Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip

Abstract

Anterior hip snapping is a rare clinical observation. The physiopathological hypothesis currently held is a sudden slip of the iliopsoas tendon over the iliopectineal eminence. For symptomatic cases, a surgical technique is proposed. The aim of this work is to describe the anatomy of the femoral portion of the iliopsoas, which is the target of surgery. We have studied, through dissection of embalmed cadavers, the different components of the musculotendinous complex forming the femoral portion of the muscle and the gliding apparatus associated with it. The psoas major tendon exhibited a characteristic rotation. The iliacus tendon, more lateral, received the most medial iliacus muscular fibers, then fused with the main tendon. The most lateral fibers, starting in particular from the ventral portion of the iliac crest, ended up without any tendon on the anterior surface of the lesser trochanter and in the infratrochanteric region. The most inferior muscular fibers of the iliacus, starting from the arcuate line, joined the principal tendon of the psoas major passing around it by its ventromedial surface. An ilio-infratrochanteric muscular bundle was observed, in a deeper position, under the iliopsoas tendon; it arose from the interspinous incisure and on the anterior inferior iliac spine, ran along the anterolateral edge of the iliacus and inserted without any tendon onto the anterior surface of the lesser trochanter of the femur and in the infratrochanteric area. The iliopectineal bursa was studied on horizontal cross sections of a frozen pelvis and on 5 of the non-frozen preparations after dividing the iliopsoas tendon. The iliopectineal bursa had the shape of a 5 to 6-cm high and 3-cm wide cavity; in its upper part, it was divided into 2 compartments: a medial compartment for the main tendon and a lateral compartment for the accessory tendon.

Case Report: Bifid Iliopsoas Tendon Causing Refractory Internal Snapping Hip

“…These include the (1) psoas major tendon, (2) medial fibers of the iliacus, which reliably merge with the psoas major tendon, (3) inferior fibers of the iliacus, which also join the main iliopsoas tendon before insertion, (4) lateral fibers of the iliacus, and (5) ilio-infratrochanteric muscular bundle, which together with the lateral fibers attach to the lesser trochanter without tendinous processes. Also, two hips showed complete splitting or a bifid psoas major tendon, which appeared physiologic [20]. Additionally, a recent dynamic sonographic study of 42 hips of healthy volunteers aiming to observe the five components, as described by Tatu et al [20], also reported one hip with a double or bifid psoas major portion of the iliopsoas tendon [7].…”

“…Bifid iliopsoas tendon as a possible cause of snapping hip has been reported in one dynamic sonographic study [4]. Anatomic variation suggestive of bifid iliopsoas tendon also has been described [14,20]. We report of a rare complication of arthroscopic release of internal snapping hip attributable to a missed bifid iliopsoas tendon.…”

“…Also, two hips showed complete splitting or a bifid psoas major tendon, which appeared physiologic [20]. Additionally, a recent dynamic sonographic study of 42 hips of healthy volunteers aiming to observe the five components, as described by Tatu et al [20], also reported one hip with a double or bifid psoas major portion of the iliopsoas tendon [7]. Based on these limited reports, a bifid iliopsoas tendon probably arises from a divide in the psoas major part of the iliopsoas tendon and most likely arises as a constitutional anatomic variant.…”

“…Traditionally, the iliopsoas tendon is considered to consist of the joining of two muscles-the iliacus and the psoas-into a common tendon with insertion on the lesser trochanter. However, focused anatomic study of 24 cadaver hips by Tatu et al [20] showed five separate elements combine to make up the iliopsoas tendon. These include the (1) psoas major tendon, (2) medial fibers of the iliacus, which reliably merge with the psoas major tendon, (3) inferior fibers of the iliacus, which also join the main iliopsoas tendon before insertion, (4) lateral fibers of the iliacus, and (5) ilio-infratrochanteric muscular bundle, which together with the lateral fibers attach to the lesser trochanter without tendinous processes.…”

Current concepts in the diagnosis and management of extra-articular hip impingement syndromes

“…These two muscles merge to form one muscle: the iliopsoas muscle, which has a musculotendinous insertion on the lesser trochanter, though some muscle fibres of the iliacus attach directly on the lesser trochanter and proximal femur [29,30]. The anatomical and functional relationship between the iliopsoas muscle and the hip has been highlighted in previous studies.…”