Arthroscopy - 2026-03-24 - Journal Article
Iliopsoas Tunnel Deepening and Fractional Lengthening Relieve Painful Internal Snapping During Concomitant Primary Hip Arthroscopy for Treatment of Femoroacetabular Impingement: A Propensity Matched Comparison.
Schab AR, Kuhns BD, Walsh EG, Quesada-Jimenez R, Kahana-Rojkind AH, Cohen MF, Domb BG
Topics
Key Takeaway
Iliopsoas tunnel deepening achieved 78.8% resolution of painful internal snapping at minimum 2-year follow-up, equivalent to the 81.8% resolution seen with fractional lengthening (P=.76).
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Summary
This study compared outcomes of iliopsoas tunnel deepening (ITD) versus fractional lengthening (IFL) performed concomitantly with primary hip arthroscopy for FAI and iliopsoas impingement with painful internal snapping, using 1:1 propensity matching on age, sex, BMI, Outerbridge grade, and labral/capsular treatment. Both groups demonstrated significant improvement across all PROs with no between-group difference in postoperative scores. Snapping resolution (78.8% ITD vs 81.8% IFL), MCID/PASS achievement rates, and revision arthroscopy rates (9.1% each) were equivalent.
Key Limitation
The significantly unequal follow-up between groups (27.9 vs 56.3 months) means durability of ITD relative to IFL beyond 2 years cannot be assessed from this data.
Original Abstract
PURPOSE
To report minimum 2-year outcomes of iliopsoas tunnel deepening (ITD) during hip arthroscopy and compare their results to propensity-matched hip arthroscopies performed with iliopsoas fractional lengthening (IFL) in patients with combined femoroacetabular impingement syndrome and iliopsoas impingement with painful internal snapping.
METHODS
Data were collected between December 2017 and January 2022 and retrospectively reviewed for all patients who underwent primary hip arthroscopy to treat femoroacetabular impingement syndrome, labral tears, and iliopsoas impingement. Hips included had 2-year minimum postoperative patient reported outcomes (PRO). Subjects receiving ITD were propensity matched to IFLs in a 1:1 ratio based on age, sex, body mass index, Acetabular Outerbridge Grade, labral treatment, and capsular treatment. Patient characteristics, procedures performed, and PROs were compared. Rates of meeting minimum clinically important difference and patient acceptable symptomatic state, revision arthroscopy, and conversion to arthroplasty were compared.
RESULTS
A total of 33 ITD hips (30 patients) and 33 IFL hips (33 patients) were included in each group. Patients in the IFL cohort had longer follow-up than ITD cohort (56.3 ± 23.9 vs 27.9 ± 9.6 months respectively, P < .01). Both groups showed significant improvement in all PROs with comparable postoperative improvement (P > .05). Similar resolution of painful internal snapping was seen, with 26 (78.79%) ITD and 27 (81.82%) IFL hips seeing resolution (P = .76). For ITD and IFL groups, rates of achieving minimum clinically important difference and patient acceptable symptomatic state were similar rates (P > .05). ITDs and IFLs underwent revision arthroscopy at comparable rates (9.1% vs 9.1%; P > .99). No conversions to arthroplasty were reported.
CONCLUSIONS
ITD yielded improvements when treating iliopsoas impingement during hip arthroscopy. ITDs had comparable improvements in PROs, resolution in painful internal snapping, and underwent revision arthroscopy at similar rates when compared to IFLs.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.