Indiscriminate Iliopsoas Tenotomy May Cause Complications—With Tight Indications and Transbursal Lengthening, We May Avoid Them
Authors: Domb BG, Maldonado DR
DOI: 10.1016/j.arthro.2021.04.065
Background:
Iliopsoas tenotomy is frequently used to treat internal snapping hip but is associated with complications such as pain recurrence, weakness, and hip instability, especially in patients with dysplasia or insufficient soft tissue support.
Methods:
Commentary advocating for selective indications and use of iliopsoas fractional lengthening (IFL) as a safer alternative.
Key Findings:
- Routine iliopsoas tenotomy carries substantial risk of adverse outcomes.
- IFL offers controlled tendon lengthening with reduced muscle disruption.
- Tight surgical indications and ensuring hip stability optimize outcomes.
Conclusions:
Employ iliopsoas fractional lengthening rather than tenotomy in patients with painful snapping who have stable hips, thereby minimizing complications.
What Does This Mean for Providers?
- Evaluate hip stability rigorously before considering iliopsoas release procedures.
- Prefer fractional lengthening over tenotomy to preserve muscle function and reduce postoperative morbidity.
- Limit iliopsoas surgery to patients meeting strict criteria and combine with stabilization procedures if needed.
- Educate patients about risks and benefits of iliopsoas procedures to facilitate informed consent.