To determine the relative influence of anteroinferior iliac spine (AIIS) or subspine decompression on proximal rectus femoris integrity and iliopsoas excursion throughout a physiological range of motion.
Nineteen cadaveric hips from 10 specimens were dissected to retain the origin of the rectus femoris direct and indirect heads. The anatomic footprints of the origins were measured with calipers. Serial 5-mm resections of the AIIS were made to determine the extent of proximal tendon disruption that corresponded to each resection. Iliopsoas tendon tracking was also assessed after sequential AIIS decompression by measuring the excursion of the medial border of the iliopsoas tendon as it traveled from its native resting position to the point where it first encountered bony impingement at the AIIS.
The mean proximal-distal footprint of the rectus femoris direct head was 17.95 ± 2.99 mm. The mean medial-lateral distance was 11.84 ± 2.34 mm. There was a consistent bare area along the inferior aspect of the AIIS that averaged 4.84 ± 1.42 mm. The average percentage of remaining footprint after each 5-mm resection (5 to 25 mm) was 96%, 65%, 35%, 14%, and 11%, respectively, with statistical significance noted after resections larger than 5 mm (P < .001). The native excursion distance of the iliopsoas tendon was 14.05 mm. With each 5-mm resection, the percentage of excursion before impingement on the AIIS increased by 18%, 45%, 72%, 95%, and 100%, respectively, which was statistically significance after all resections (P < .001).
Our study maps the anatomic footprint of the direct head of the rectus femoris tendon and confirms a previously identified bare area along the inferior aspect of the AIIS. Female cadaveric hips had a significantly smaller rectus footprint than male cadavers in our study (P < .001). Subspine decompression greater than 10 mm significantly compromises the rectus femoris origin and should be avoided when performing arthroscopic AIIS decompression. In addition, subspine decompression significantly improves tracking of the iliopsoas tendon throughout a physiological range of motion and may be considered a surgical adjunct when treating symptomatic iliopsoas snapping.
Arthroscopic subspine decompression serves as an important treatment modality for AIIS impingement. With a more thorough understanding of AIIS anatomy, subspine decompression can be used to relieve impingement symptoms and possibly improve iliopsoas tracking while safely maintaining rectus femoris footprint integrity.
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- Femoroacetabular impingement: A cause for osteoarthritis of the hip.Clin Orthop Relat Res. 2003; : 112-120
- Anterior inferior iliac spine morphology correlates with hip range of motion: A classification system and dynamic model.Clin Orthop Relat Res. 2013; 471: 2497-2503
- Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine.J Bone Joint Surg Br. 2008; 90: 677-679
- Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: A series of 10 patients treated with arthroscopic decompression.Arthroscopy. 2012; 28: 1644-1653
- Making a case for anterior inferior iliac spine/subspine hip impingement: Three representative case reports and proposed concept.Arthroscopy. 2011; 27: 1732-1737
- Anatomic footprint of the direct head of the rectus femoris origin: Cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression.Arthroscopy. 2013; 29: 1932-1940
- Origin of the direct and reflected head of the rectus femoris: An anatomic study.Arthroscopy. 2014; 30: 796-802
- Hip pathology in the adolescent athlete.J Am Acad Orthop Surg. 2013; 21: 665-674
Published online: June 18, 2015
Accepted: March 19, 2015
Received: July 30, 2014
The authors report the following potential conflict of interest or source of funding: Arthrex donated the cadaveric specimens.
Published by Elsevier Inc.