title: Internal Snapping Hip Syndrome: Incidence of Multiple-Tendon Existence and Outcome After Endoscopic Transcapsular Release.
abstract: OBJECTIVE
  To report the frequency of presentation of bifid or multiple iliopsoas tendons in patients who underwent endoscopic release for internal snapping hip syndrome (ISHS) and to compare both groups.
  
  
  METHODS
  A consecutive series of patients with ISHS were treated with endoscopic transcapsular release of the iliopsoas tendon at the central compartment and prospectively followed up. The inclusion criteria were patients with a diagnosis of ISHS with failure of conservative treatment. During the procedure, the presence of a bifid tendon was intentionally looked for. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated preoperatively and at last follow-up. Four patients presented with a bifid tendon and one patient had 3 tendons. At a minimum of 12 months' follow-up, the presence of snapping recurrence was evaluated and the WOMAC scores were compared between both groups.
  
  
  RESULTS
  Among 279 hip arthroscopies, 28 patients underwent central transcapsular iliopsoas tendon release. The mean age was 29.25 years (range, 16 to 65 years; 6 left and 22 right hips). Group 1 included 5 patients with multiple tendons; the remaining patients formed group 2 (n = 23). None of the patients presented with ISHS recurrence. The mean WOMAC score in group 1 was 39 points (95% confidence interval [CI], 26.2 to 55.4 points) preoperatively and 73.6 points (95% CI, 68.4 to 79.6 points) at last follow-up. In group 2 the mean WOMAC score was 47.21 points (95% CI, 44.4 to 58.2 points) preoperatively and 77.91 points (95% CI, 67.8 to 83.4 points) at last follow-up. We identified a bifid tendon retrospectively on magnetic resonance arthrograms in 3 of the 5 cases that were found to have multiple tendons during surgery. None of these were recognized before the procedures.
  
  
  CONCLUSIONS
  In this series the surgeon intentionally looked for multiple tendons, which were found in 17.85% of the cases. Clinical results in patients with single- and multiple-tendon snapping seem to be similarly adequate. However, the possibility of a type II error should be considered given the small number of patients.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of Adult Joint Reconstruction, National Rehabilitation Institute of Mexico, Mexico City, Mexico. Electronic address: vichip2002@yahoo.com.mx.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Ilizaliturri
authors.affiliation: Department of Adult Joint Reconstruction, National Rehabilitation Institute of Mexico, Mexico City, Mexico.
authors.forename: Carlos
authors.initials: C
authors.lastname: Suarez-Ahedo
authors.affiliation: Department of Adult Joint Reconstruction, National Rehabilitation Institute of Mexico, Mexico City, Mexico.
authors.forename: Marco
authors.initials: M
authors.lastname: Acuña
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001175:Arthrography; D001182:Arthroscopy / Q000379:methods; D005260:Female; D006615:Hip / Q000601:surgery; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016658:Psoas Muscles / Q000002:abnormalities* / Q000601:surgery; D012008:Recurrence; D052256:Tendinopathy / Q000601:surgery*; D013710:Tendons / Q000002:abnormalities* / Q000601:surgery; D058971:Tenotomy / Q000379:methods*