other significant hip abnormalities. All but one were female. Average age was 19 (12-25 years). Labral repair was performed in all but two patients. Average anchors used were 1.2 per hip. Pre- and postoperative Harris hip scores were obtained with a minimum follow-up of six months for 16 patients. Average Harris hip score improved from 70 preop to 94 postop. There were no significant complications identified.
We describe a recently recognized entity encountered in the treatment of athletes with hip pain consisting of labrum pathology associated with the psoas tendon rather than bony abnormality. Arthroscopic treatment, including a psoas tendon release and a more medial labrum repair, can provide relief with no significant complications in the short term.
Understanding the unique pathoanatomy of this entity may allow the surgeon to provide more thorough informed consent, prepare for a more medial labrum repair than usual, and provide appropriate referral when necessary.
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ABSTRACT: Hip pain is a significant problem in the young adult (15–40 years) affecting atleast one in 20 patients. Though most sources of pain are from the hip joint, it may also be caused by structures external to it, such as the iliopsoas muscle complex. Recent advances in radiological imaging and hip arthroscopy have increased our understanding of this muscle and its surgical management. We present a comprehensive review of the iliopsoas and its pathologies, with specific emphasis on its arthroscopic treatment.08/2014; DOI:10.1016/j.jajs.2014.06.006
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ABSTRACT: Extra-articular hip impingement can be the result of psoas impingement (PI), subspine impingement (SSI), ischiofemoral impingement (IFI), and greater trochanteric/pelvic impingement (GTPI). Symptoms may be due to bony abutment or soft-tissue irritation, and often, it is a challenge to differentiate among symptoms preoperatively. Currently, the clinical picture and diagnostic criteria are still being refined for these conditions. This systematic review was conducted to examine each condition and elucidate the indications for, treatment options for, and clinical outcomes of surgical management. We searched online databases (Medline, Embase, and PubMed) for English-language clinical studies published from database inception through December 31, 2013, addressing the surgical treatment of PI, SSI, IFI, and GTPI. For each condition, 2 independent assessors reviewed eligible studies. Descriptive statistics are presented. Overall, 9,521 studies were initially retrieved; ultimately, 14 studies were included examining 333 hips. For PI, arthroscopic surgery resulted in 88% of patients achieving good to excellent results, as well as significant improvements in the Harris Hip Score (P = .008), Hip Outcome Score-Activities of Daily Living (P = .02), and Hip Outcome Score-Sport (P = .04). For SSI, arthroscopic decompression, with no major complications, resulted in a mean 18.5° improvement in flexion range of motion, as well as improvements in pain (mean visual analog scale score of 5.9 points preoperatively and 1.2 points postoperatively) and the modified Harris Hip Score (mean of 64.97 points preoperatively and 91.3 points postoperatively). For both IFI and GTPI, open procedures anecdotally improved patient symptoms, with no formal objective outcomes data reported. This review suggests that there is some evidence to support that surgical treatment, by arthroscopy for PI and SSI and by open surgery for IFI and GTPI, results in improved patient outcomes. Systematic review of Level IV and V (case report) studies.Arthroscopy The Journal of Arthroscopic and Related Surgery 05/2014; 30(8). DOI:10.1016/j.arthro.2014.02.042 · 3.19 Impact Factor
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ABSTRACT: The modified mid-anterior portal is a utilitarian hip arthroscopy working portal that permits dual-portal comprehensive surgery for femoroacetabular impingement and related chondrolabral procedures without the need for interportal exchange. Its distal location facilitates labral reparative and reconstructive procedures while minimizing iatrogenic acetabular chondral damage. The relatively lateral location permits instrument navigation not only along the anterosuperior acetabular rim and anterolateral proximal femur typically required for acetabuloplasty and femoroplasty but even to the posterior regions of the hip in cases of global pincer femoroacetabular impingement and posterior extensions of cam morphology and the anteromedial proximal femur while avoiding direct injury to the lateral femoral cutaneous nerve.08/2014; 3(4). DOI:10.1016/j.eats.2014.05.005