Tenotomy for Iliopsoas Pathology is Infrequently Performed and Associated with Poorer Outcomes in Hips Undergoing Arthroscopy for Femoroacetabular Impingement

Dean Matsuda, Premier Hip Arthroscopy, Marina del Rey, California. Electronic address: saltandlight777@hotmail.com.
Benjamin R. Kivlan, Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania.
Shane J. Nho, Department of Orthopedic Surgery, Division of Sports Medicine, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois.
Andrew B. Wolff, Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, District of Columbia.
John P. Salvo, Rothman Institute, Philadelphia, Pennsylvania; Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
John J. Christoforetti, Center for Athletic Hip Injury, Allegheny Health Network, Pittsburgh, Pennsylvania; Department of Orthopaedic Surgery, Drexel University School of Medicine, Pittsburgh, Pennsylvania.
RobRoy L. Martin, American Hip Institute, Pittsburgh, Pennsylvania; Department of Physical Therapy, Rangos School of Health Sciences, Pittsburgh, Pennsylvania.
Dominic S. Carreira, Peachtree Orthopedics, Atlanta, Georgia, U.S.A.


PURPOSE: The purpose of this article was to report prevalence of iliopsoas pathology in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI), incidence of rendered tenotomy, and outcomes of hips with iliopsoas involvement compared with those with primary FAI. METHODS: A cohort study from a hip arthroscopy study group using a prospectively-collected multicenter database was performed. Patients who underwent isolated hip arthroscopy for FAI from January 2016 to March 2017 were assigned to the Iliopsoas group (defined as preoperative diagnosis of coxa saltans internus, intraoperative anteroinferior labral bruising or tear, and preoperative positive psoas injection) or control group. The prevalence of iliopsoas pathology, radiographic and intraoperative findings, and rendered procedures between groups were compared. Mean 2-year (minimum 1.8 year) outcomes of iliopsoas groups with and without rendered tenotomy and a control group were compared. RESULTS: There were 1393 subjects, of which 92 (7%) comprised the iliopsoas study group with 1301 subjects control subjects. Sixteen subjects in the iliopsoas group received tenotomy (17% of iliopsoas group, 1% of all subjects), whereas 76 subjects (83% of iliopsoas group) with iliopsoas involvement did not. There was significant effect on postoperative International Hip Outcome Tool-12 (iHOT-12) scores based on iliopsoas involvement and treatment, F(2,1390) = 3.74, P = .02. Compared with the control group (M = 73, standard deviation [SD] = 24), the non-tenotomized iliopsoas group (M = 69, SD = 32) had similar postoperative scores (P = .46), whereas the tenotomized iliopsoas group (M = 57, SD = 28) averaged lower postoperative scores (P = .03). In the tenotomy group, 25% achieved the iHOT-12 substantial clinical benefit and patient acceptable symptomatic state value for normal function and 100% satisfaction, compared to 49% and 41% for the without tenotomy and control groups. CONCLUSIONS: Tenotomy in patients with iliopsoas pathology undergoing arthroscopic surgery for FAI is infrequently performed and is associated with poorer outcomes. Co-afflicted patients treated without tenotomy have similar successful outcomes to patients with primary FAI. Indiscriminate tenotomy for iliopsoas pathology in this setting should be cautiously considered. LEVEL OF EVIDENCE: Level III, cohort study.