THE PSOAS TENDON REGENERATES AFTER ATHROSCOPIC TENOTOMY THROUGH THE CENTRAL COMPARTMENT OF THE HIP
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1 THE PSOAS TENDON REGENERATES AFTER ATHROSCOPIC TENOTOMY THROUGH THE CENTRAL COMPARTMENT OF THE HIP Márquez W 1,7, Gómez-Hoyos J 2,7, Llano J 3,8, Aguilera B 4, Nossa J 5, Márquez J 6, Clavijo M 6,7, Gallo J 6,7 1. Department of Orthopedic Surgery, Clínica Las Américas 2. Department of Orthopedic Surgery, University of Antioquia 3. Department of Radiology, Clínica Las Américas 4. Joint Replacement Group, Centro Médico Imbanaco 5. Department of Orthopedic Surgery, FUCS 6. Department of Sports Medicine, Universidad de Antioquia 7. GRINMADE Research Group 8. IATM Research Group Colombia, 2012
2 Acknowledgments
3 Disclosure / Conflict of interest The authors confirm that they have no company affiliations and/or conflict of interest notifications of relevance to this presentation.
4 Background Snapping hip is characterized by snap of the hip that can be painful The psoas tendon shifts from lateral to medial position, over the iliopectineal eminence or femoral head Patients with persistent pain and functional limitation may improve with arthroscopic psoas tenotomy. There is concern about the effect on hip flexion strength Our experience shows normal hip flexion returns a few months after the procedure Our hypothesis is that the psoas tendon regenerates
5 Purpose To evaluate whether the psoas tendon regenerates after arthroscopic tenotomy through the central compartment of the hip in patients with internal snapping hip.
6 Methods Eight had less than 6 months of follow-up 27 patients with internal snapping hip All underwent arthroscopic tenotomy of the psoas through the central comparment of the hip (Wensttein technique) 19 patients included MRI: Phillips Achieva Nova Dual Series of 1.5T SPIR, proton density, sagital T1 and axial proton density Two radiologists Variables Quantitative: Mean and standard deviation Nominal: Frequencies and proportions Comparison (pre and post): paired Student t or Wilcoxon tests Data analysis: SPSS version 20.0 Preoperative MRI Postoperative MRI Measurement of the tendon perimeter WOMAC Score (pre and post) Flexion force of the hip (only post)
7 Example Preoperative MRI. Observe the continuous tendon in sagital view before tenotomy. Preoperative MRI with anteroposterior and transverse tendon measurements in an axial view Observe the discontinuous psoas tendon 20 days after tenotomy. Postoperative MRI of a regenerated tendon with anteroposterior and transverse measures. Seven months after tenotomy.
8 Results I 8 patients excluded due to less than 6 months follow up 19 patients included (7 males, 12 female) Aged 18 to 54 years BMI: ±4.43 All had femoroacetabular impingement Mean follow up of: months
9 Results II Pain improved in all patients The mean WOMAC score improved in all patients o Pre: 49±15.9 vs. Post: 10.74±11.35 points, P <0.001 Hip flexion force was 5/5 in all patients in the final follow up Psoas regeneration was observed in all patients On average, 84.3% of the perimeter of the psoas tendon was recovered o Pre: ± 5.68 mm vs. Post: ± 6.5 mm, P <0.001
10 Conclusions The psoas tendon regenerates after arthroscopic transcapsular tenotomy with radiofrequency in patients with internal snapping hip. Tendon thickness recovery averaged greater than 80% compared with the preoperative measurement. The function of hip flexion recovers in all patients.
11 References 1. Byrd J. Snapping hip. Oper Tech Sports Med. 2005;13: Wettstein M, Jung J, Dienst M. Arthroscopic psoas tenotomy. Arthroscopy Aug.;22(8):907.e Ilizaliturri V, Chaidez C, Villegas P, Briseño A, Camacho J. Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy. 2009;25(2): Yamamoto Y, Hamada Y, Ide T, Usui I. Arthroscopic surgery to treat intra-articular type snapping hip. Arthroscopy Sep.;21(9): Dobbs MB, Gordon JE, Luhmann SJ, Szymanski DA, Schoenecker PL. Surgical correction of the snapping iliopsoas tendon in adolescents. J Bone Joint Surg Am Mar.;84- A(3): Gruen GS, Scioscia TN, Lowenstein JE. The surgical treatment of internal snapping hip. The American Journal of Sports Medicine Jun.;30(4): Hoskins JS, Burd TA, Allen WC. Surgical correction of internal coxasaltans: a 20-year consecutive study. The American Journal of Sports Medicine Jun.;32(4): Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. The American Journal of Sports Medicine Aug.;18(5): Ilizaliturri VM Jr, Villalobos FE Jr, Chaidez PA, Valero FS, Aguilera JM. Internal Snapping Hip Syndrome: Treatment by Endoscopic Release of the Iliopsoas Tendon. Arthroscopy Nov.;21(11):
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