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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 is to show the gross anatomy of the anterior aspect of the hip and the iliopsoas tendon and its endoscopic release, and to document the clinical results of arthroscopic iliopsoas tenotomies performed at the level of the labrum to treat internal snapping hip.

METHODS: We show the video of gross anatomy of the anterior aspect of the hip and the endoscopic iliopsoas tendon release, and the charts from 38 patients with internal snapping hip who undewent arthroscopic release of the iliopsoas tendon at the level of the labrum were restrospectively reviewed. At least two years' follow up was considered necessary for analysis. Thirty-six patients had concomitant symptomatic femoroacetabular impingement. Two subjects had a traumatic labral injury. Osteoarthritis was not found in all selected cases. Pain and function was assessed preoperatively and postoperatively with the Western Ontario and McMaster Universities Osteoarthritis Index score and satisfaction scale from 0 to 10 (with 10 representing the best score), respectively. Postoperative active flexion force was graded clinically between 1 and 5 with the Medical Research Council score.

RESULTS: The mean age of the 38 patients was 36.89 years (17 to 57,SD±11.43), BMI was 22.62 (18.54 to 28.7, SD+/-2.51), the average follow-up was 36.02 months (24 to 56, SD+/-8.79). Hip snapping disappeared in 37 of the 38 patients. One patient continued with painless snapping. Pain and function improved in 36 patients, and the mean Western Ontario and McMaster Universities Osteoarthritis Index score fell from 47.89±15.90 points to 8.57±9.86 (with 100 representing the worst score) (P < .001). The satisfaction scale at follow up was 8.52 (3 to 10, SD±1.33). Muscle force recovered completely in all cases. Two patients had pain due to insufficient correction of femoroacetabular impingement.

DISCUSSION AND CONCLUSION: An arthroscopic release of the iliopsoas tendon at the level of the labrum is a highly effective intervention for treating symptomatic internal snapping hip.

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