Clinical Outcomes and Return to Sport in Competitive Athletes Undergoing Iliopsoas Fractional Lengthening as a Part of Hip Arthroscopy - Minimum Two-Year Follow-Up

OBJECTIVES: The iliopsoas is a hip flexor and stabilizer that may be associated with internal snapping. Although flexion and stability are important in competitive athletes, painful internal snapping may be debilitating and may necessitate arthroscopic iliopsoas fractional lengthening (IFL). The purpose of this study was to report minimum two-year results for athletes’ patient-reported outcomes (PROs), returning to sports, and competitive abilities after IFL during hip arthroscopy. We hypothesized that IFL for internal snapping in athletes is a safe procedure and will demonstrate favorable outcomes, with a majority of athletes returning to sports with the same or higher competitive abilities. METHODS: Data were prospectively collected and retrospectively reviewed for 1,682 patients undergoing hip arthroscopy between February 2008 and October 2013. Inclusion criteria were as follows: high school, collegiate, or professional athlete, who underwent arthroscopic IFL, and agreed to preoperative modified Harris Hip Score (mHHS), Non-Arthritic Athletic Hip Score (NAHS), Hip Outcome Score - Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). All patients failed to improve with at least three months of conservative treatment, including physical therapy, anti-inflammatories, and rest. Exclusion criteria were as follows: patients under 16 years old, Tönnis grade > 1, previous hip conditions such as Legg-Calve-Perthes disease, hip fractures, slipped capital femoral epiphysis, avascular necrosis of the femoral head, hip dysplasia, and previous surgical intervention for either hip. RESULTS: Fifty athletes were eligible for inclusion, 44 (88%) of which had minimum two-year follow-up. All PRO scores demonstrated significant improvements at latest follow-up (p < 0.0001). Mean improvements were as follows: mHHS (65.1 to 83.7), NAHS (60.7 to 86.2), HOS-SSS (41.5 to 75.4), VAS (5.8 to 2.0). Mean satisfaction was 8.1. Painful snapping was resolved in 41 patients (93%). Six patients (14%) had non-painful snapping at latest follow-up. Of the 44 athletes, 6 (14%) did not return to sport due to their hip symptomatology, 29 (65.9%) returned to sports, and 24 (54.5%) maintained or improved their competitive abilities. Nine patients (20.5%) did not return to sports for reasons unrelated to their hip (e.g., loss of interest, aging, etc.). The only complications were two (4.6%) superficial wound infections that resolved with topical treatment. There were no complaints of weakness in hip flexion. CONCLUSION: In competitive athletes, IFL during hip arthroscopy is safe and demonstrates favorable improvements in PROs and VAS, high satisfaction, and high rate of symptom resolution at a minimum of two years postoperatively. The majority of patients were able to return to sports and maintain or improve their competitive levels.