MR Appearance and Clinical Significance of Changes in the Hip Muscles and Iliopsoas Tendon after Arthroscopic Iliopsoas Tenotomy in Symptomatic Patients

Hain, Kendra S.; Blankenbaker, Donna G.; Smet, Arthur A. De; Keene, James S.; Río, Alejandro Muñoz del

doi:10.1007/s11420-013-9361-9

Cited by 34 publications

(40 citation statements)

References 11 publications

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“…Iliopsoas atrophy was seen by MRI evaluation of 20 patients who had underwent a psoas tenotomy at the level of the lesser trochanter 45 . Iliacus and psoas muscle atrophy were present in 65% and 85% of the patients in the study.…”

Section: Treatmentmentioning

confidence: 99%

Understanding and Treating the Snapping Hip

Yen

Lewis

Kim

2015

Sports Medicine and Arthroscopy Review

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Snapping hip, or coxa saltans is a palpable or auditory snapping with movement of the hip joint. Extra-articular snapping is divided into external and internal types, and is caused laterally by the iliotibial band and anteriorly by the iliopsoas tendon. Snapping of the iliopsoas usually requires contraction of the hip flexors and may be difficult to distinguish from intra-articualar coxa saltans. Ultrasound can be a useful modality to dynamically detect tendon translation during hip movement to support the diagnosis of extra-articular snapping. Coxa saltans is typically treated with conservative measures including anti-inflammatories, stretching and avoidance of inciting activities. Recalcitrant cases are treated with surgery to lengthen the iliopsoas or iliotibial band.

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Section: Treatmentmentioning

confidence: 99%

Understanding and Treating the Snapping Hip

Yen

Lewis

Kim

2015

Sports Medicine and Arthroscopy Review

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“…The results of Blomberg et al 6 may also explain in part the finding that although 25% of the lesser trochanteric patients in the study by Hain et al 15 developed gluteus maximus atrophy, none of the labral-level tenotomy patients in the current study did. This may have occurred because the smaller muscle mass left intact after lesser trochanteric tenotomies resulted in a greater loss of the normal opposition to hip extension generated by the iliacus and psoas muscles, and thus, the development of gluteus maximus atrophy.…”

Section: Discussionmentioning

confidence: 43%

Magnetic Resonance Imaging Appearance of the Hip Musculature After Arthroscopic Labral-Level Iliopsoas Tenotomies

Walczak

Blankenbaker

Tuite

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Iliopsoas (IP) muscle atrophy is a known consequence of open IP tenotomy, but the severity of IP muscle atrophy that occurs after arthroscopic labral-level IP tenotomies has not been documented.Purpose:To document the severity of muscle atrophy that occurs in the iliacus, psoas, and adjacent hip musculature after arthroscopic labral-level IP tenotomy.Study Design:Case series; Level of evidence, 4.Methods:Twenty-eight patients who had magnetic resonance arthrograms (MRAs) obtained prior to and 3 months to 5 years after arthroscopic labral-level IP tenotomies are the basis of this report. The pre- and postoperative MRAs of each patient were examined in consensus by 2 musculoskeletal radiologists who graded the postoperative muscle atrophy from 0 (no fatty infiltration) to 4 (>75% fatty infiltration) and noted any compensatory muscle hypertrophy or abnormal IP tendon morphology. Patients also were assessed with the Byrd 100-point modified Harris Hip Scoring system (MHHS) preoperatively and at the time of their postoperative MRA.Results:Postoperative MRAs were obtained on average 1.7 years (range, 3 months to 5 years) after hip arthroscopy. None of the patients had muscle atrophy on their preoperative MRAs. In contrast, 89% of patients had iliacus and psoas muscle atrophy on their postoperative MRAs, but only 2 (7%) developed grade 4 atrophy, and the majority (64%) had either grade 1 (n = 15) or no atrophy (n = 3). In addition, there were no significant differences in the MHHS of the patients with mild (grades 0-1), moderate (grades 2-3), or severe (grade 4) postoperative atrophy. Postoperative MRAs also demonstrated low-grade atrophy (grades 1-2) in the quadratus femoris (n = 5) and rectus femoris (n = 1) muscles, and 16 patients (57%) had distortion of the tendon, but none had a gap in their tendon.Conclusion:A majority of patients (89%) developed IP muscle atrophy after arthroscopic labral-level IP tenotomies, and although this percentage was similar (89% vs 90%) to that reported with lesser trochanteric IP tenotomies, the patients did not (1) develop atrophy of the gluteus maximus and vastus lateralis muscles, (2) have chronic IP tendon disruption, or (3) develop the severity of IP atrophy (55% grade 4 vs 7% grade 4) that has been reported after arthroscopic lesser trochanteric IP tenotomies.

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“…Another interesting finding was that the atrophy was not associated with a significant decrease in hip function. In fact, there was no significant difference in the modified HHS of the patients with no atrophy, mild to moderate atrophy, and severe iliacus or psoas muscle atrophy at two years follow-up, and the majority of the patient's with grade 4 atrophy showed good clinical outcomes 27 . According to this this study, other Authors reported a significant clinical @ C I C E d i z i o n i I n t e r n a z i o n a l i loss of flexion strength after surgery in all patients but they improved in a period lasting from 6 to 10 weeks 26,29 .…”

Section: @ C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 82%