Purpose
To report the frequency of presentation of bifid or multiple iliopsoas tendons in
patients who underwent endoscopic release for internal snapping hip syndrome (ISHS)
and to compare both groups.
Methods
A consecutive series of patients with ISHS were treated with endoscopic transcapsular
release of the iliopsoas tendon at the central compartment and prospectively followed
up. The inclusion criteria were patients with a diagnosis of ISHS with failure of
conservative treatment. During the procedure, the presence of a bifid tendon was intentionally
looked for. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
scores were evaluated preoperatively and at last follow-up. Four patients presented
with a bifid tendon and one patient had 3 tendons. At a minimum of 12 months' follow-up,
the presence of snapping recurrence was evaluated and the WOMAC scores were compared
between both groups.
Results
Among 279 hip arthroscopies, 28 patients underwent central transcapsular iliopsoas
tendon release. The mean age was 29.25 years (range, 16 to 65 years; 6 left and 22
right hips). Group 1 included 5 patients with multiple tendons; the remaining patients
formed group 2 (n = 23). None of the patients presented with ISHS recurrence. The
mean WOMAC score in group 1 was 39 points (95% confidence interval [CI], 26.2 to 55.4
points) preoperatively and 73.6 points (95% CI, 68.4 to 79.6 points) at last follow-up.
In group 2 the mean WOMAC score was 47.21 points (95% CI, 44.4 to 58.2 points) preoperatively
and 77.91 points (95% CI, 67.8 to 83.4 points) at last follow-up. We identified a
bifid tendon retrospectively on magnetic resonance arthrograms in 3 of the 5 cases
that were found to have multiple tendons during surgery. None of these were recognized
before the procedures.
Conclusions
In this series the surgeon intentionally looked for multiple tendons, which were found
in 17.85% of the cases. Clinical results in patients with single- and multiple-tendon
snapping seem to be similarly adequate. However, the possibility of a type II error
should be considered given the small number of patients.
Level of Evidence
Level IV.
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Article info
Publication history
Published online: June 04, 2015
Accepted:
April 9,
2015
Received:
July 15,
2014
Footnotes
The authors report that the following potential conflict of interest or source of funding: V.M.I. receives support from Conmed, Mytek, Biomet, and Smith & Nephew.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
