Iliopsoas tendon release

Abstract

Iliopsoas tendon release is indicated as treatment of the internal snapping hip syndrome. It may also be performed to treat iliopsoas tendinitis. Different techniques have been described to endoscopically perform this procedure. The tendon may be released in three levels on its way distal as it goes across the front of the hip; only the tendinous portion of the muscle-tendon complex is released, which makes all of these techniques partial releases. The so-called central transcapsular release is the most proximal form of iliopsoas tendon release. It is performed through an anterior capsulotomy from the central compartment with the hip in traction. At this level, the tendon constitutes about 40% of the volume of the muscle-tendon complex; therefore the central transcapsular is the most partial release technique. The transcapsular peripheral release is performed through an anterior hip capsulotomy from the hip periphery without traction. At this level, the tendon represents about 53% of the volume of the tendon muscle complex: this is also considered a partial release but it affects more of the overall volume of the muscle-tendon complex. The iliopsoas tendon may also be released at the level of its insertion on the lesser trochanter. This is not transcapsular but intrabursal. It is performed without traction; at this level, the muscle-tendon complex is conformed with 60% of tendon fibers so it is the less partial release. In general, when a more selective tendon release is needed, proximal release techniques are preferred. Lesser trochanter release is more utilized for revision releases and in the presence tendinitis with total hip replacement. Endoscopic techniques seem to have better results as presented in the peer-reviewed literature; this is probably because they are always used in conjunction with hip arthroscopy, which provides treatment for associated intra-articular lesions.