How has Arthroscopic Management of the Iliopsoas Evolved, and Why? A Survey of High-Volume Arthroscopic Hip Surgeons
Authors: Chen AW, Steffes MJ, Laseter JR, Maldonado DR, Ortiz-Declet V, Perets I, Domb BG
DOI: 10.1093/jhps/hnaa023
Background:
Iliopsoas pathology, including internal snapping hip, is commonly addressed via arthroscopic tenotomy, but consensus on optimal management is lacking.
Methods:
Survey of 16 high-volume arthroscopic hip surgeons regarding current iliopsoas management practices and rationale.
Key Findings:
- Iliopsoas tenotomy is primarily reserved for refractory internal snapping, often combined with labral repair.
- Usage of tenotomy has decreased over time due to concerns about postoperative hip flexion weakness.
- Surgeons tend to avoid iliopsoas tenotomy in patients with borderline dysplasia or ligamentous laxity to prevent destabilization.
Conclusions:
Iliopsoas management has shifted towards more selective application of tenotomy, balancing symptom relief with preservation of hip flexion strength and stability.
What Does This Mean for Providers?
Surgeons should individualize iliopsoas treatment strategies, particularly avoiding tenotomy in patients with borderline dysplasia or ligamentous laxity to mitigate risk of hip instability and weakness, while still addressing symptoms effectively.