Iliopsoas Impingement: A Newly Identified Cause of Labral Pathology in the Hip

Benjamn G. Domb, MD
Hinsdale Orthopedics, IL

Michael K. Shindle, MD
Summit Medical Group, NJ

Benjamin McArthur, MD
Department of Orthopedic Surgery,
Hospital for Special Surgery

James E. Voos, MD
Department of Orthopedic Surgery,
Hospital for Special Surgery

Erin M. Magennis, BA
Department of Orthopedic Surgery,
Hospital for Special Surgery

Bryan T. Kelly, MD

Bryan T. Kelly, MD

Chief, Sports Medicine and Shoulder Service, Hospital for Special Surgery
Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Assistant Professor of Orthopedic Surgery, Weill Cornell Medical College

Abstract

Labral tears typically occur anterosuperiorly in association with femoroacetabular impingement or dysplasia. Less commonly, labral pathology may occur in an atypical direct anterior location adjacent to the iliopsoas tendon in the absence of bony abnormalities. We hypothesize that this pattern of injury is related to compression or traction on the anterior capsulo-labral complex by the iliopsoas tendon where it crosses the acetabular rim. In a retrospective review of prospectively collected data, we identified 25 patients that underwent isolated, primary, unilateral iliopsoas release and presented for at least 1 year follow-up (mean 21 months). Pre-operative demographics, clinical presentation, intra-operative findings, and outcome questionnaires were analyzed. The injury was treated with a tenotomy of the iliopsoas tendon at the level of the joint line and either labral debridement or repair. Mean post-operative outcome scores were 87.17, 92.46, and 78.8 for the modified Harris Hip Score, activities of daily living Hip Outcome Score, and sports-related score, respectively. The atypical labral injury identified in this study appears to represent a distinct pathological entity, psoas impingement, with an etiology which has not been previously described.

This article appears in HSS Journal: Volume 7, Number 2.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

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