Clinical Outcomes of Iliopsoas Fractional Lengthening in Competitive Athletes Undergoing Hip Arthroscopy - Minimum Two-Year Follow-Up

Background: The iliopsoas is a hip flexor and stabilizer that may be associated with internal snapping. Although flexion and stability are important in competitive athletes, painful internal snapping may be debilitating and may necessitate arthroscopic iliopsoas fractional lengthening (IFL).

Purpose: To report minimum two-year results for athletes’ patient-reported outcomes (PROs), return to sport, and competitive abilities after IFL during hip arthroscopy.

Methods: Data were prospectively collected and retrospectively reviewed for 1,682 patients undergoing hip arthroscopy between February 2008 and October 2013. Inclusion criteria were high school, collegiate, or professional athletes who underwent arthroscopic IFL after failing to improve with conservative treatment and who completed preoperative 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 patients 1, previous hip conditions or surgeries, and hip dysplasia.

Results: Fifty athletes were eligible for inclusion, 44 (88%) of which had minimum two-year follow-up. All PROs demonstrated significant (p < 0.0001) improvements at latest follow-up: mHHS (18.6), NAHS (25.5), HOS-SSS (33.9), VAS (-3.8). Mean satisfaction was 8.1. Painful snapping was resolved in 41 patients (93%). Six patients (14%) had non-painful snapping at latest follow-up. Of the 44 athletes, 6 (14%) did not return to sport due to their hip symptomatology, 29 (65.9%) returned to sports, and 24 (54.5%) maintained or improved their competitive abilities. Nine patients (20.5%) did not return to sport for reasons unrelated to their hip. There were no complaints of weakness in hip flexion.

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 minimum two-year follow-up. The majority of patients were able to return to sports and maintain or improve their competitive levels.