HSS Journal

, 7:145

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

  • Benjamin G. Domb
  • Michael K. Shindle
  • Benjamin McArthur
  • James E. Voos
  • Erin M. Magennis
  • Bryan T. Kelly
Original Article


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.


psoas impingement hip arthroscopy labral tears 


  1. 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.PubMedCrossRefGoogle Scholar
  2. 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.PubMedCrossRefGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 4.
    Blankenbaker DG, De Smet AA, Keene JS, Fine JP, Classification and localization of acetabular labral tears. Skeletal Radiol. 2007; 36:391–7.PubMedCrossRefGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 6.
    Byrd JW, Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect. 2006; 55:347–55.PubMedGoogle Scholar
  7. 7.
    Byrd JW, Labral lesions: an elusive source of hip pain case reports and literature review. Arthroscopy. 1996; 12:603–12.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 9.
    Delp, SL, Hess WE, Hungerford DS, Jones LC, Variation of rotation moment arms with hip flexion. J Biomech. 1999; 32:493–501.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 12.
    Farjo LA, Glick JM, Sampson TG, Hip arthroscopy for acetabular labral tears. Arthroscopy. 1999; 15:132–7.PubMedCrossRefGoogle Scholar
  13. 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.PubMedCrossRefGoogle Scholar
  14. 14.
    Fitzgerald RH Jr, Acetabular labrum tears. Diagnosis and treatment. Clin Orthop Relat Res. 1995; 311:60–8.PubMedGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 16.
    Hooper AC, The role of the iliopsoas muscle in femoral rotation. Ir J Med Sci. 1977; 146:108–12.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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; 406:38–47PubMedCrossRefGoogle Scholar
  22. 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; 393:25–37PubMedCrossRefGoogle Scholar
  23. 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; 40:211–6Google Scholar
  24. 24.
    Peterson LT, Tenotomy in the treatment of spastic paraplegia; with special reference to tenotomy of the iliopsoas. J Bone Joint Surg Am. 1950; 32:875–86PubMedGoogle Scholar
  25. 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; 87:832–41PubMedCrossRefGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.PubMedCrossRefGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.PubMedCrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 33.
    Skyrme AD, Cahill DJ, Marsh HP, Ellis H, Psoas major and its controversial rotational action. Clin Anat. 1999; 12:264–5PubMedCrossRefGoogle Scholar
  34. 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; 17:563–70PubMedGoogle Scholar
  35. 35.
    Taher RT, Power RA, Iliopsoas tendon dysfunction as a cause of pain after total hip arthroplasty relieved by surgical release. J Arthroplasty. 2003; 18:387–8PubMedCrossRefGoogle Scholar
  36. 36.
    Tanzer, M. and N. Noiseux, Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res, 2004(429): p. 170–7PubMedCrossRefGoogle Scholar
  37. 37.
    Taylor GR, Clarke NM, Surgical release of the snapping iliopsoas tendon. J Bone Joint Surg Br. 1995; 77:881–3PubMedGoogle Scholar
  38. 38.
    Trousdale RT, Cabanela ME, Berry DJ, Anterior iliopsoas impingement after total hip arthroplasty. J Arthroplasty. 1995; 10:546–9PubMedCrossRefGoogle Scholar
  39. 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.PubMedCrossRefGoogle Scholar
  40. 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; 426:145PubMedCrossRefGoogle Scholar
  41. 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; 7:199–207PubMedCrossRefGoogle Scholar
  42. 42.
    Wettstein M, Jung J, Dienst M, Arthroscopic psoas tenotomy. Arthroscopy. 2006; 22:907 e1–4.PubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2011

Authors and Affiliations

  • Benjamin G. Domb
    • 2
  • Michael K. Shindle
    • 3
  • Benjamin McArthur
    • 1
  • James E. Voos
    • 1
  • Erin M. Magennis
    • 1
  • Bryan T. Kelly
    • 1
  1. 1.Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Hinsdale Orthopedics1010 Executive CourtWestmontUSA
  3. 3.Summit Medical GroupBerkely HeightsUSA

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