The surgical treatment of internal snapping hip.
BACKGROUND
Internal snapping hip is an underdiagnosed cause of hip pain that sidelines many recreational and competitive athletes. It originates from a taut iliopsoas tendon that snaps across bony prominences when the hip is extended from a flexed position. When nonoperative treatment methods fail, fractional tendon-lengthening procedures may be used.


OBJECTIVE
Surgical tendon lengthening through a true ilioinguinal approach, which has not been previously reported, will achieve good results in patients with internal snapping hip.


METHODS
Retrospective cohort study.


METHODS
In 30 patients with symptoms in their anterior hip, internal snapping hip was diagnosed by history and physical examination. All patients were initially treated nonoperatively; 19 (63%) improved and did not require further intervention. Eleven patients (12 hips) whose symptoms were recalcitrant to physical therapy were offered the surgical option of iliopsoas tendon lengthening. The procedure was performed via an ilioinguinal intrapelvic approach. Patients were followed up for an average of 3 years.


RESULTS
All 11 surgically treated patients (100%) had complete postoperative mitigation of their snapping hip. Nine (82%) reported excellent pain relief. Moreover, nine patients thought that they had greatly benefited from the tendon lengthening and would repeat the surgery.


CONCLUSIONS
Although nonoperative measures are usually successful in the treatment of internal snapping hip, surgical tendon lengthening is a viable approach in cases refractory to nonoperative therapy.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Gary S
GS
Gruen
Thomas N
TN
Scioscia
Jason E
JE
Lowenstein
D000293:Adolescent; D000328:Adult; D005260:Female; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000601:surgery; D016658:Psoas Muscles / Q000503:physiopathology*; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D016896:Treatment Outcome