Are Lesser Trochanteric Tenotomies More Effective than Labral-Level Releases for the Treatment of Iliopsoas Snapping and Impingement?

OBJECTIVES: Currently arthroscopic iliopsoas tenotomies (AIT's) are performed at the level of the labrum to treat both painful snapping and labral injuries to impingement of the tendon. However, two recent studies found that although this labral-level procedure relieved painful labral impingement, recurrent snapping of the tendon occurred in 18 to 60% of the cases (1-2). The objective of this study was to determine if arthroscopic tenotomies done at the lesser trochanter would more effectively treat both central labral impingement and snapping of the tendon. METHODS: From a review of the senior author's data base of 1150 hip arthroscopies, 30 patients that had AIT's at the lesser trochanter to treat both painful snapping of the tendon and labral injuries due to impingement of the tendon were identified (Figure 1). The location of the labral injuries was recorded on each patient's “hip sheet” at the time of their hip arthroscopy and the diagnosis of iliopsoas impingement was confirmed from a review of each patient's operative note and intra-operative photographs. All hips were examined and assessed with Byrd's 100-point modified Harris hip scoring system prior to the release and at 3, 6, 12, and 24 months after surgery. RESULTS: Average age of the 30 patients (14 of which were competitive athletes) was 28 years, and their preoperative scores averaged 44 points. After surgery, the patients had hip flexor weakness, used crutches for 2 to 4 weeks and had six-week scores that averaged 77 points. Their scores continued to improve and at 6, 12, and 24 months after surgery, the scores averaged 88, 90, and 91 points, respectively. After an average follow-up of 30 months (range 24-42 months), none of the patients had recurrence of the painful snapping of their tendon, and all 14 competitive athletes returned to full participation in their sport which included Division 1-A crew and soccer (she played 90 mins/game), and high school basketball and softball (she played catcher), at an average of 8.8 months (range 4-12 months) after surgery. CONCLUSION: Arthroscopic iliopsoas tenotomies performed at the level of the lesser trochanter appear to be more effective than labral-level tenotomies for the treatment of patients that have both intra-articular labral impingement and a painful snapping of the tendon.