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Internal Snapping Hip: From Anatomy to Endoscopic Release

February 19, 2016

Contributors: Juan Carlos Gomez Hoyos, MD; Francisco Javier Monsalve, MD; Lorena Bejarano-Pineda, MD; Alvaro Vanegas-Gomez, MD; William Henry Marquez, MD; William Henry Marquez, MD

Introduction: The purpose of this video is to show the gross anatomy of the anterior aspect of the hip and the iliopsoas tendon and endoscopic release. The video also reviews the clinical results of arthroscopic iliopsoas tenotomy performed at the level of the labrum to manage internal snapping hip. Methods: This video shows the gross anatomy of the anterior aspect of the hip and endoscopic iliopsoas tendon release. The charts of 38 patients with internal snapping hip who underwent arthroscopic iliopsoas tendon release at the level of the labrum were retrospectively reviewed. Patients with a follow-up of at least 2 years were included in the analysis. Thirty-six patients had concomitant symptomatic femoroacetabular impingement. Two patients had a traumatic labral injury. Osteoarthritis was not noted in all selected patients. Pain and function were assessed preoperatively and postoperatively via the Western Ontario and McMaster Universities Osteoarthritis Index and via patient satisfaction on a scale ranging from 0 to 10 (10 representing the best score), respectively. Postoperative active flexion force was graded clinically on a scale from 1 to 5 based on the Medical Research Council score. Results: The mean age of the 38 patients was 36.89 years (range, 17 to 57 years; standard deviation [SD] ±11.43 years). The mean body mass index of the 38 patients was 22.62 kg/m2 (range, 18.54 to 28.7 kg/m2; SD ± 2.51 kg/m2). The mean follow-up was 36.02 months (range, 24 to 56 months; SD ± 8.79 months). Hip snapping disappeared in 37 of the 38 patients. One patient had painless snapping. Pain and function improved in 36 patients, and the mean Western Ontario and McMaster Universities Osteoarthritis Index score decreased from 47.89 ± 15.90 to 8.57 ± 9.86 (100 representing the worst score; P < 0.001). The mean satisfaction score at follow-up was 8.52 (range, 3 to 10; SD ± 1.33). Muscle force recovered completely in all the patients. Two patients had pain as a result of insufficient correction of femoroacetabular impingement. Discussion and Conclusion: Arthroscopic release of the iliopsoas tendon at the level of the labrum is a highly effective treatment option for the management of symptomatic internal snapping hip.