Purpose

Traditionally, iliopsoas impingement has been managed with iliopsoas tenotomy or fractional lengthening (IFL), while iliopsoas tunnel deepening (ITD) has recently emerged as a novel treatment option. This study aims to report minimum two-year outcomes of ITD during hip arthroscopy and compare their results to a propensity-matched cohort undergoing IFL.

Methods

Data was collected between December 2017 and January 2022 and retrospectively reviewed for all patients who underwent primary hip arthroscopy to treat FAI, labral tears, and iliopsoas impingement. Hips included had preoperative and minimum two-year minimum post-operative patient reported outcomes (PRO). Subjects receiving ITD were propensity matched to IFLs in a 1:1 ratio based on age, sex, BMI, intraoperative cartilage status, labral treatment, and capsular management. Patient demographics, radiographic measurements, intraoperative findings, surgical procedures, and PROs were compared. Clinically relevant outcomes including the minimum clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were compared between groups.

Results

A total of 66 hips were included in the study. Both groups demonstrated significant improvement in all PROs with comparable postoperative improvement (p > 0.05). Both groups had high rates of resolution of painful internal snapping, including 26 (78.79%) ITD and 27 (81.82%) IFL hips (p > 0.05). MCID, PASS and MOI were met at similar rates between the two groups (p > 0.05). ITDs and IFLs underwent revision arthroscopy at comparable rates (9.1% vs. 9.1%; p > 0.05). No conversions to arthroplasty were reported in either group.

Conclusion

Both ITD and IFL improved mechanical symptoms and painful internal snapping when treating iliopsoas impingement during hip arthroscopy. ITDs had comparable improvements in PROs and clinical outcomes when compared to IFLs. Both ITD and IFL appear to be efficacious procedures when managing iliopsoas impingement.