Conservative Management of a Displaced Iliopsoas Avulsion in an Adolescent: A Case Report and Systematic Review

Objective: To report a case of traumatic iliopsoas tendon avulsion with displacement exceeding the commonly cited 2-cm surgical threshold, managed successfully without surgery, and to systematically review the literature on optimal treatment and return-to-sport outcomes. Design: Case report combined with a PRISMA-compliant systematic review of PubMed, Cochrane Library, and Embase. Setting: Level I university trauma center; systematic review of published case reports and series. Participants: A 16-year-old male competitive soccer player (index case) and 58 additional patients from the literature, predominantly adolescent males with sports-related iliopsoas avulsion. Interventions: The index patient received conservative treatment with staged weight bearing and structured physiotherapy. Across the literature, 90% (52/58) were treated conservatively and 10% operatively. Main Outcome Measures: Clinical recovery, strength restoration, radiographic union on MRI, and return to sport. Results: Eighteen studies (58 patients; 59 including this case) were analyzed. A bony lesser-trochanter avulsion was present in 98% (57/58). Of at least 9 patients with displacement >2 cm, 5 recovered fully nonoperatively. The index patient was pain-free with full strength and unrestricted soccer return at 3 months; 6-month MRI showed radiographic nonunion despite complete functional recovery. Return to sport approached 100%, typically within 10 to 12 weeks. Conclusions: Available very low-certainty evidence suggests that nonoperative management can achieve favorable clinical recovery and return to sport after traumatic iliopsoas avulsion, including in some cases with displacement greater than 2 cm. Return-to-sport decisions may reasonably prioritize restored, pain-free function over radiographic union, but larger prospective studies are needed.