Purpose
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.
Methods
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.
Results
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).
Conclusions
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.
Clinical Relevance
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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
Article info
Publication history
Published online: June 18, 2015
Accepted:
March 19,
2015
Received:
July 30,
2014
Footnotes
The authors report the following potential conflict of interest or source of funding: Arthrex donated the cadaveric specimens.
Identification
Copyright
Published by Elsevier Inc.
