Iliopsoas Tunnel Deepening and Fractional Lengthening Relieve Painful Internal Snapping During Concomitant Primary Hip Arthroscopy for Treatment of Femoroacetabular Impingement: A Propensity Matched Comparison
Author(s):Schab AR, Kuhns BD, Walsh EG, Quesada-Jimenez R, Kahana-Rojkind AH, Cohen MF, Domb BG.
DOI Link: 10.1002/arj.70070
Background
Management of iliopsoas impingement with painful internal snapping during hip arthroscopy remains debated, with iliopsoas fractional lengthening (IFL) as a commonly utilized technique. Iliopsoas tunnel deepening (ITD) has emerged as an alternative, though comparative outcomes are limited.
Methods
A retrospective review of prospectively collected data was performed on patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome, labral pathology, and iliopsoas impingement. Patients undergoing ITD were propensity-matched 1:1 to those undergoing IFL based on demographic and surgical variables. Minimum 2-year patient-reported outcomes (PROs), rates of achieving MCID and PASS, resolution of internal snapping, and secondary surgeries were compared.
Key Findings
Both ITD and IFL groups demonstrated significant improvement in all PROs (P < .05), with no differences in magnitude of improvement (P > .05).
Resolution of painful internal snapping was comparable (78.8% ITD vs 81.8% IFL; P = .76).
Rates of achieving MCID and PASS were similar between groups (P > .05).
Revision arthroscopy rates were equivalent (9.1% vs 9.1%; P > .99).
No patients required conversion to arthroplasty.
Conclusion
Iliopsoas tunnel deepening provides outcomes comparable to fractional lengthening in the treatment of iliopsoas impingement during hip arthroscopy, including similar improvements in PROs, symptom resolution, and reoperation rates.
What Does This Mean for Providers?
ITD represents a viable alternative to IFL for managing iliopsoas impingement with internal snapping in the setting of hip arthroscopy. Given equivalent clinical outcomes and complication profiles, surgeons may consider ITD as part of their surgical armamentarium, particularly in cases where preservation of iliopsoas function is desired. Procedure selection should be individualized based on patient anatomy and intraoperative findings.