Mid-term Outcomes of Arthroscopic Iliopsoas Fractional Lengthening For Treatment of Painful Internal Snapping Of the Hip with Concurrent Treatment of Femoro-Acetabular Impingement and Labral Tears

Background: Favorable short-term outcomes have been reported for treating painful internal snapping of the hip (iliopsoas impingement) with partial or complete iliopsoas release. However, longer-term results of arthroscopic IFL are unknown.

Purpose: To report minimum five-year outcomes, durability of outcomes, and painful snapping resolution for patients that underwent hip arthroscopy for the treatment of femoro-acetabular impingement (FAI) and/or labral tears with concomitant IFL to treat painful snapping.

Methods: Data were prospectively collected on patients that underwent hip arthroscopy to treat labral tears and FAI between February 2008 and January 2011. Inclusion criteria were concomitant IFL for painful snapping and had preoperative baseline scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). Exclusion criteria were preoperative Tönnis grade > 0, Workman’s Compensation, previous ipsilateral hip surgery, dysplasia, Legg-Calve Perthes disease, AVN, or SCFE. Minimum five-year outcomes were reported.

Results: Seventy-one cases (64 patients) were eligible for review (81.6% follow-up). Mean follow-up time was 69.1 months. All outcomes demonstrated significant improvements: mHHS (19.2), NAHS (23), HOS-SSS (30), and VAS (-4.1). Mean satisfaction was 8.3/10. All outcomes maintained durability between two-year and latest scores. Painful snapping was resolved in 83.8% of cases. Eleven hips (15.5%) required future revision arthroscopy at a mean of 30.0 months. Three hips (4.2%) required total hip arthroplasty at a mean of 63.1 months. Risk factors for poor outcomes (mHHS < 70) included older age (p = 0.015), higher BMI (p = 0.02), and lower preoperative NAHS (p = 0.048). Three cases (4.2%) had postoperative complications.

Conclusions: IFL as a part of hip arthroscopy for the treatment of FAI and labral tears is a safe procedure, successfully eliminates most cases with internal snapping, and demonstrates favorable mid-term outcomes that remain durable.