A Matched-Pair Controlled Study of Arthroscopic Psoas Tenotomy with Minimum 2-Year Follow-Up: Do Patients with Psoas Tenotomy Achieve Similar Outomes?

OBJECTIVES: It is unknown whether pateints undergoing tenotomy for painful internal snapping at the time of hip arthroscopy can expect equivalent functional outcome to patients undergoing hip arthroscopy without tenotomy. The contribution of the psoas tendon and hip capsule to hip stability is also currently debated. The purpose of this matched study is to (1) compare two-year outcome scores in a study group who underwent psoas tenotomy to a matched control group who did not have a psoas tenotomy, and (2) perform a subgroup analysis of the study group comparing capsular repair to capsular release. METHODS: Between April of 2008 and December of 2012, we prospectively collected data and reviewed 694 hip arthroscopies with a minimum 2 year follow up. A total of 243 patients had undergone psoas tenotomy and comprised the study group available for matching. After a power analysis was performed we matched 50 patients in the control group to 50 patients in the study group. A subgroup analysis of the study group was then performed based on the capsular treatment performed. Twenty five patients who underwent capsular release were compared to 25 patients who underwent capsular repair. The protocol included pre- and post-operative administration of four hip-specific patient-reported outcome (PRO) tools, the visual analog scale (VAS), and patient satisfaction scores. RESULTS: Both the study group (n=50) and control group (n=50) demonstrated a statistically significant improvement in patient-reported outcome (PRO) scores and pain scores at 2-year follow up (p<0.05). No statistical differences in PRO scores, pain scores, or patient satisfaction was observed at 2-years between the study group and the control group as well as between the capsular repair and capsular release subgroups. CONCLUSION: In patients with painful internal snapping and psoas impingement lesions arthroscopic psoas tenotomy appears to result in similar two-year outcomes to patients not undergoing psoas tenotomy at the time of labral treatment. We were unable to detect a significant role for capsular closure at the time of psoas tenotomy; however, this requires further study.