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Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion

  • Hip
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement.

Methods

All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS).

Results

Ten patients with a mean age of 18 years (range 14–28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7–3.5), the median post-operative mHHS was 89.7 (65.7–96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal.

Conclusion

Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up.

Level of evidence

IV.

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Authors and Affiliations

  1. Mayo Clinic, 200 1st St SW, Rochester, MN, 55901, USA

    Luke Spencer-Gardner, Michael J. Stuart & Aaron J. Krych

  2. Medsport Clinic University of Michigan, 24 Frank Lloyd Wright Dr Ste 1000, Ann Arbor, MI, 48105, USA

    Asheesh Bedi

  3. Twin Cities Orthopedics, 4010 West 65th Street, Edina, MN, 55435, USA

    Christopher M. Larson

  4. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Bryan T. Kelly

Authors
  1. Luke Spencer-Gardner
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  2. Asheesh Bedi
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  3. Michael J. Stuart
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  4. Christopher M. Larson
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  5. Bryan T. Kelly
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  6. Aaron J. Krych
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Correspondence to Aaron J. Krych.

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Spencer-Gardner, L., Bedi, A., Stuart, M.J. et al. Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion. Knee Surg Sports Traumatol Arthrosc 25, 55–61 (2017). https://doi.org/10.1007/s00167-015-3812-4

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  • DOI: https://doi.org/10.1007/s00167-015-3812-4

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