Mid-term Outcomes of Iliopsoas Fractional Lengthening (IFL) for Internal Snapping as a Part of Hip Arthroscopy: A Matched Control Study

Itay Perets 1,2 Edwin O. Chaharbakhshi 1,3 Yosif Mansor 1,4 Lyall J. Ashberg 1,5 Brian H. Mu 1,6 Muriel R. Battaglia 1 Benjamin G. Domb 1,7
1Research, American Hip Institute, USA
2Orthopaedic Surgery, Hadassah Hebrew University Hospital, Israel
3Medicine, Loyola Stritch College of Medicine, USA
4Orthopaedic Surgery, Chaim Sheba Medical Center at Tel Hashomer, Israel
5Orthopaedic Surgery, Atlantis Orthopaedics, USA
6Medicine, Rosalind Franklin University of Medicine and Science, USA
7Orthopaedic Surgery, Hinsdale Orthopaedics, USA

Introduction: Internal snapping of the hip is presumed to be caused by the iliopsoas tendon sliding across the femoral head and snapping across the iliopectineal ridge. Studies have demonstrated favorable short-term outcomes of iliopsoas fractional lengthening (IFL) during hip arthroscopy for the treatment of femoro-acetabular impingement (FAI). We examined minimum five-year outcomes and rate of painful snapping resolution for patients who underwent arthroscopic IFL.

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 (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score – Sports Subscale (HOS-SS), and visual analog scale (VAS) 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 suffer from painful snapping or undergo IFL, but satisfied the inclusion andexclusion criteria.

Results: There were 57 eligible cases (80.3% follow-up). Mean follow-up time was 69.3 months. All outcomes demonstrated statistically significant improvements between preoperative and latest follow-up scores for the following measures (P < 0.001): mHHS (from 64.3 to 84.9), NAHS (from 61.7 to 85.2), HOS-SS (from 47.0 to 75.0), and VAS (from 6.5 to 2.2). Mean satisfaction was 8.1/10. Painful snapping 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.

Conclusions: IFL during hip arthroscopy for treatment of FAI and labral tears is safe, successfully eliminates most cases of painful internal snapping, and demonstrates favorable outcomes at mid-term follow-up compared with a control group that did not undergo IFL.









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