Surgical correction of the snapping iliopsoas tendon

Eighteen patients with 20 symptomatic hips underwent lengthening of the iliopsoas tendon for persistent painful snapping of this "internal" variety of snapping hip. We referred to the pathologic, painful snapping of the ilio psoas in the deep anterior groin as the "internal" snap ping hip. This is in contrast to the more common and better-known "external" snapping that involves the greater trochanter and its overlying soft tissues. The results of our iliopsoas lengthening procedure are pre sented here. Lengthening of the iliopsoas tendon was accom plished by step cutting of the tendinous portion of the iliopsoas. The pathoanatomy of this poorly understood symptom complex was described in a 1984 paper from this institution and is reviewed here. Iliopsoas bursography demonstrated a sudden jerk ing movement of the iliopsoas tendon between the anterior inferior iliac spine and iliopectineal eminence, synchronous with the patient's pain and often accom panied by an audible snap. The average preoperative duration of symptoms was 2.9 years, and the average length of postoperative followup was 25 months. All patients, except one, had a marked reduction in the frequency of snapping after tendon lengthening, and 14 of 20 hips had no snapping postoperatively. Of the six patients who had recurrence of snapping, all but one stated that this occurred much less frequently and was much less painful compared to the preoperative state. Two hips required reoperation. Postoperatively, only three patients complained of subjective weakness, and most patients were unlimited in physical activity with return to activities such as competitive football, pole vaulting, and long-distance running. A frequent complication has been transient or per manent sensory loss of the anterolateral thigh, yet no motor deficits have occurred. An operative approach through a cosmetic transverse inguinal incision, differ ent from our previous approach, is described. Nearly all patients felt that they were much better because of the procedure, and only one patient stated that she would not repeat the procedure for the same problem. We feel that judicious lengthening of the painful snap ping iliopsoas tendon near the brim of the pelvis can be of great benefit to symptomatic patients.