Skip to main content
SpringerLink
Log in

Iliopsoas Impingement: A Newly Identified Cause of Labral Pathology in the Hip

  • Original Article
  • Published:
HSS Journal ®

Abstract

Labral tears typically occur anterosuperiorly in association with femoroacetabular impingement or dysplasia. Less commonly, labral pathology may occur in an atypical direct anterior location adjacent to the iliopsoas tendon in the absence of bony abnormalities. We hypothesize that this pattern of injury is related to compression or traction on the anterior capsulo-labral complex by the iliopsoas tendon where it crosses the acetabular rim. In a retrospective review of prospectively collected data, we identified 25 patients that underwent isolated, primary, unilateral iliopsoas release and presented for at least 1 year follow-up (mean 21 months). Pre-operative demographics, clinical presentation, intra-operative findings, and outcome questionnaires were analyzed. The injury was treated with a tenotomy of the iliopsoas tendon at the level of the joint line and either labral debridement or repair. Mean post-operative outcome scores were 87.17, 92.46, and 78.8 for the modified Harris Hip Score, activities of daily living Hip Outcome Score, and sports-related score, respectively. The atypical labral injury identified in this study appears to represent a distinct pathological entity, psoas impingement, with an etiology which has not been previously described.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Beaule PE, Le Duff MJ, Zaragoza E, Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007; 89:773–779.

    PubMed  Google Scholar 

  2. Beck M, Kalhor M, Leunig M, Ganz R, Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005; 87:1012–1018.

    Article  CAS  Google Scholar 

  3. Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R, Anterior femoroacetabular impingement: Part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004; 418:67–73.

    Article  Google Scholar 

  4. Blankenbaker DG, De Smet AA, Keene JS, Fine JP, Classification and localization of acetabular labral tears. Skeletal Radiol. 2007; 36:391–7.

    Article  CAS  Google Scholar 

  5. Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006; 88:1448–57.

    Article  Google Scholar 

  6. Byrd JW, Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect. 2006; 55:347–55.

    PubMed  Google Scholar 

  7. Byrd JW, Labral lesions: an elusive source of hip pain case reports and literature review. Arthroscopy. 1996; 12:603–12.

    Article  CAS  Google Scholar 

  8. Cyteval C, Sarrabere MP, Cottin A, Assi C, Morcos L, Maury P, Taourel P, Iliopsoas impingement on the acetabular component: radiologic and computed tomography findings of a rare hip prosthesis complication in eight cases. J Comput Assist Tomogr. 2003; 27:183–8.

    Article  Google Scholar 

  9. Delp, SL, Hess WE, Hungerford DS, Jones LC, Variation of rotation moment arms with hip flexion. J Biomech. 1999; 32:493–501.

    Article  CAS  Google Scholar 

  10. Dora C, Houweling M, Koch P, Sierra RJ. Iliopsoas impingement after total hip replacement: the results of non-operative management, tenotomy, or acetabular revision. J Bone Joint Surg Br. 2007; 89:1031–1035.

    Article  CAS  Google Scholar 

  11. Espinosa, N, Rothenfluh DA, Beck M, Ganz R, Leunig M, Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006; 88:925–35.

    PubMed  Google Scholar 

  12. Farjo LA, Glick JM, Sampson TG, Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999; 15:132–7.

    Article  CAS  Google Scholar 

  13. Feldkamp M, Denker P, Importance of the iliopsoas muscle in soft-tissue surgery of hip deformities in cerebral palsy children. Arch Orthop Trauma Surg. 1989; 108:225–30.

    Article  CAS  Google Scholar 

  14. Fitzgerald RH Jr, Acetabular labrum tears. Diagnosis and treatment. Clin Orthop Relat Res. 1995; 311:60–8.

    Google Scholar 

  15. Flanum ME, Keene JS, Blankenbaker DG, Desmet AA, Arthroscopic treatment of the painful “internal” snapping hip: results of a new endoscopic technique and imaging protocol. Am J Sports Med. 2007; 35:770–9.

    Article  Google Scholar 

  16. Hooper AC, The role of the iliopsoas muscle in femoral rotation. Ir J Med Sci. 1977; 146:108–12.

    Article  CAS  Google Scholar 

  17. Hoskins JS, Burd TA, Allen WC, Surgical correction of internal coxa saltans: a 20-year consecutive study. Am J Sports Med. 2004; 32:998–1001.

    Article  Google Scholar 

  18. Ilizaliturri VM Jr, Villalobos FE Jr, Chaidez PA, Valero FS, Aguilera JM, Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy. 2005; 21:1375–80.

    Article  Google Scholar 

  19. Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy. 2005; 21:1496–504.

    Article  Google Scholar 

  20. Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M, Anterior femoroacetabular impingement: part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004; 418:61–6.

    Article  Google Scholar 

  21. McCarthy J, Noble P, Aluisio FV, Schuck M, Wright J, Lee JA, Anatomy, pathologic features, and treatment of acetabular labral tears. Clin Orthop Relat Res. 2003; 406:38–47

    Article  Google Scholar 

  22. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J, The Otto E. Aufranc Award: The role of labral lesions to development of early degenerative hip disease. Clin Orthop Relat Res. 2001; 393:25–37

    Article  Google Scholar 

  23. Onimus M, Manzone P, Allamel G, Prevention of hip dislocation in children with cerebral palsy by early tenotomy of the adductor and psoas muscle. Ann Pediatr. 1993; 40:211–6

    CAS  Google Scholar 

  24. Peterson LT, Tenotomy in the treatment of spastic paraplegia; with special reference to tenotomy of the iliopsoas. J Bone Joint Surg Am. 1950; 32:875–86

    Article  Google Scholar 

  25. Presedo A, Oh CW, Dabney KW, Miller F, Soft-tissue releases to treat spastic hip subluxation in children with cerebral palsy. J Bone Joint Surg Am. 2005; 87:832–41

    Article  Google Scholar 

  26. Rajendran K, The insertion of the iliopsoas as a design favouring lateral rather than medial rotation at the hip joint. Singapore Med J. 1989; 30:451–2.

    CAS  PubMed  Google Scholar 

  27. Robertson WJ, Kadrmas WR, Kelly BT, Arthroscopic management of labral tears in the hip: a systematic review of the literature. Clin Orthop Relat Res. 2007; 455:88–92.

    Article  Google Scholar 

  28. Samilson RL, Current concepts of surgical management of deformities of the lower extremities in cerebral palsy. Clin Orthop Relat Res. 1981; 158:99–107.

    Google Scholar 

  29. Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr., Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001; 382:232–40.

    Article  Google Scholar 

  30. Shindle MK, Voos JE, Nho SJ, Heyworth BE, Kelly BT, Arthroscopic management of labral tears in the hip. J Bone Joint Surg Am. 2008; 90 Suppl 4:2–19.

    Article  Google Scholar 

  31. Shindle MK, Voos JE, Heyworth BE, Mintz DN, Moya LE, Buly RL, Kelly BT, Hip arthroscopy in the athletic patient: current techniques and spectrum of disease. J Bone Joint Surg Am. 2007; 89 Suppl 3:29–43.

    PubMed  Google Scholar 

  32. Skaggs DL, Kaminsky CK, Eskander-Rickards E, Reynolds RA, Tolo VT, Bassett GS. Psoas over the brim lengthenings. Anatomic investigation and surgical technique. Clin Orthop Relat Res. 1997; 339:174–9.

    Article  Google Scholar 

  33. Skyrme AD, Cahill DJ, Marsh HP, Ellis H, Psoas major and its controversial rotational action. Clin Anat. 1999; 12:264–5

    Article  CAS  Google Scholar 

  34. Sutherland DH, Zilberfarb JL, Kaufman KR, Wyatt MP, Chambers HG. Psoas release at the pelvic brim in ambulatory patients with cerebral palsy: operative technique and functional outcome. J Pediatr Orthop. 1997; 17:563–70

    Article  CAS  Google Scholar 

  35. Taher RT, Power RA, Iliopsoas tendon dysfunction as a cause of pain after total hip arthroplasty relieved by surgical release. J Arthroplasty. 2003; 18:387–8

    Article  Google Scholar 

  36. Tanzer, M. and N. Noiseux, Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res, 2004(429): p. 170–7

    Article  Google Scholar 

  37. Taylor GR, Clarke NM, Surgical release of the snapping iliopsoas tendon. J Bone Joint Surg Br. 1995; 77:881–3

    Article  CAS  Google Scholar 

  38. Trousdale RT, Cabanela ME, Berry DJ, Anterior iliopsoas impingement after total hip arthroplasty. J Arthroplasty. 1995; 10:546–9

    Article  CAS  Google Scholar 

  39. Ward WT, Fleisch ID, Ganz R, Anatomy of the iliocapsularis muscle. Relevance to surgery of the hip. Clin Orthop Relat Res. 2000; 374:278–85.

    Article  Google Scholar 

  40. Wenger DE, Kendell KR, Miner MR, Trousdale RT, Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004; 426:145

    Article  Google Scholar 

  41. Yoshio M, Murakami G, Sato T, Sato S, Noriyasu S, The function of the psoas major muscle: passive kinetics and morphological studies using donated cadavers. J Orthop Sci. 2002; 7:199–207

    Article  Google Scholar 

  42. Wettstein M, Jung J, Dienst M, Arthroscopic psoas tenotomy. Arthroscopy. 2006; 22:907 e1–4.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Benjamin McArthur MD, James E. Voos MD, Erin M. Magennis BA & Bryan T. Kelly MD

  2. Hinsdale Orthopedics, 1010 Executive Court, Suite 250,, Westmont, IL, 60559, USA

    Benjamin G. Domb MD

  3. Summit Medical Group, 1 Diamond Hill Road, Berkely Heights, NJ, 07922, USA

    Michael K. Shindle MD

Authors
  1. Benjamin G. Domb MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael K. Shindle MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin McArthur MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James E. Voos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erin M. Magennis BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bryan T. Kelly MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael K. Shindle MD.

Additional information

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of this case, that all investigations were conducted in conformity with ethical principles of research.

Level of Evidence: Level IV: Case Series

Rights and permissions

Reprints and permissions

About this article

Cite this article

Domb, B.G., Shindle, M.K., McArthur, B. et al. Iliopsoas Impingement: A Newly Identified Cause of Labral Pathology in the Hip. HSS Jrnl 7, 145–150 (2011). https://doi.org/10.1007/s11420-011-9198-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11420-011-9198-z

Keywords

Search

Navigation