The Journal of Bone and Joint Surgery (American) 84:420-424 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
Surgical Correction of the Snapping Iliopsoas Tendon in Adolescents
Matthew B. Dobbs, MD,
J. Eric Gordon, MD,
Scott J. Luhmann, MD,
Deborah A. Szymanski, RN and
Perry L. Schoenecker, MD
Investigation performed at Shriners Hospitals for Children,
St. Louis Unit, and Saint Louis Children’s Hospital, St.
Louis, Missouri
Matthew B. Dobbs, MD
J. Eric Gordon, MD
Scott J. Luhmann, MD
Perry L. Schoenecker, MD
Department of Orthopaedic Surgery, Saint Louis Children’s Hospital,
Washington University School of Medicine, One Children’s
Place, St. Louis, MO 63110. E-mail address for M.B. Dobbs: dobbsmatthew{at}hotmail.com
Deborah A. Szymanski, RN
Shriners Hospitals for Children, 2001 S. Lindbergh Boulevard,
St. Louis, MO 63131
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. They did not
receive payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other
charitable or nonprofit organization with which the authors are
affiliated or associated.
A commentary is available with the electronic versions of this article,
on our web site (www.jbjs.org) and on our quarterly CD-ROM (call
our subscription department, at 781-449-9780, to order the CD-ROM).
Background: There have been very few reports
regarding symptomatic snapping of the iliopsoas tendon, and none
of those reports have dealt exclusively with an adolescent population.
We report our experience with the surgical treatment of this entity in
a group of patients who had an average age of fifteen years.
Methods: Nine adolescent patients (eleven hips)
underwent fractional lengthening of the iliopsoas tendon at the
musculotendinous junction because of persistent painful snapping
of the hip. A modified iliofemoral approach to the iliopsoas tendon
was used. The diagnosis in all cases was made on the basis of the history
and a physical examination. Plain radiographs were made for all
patients to rule out an osseous intra-articular loose body. Follow-up
consisted of personal interviews and physical examinations performed
at least two years postoperatively.
Results: Preoperatively, all patients had audible
snapping with pain localized to the anterior part of the groin.
The average duration of symptoms was 2.3 years. Prior to the onset
of symptoms, all but one of the patients had been involved in competitive
athletic activities. Postoperatively, all patients were able to
return to the preoperative level of activity without subjective
weakness. The average duration of postoperative follow-up was four
years. Hip-flexion strength was noted to be nearly equal to that
on the contralateral side. All patients reported that they would
have the operation again under similar circumstances. One patient
had recurrent snapping but stated that it was less frequent and
less painful than the preoperative snapping. Two patients had transient
sensory loss in the anterolateral aspect of the thigh.
Conclusions: We conclude that fractional lengthening
of the iliopsoas tendon at the musculotendinous junction is an effective
and safe approach for adolescent patients with persistent symptomatic snapping
of the iliopsoas tendon that is unresponsive to conservative measures.
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