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Endoscopy successful in treating snapping iliopsoas tendon
Although it has not shown a perfect success rate, one study says endoscopy has clear advantages.
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Endoscopic management of a snapping iliopsoas tendon can produce satisfactory results in resolving the issue; however, the process is not yet perfect, and a small percentage of patients will still suffer from symptoms, according to a recently presented study.
The findings were presented by J.W. Thomas Byrd, MD, at the 28th Annual Meeting of the Arthroscopy Association of North America.
Although the endoscopic approach is not without flaws, Byrd said the study’s findings point toward it being a superior option when compared with an open approach.
“Endoscopic release is a highly successful but not perfect operation,” he said. “The indications in my mind for an open approach are unclear. I am not really sure why you would want to do an open operation when the endoscopic option works so well.”
Findings point to success
Investigators looked prospectively at 68 hips in 65 patients, assessing each with a modified Harris Hip score. All patients underwent tenotomy for a snapping iliopsoas tendon with a minimum 1-year follow-up. According to the study, two techniques were utilized: releasing the tendon from the lesser trochanter via the iliopsoas bursa (21 hips) or release through a medial capsular window via the peripheral compartment (47 hips).
All patients had an average 24 months follow-up. According to the study abstract, the average improvement for each hip was 25 points with the snapping resolved in 95.6% of cases. Forty-eight hips had coexistent intra-articular pathology that was addressed. Three patients developed heterotopic ossification that required excision — all of which from the lesser trochanter. Four patients also underwent a repeat arthroscopy due to no resolution of symptoms.
The positives of using the endoscopic approach are too great to ignore, according to Byrd.
Obvious advantage
“The obvious advantage is its less invasive nature,” he said. “It is an outpatient procedure with less postsurgical pain and fewer complications that facilitates recovery, but really I think the most important advantage is it allows the ability to assess and address associated intra-articular pathology that is present in the majority of the cases, and I suspect that this is more responsible for our superior result.”
As illustrated in the study findings, any surgical violation of the iliopsoas tendon — even through endoscopic means — could result in heterotopic ossification and, thus, warrants prophylaxis, Burd said.
Looking at the study from the moderator’s perspective, Byrd said the results were more than acceptable but also opened the door for more questions to be asked.
“We reported 96% resolution of the snapping, and that is good, but what that means is that we had three patients who we did the operation on and it did not solve their problems,” he said. “In my mind, that was not a failure of the technique but it was a failure to make the correct diagnosis. That tells me that there is a lot we still do not understand.”
For more information:J.W. Thomas Byrd, MD, is the founder of the Nashville Sports Medicine Foundation in Nashville, Tenn. He can be reached at Nashville Sports Medicine Foundation, Baptist Medical Plaza I, 2011 Church St., Suite. 100, Nashville, TN 37203; 615-284-5800; e-mail: byrd@nsmoc.com.
- Reference:
Byrd JWT. Endoscopic management of the snapping iliopsoas tendon. Paper #SS-33. Presented at the 28th Annual Meeting of the Arthroscopy Association of North America. April 30 – May 3, 2009. San Diego.