Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 1/2011

01-01-2011 | Case Report

Case Report: Bifid Iliopsoas Tendon Causing Refractory Internal Snapping Hip

Authors: Beatrice Shu, MD, Marc R. Safran, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2011

Login to get access

Abstract

Background

Treatment of painful internal snapping hip (coxa saltans) via arthroscopic lengthening or release of the iliopsoas tendon is becoming preferred over open techniques because of the benefits of minimal dissection, the ability to address concomitant intraarticular disorders, and a low complication rate. Persistent snapping after release is uncommon, especially when performed arthroscopically. Reported causes include incomplete release, intraarticular disorders, and incorrect diagnosis. Anatomic variants are not discussed in the orthopaedic literature.

Case Description

We report a case of an 18-year-old softball player with internal snapping hip treated with arthroscopic iliopsoas release in the peripheral compartment. Postoperatively, the athlete continued to have painful snapping. Repeat arthroscopy with a larger capsulotomy revealed a bifid iliopsoas tendon causing refractory internal snapping hip, which resolved after revision arthroscopic release.

Literature Review

Bifid iliopsoas tendon as a cause of persistent snapping of the hip has not been reported in the orthopaedic literature. Prior sonographic and anatomic studies suggest the bifid iliopsoas tendon exists but is uncommon.

Purpose and Clinical Relevance

Recognition that a bifid iliopsoas tendon may be the source of painful internal snapping hip is important to prevent clinical failure of surgical management of the internal snapping hip. The differential diagnosis of failed iliopsoas lengthening surgery should include the consideration of an incompletely lengthened tendon attributable to bifid iliopsoas tendon anatomy. Prevention of this complication includes making a large enough capsulotomy to identify the tendon and to ensure it is not bifid.
Literature
1.
Allen WC, Cope R. Coxa saltans: the snapping hip revisited. J Am Acad Orthop Surg. 1995;3:303–308.PubMed
2.
Anderson SA, Keene JS. Results of arthroscopic iliopsoas tendon release in competitive and recreational athletes. Am J Sports Med. 2008;36:2363–2371.CrossRefPubMed
3.
Byrd JW. Evaluation and management of the snapping iliopsoas tendon. Instr Course Lect. 2006;55:347–355.PubMed
4.
Deslandes M, Guillin R, Cardinal E, Hobden R, Bureau NJ. The snapping iliopsoas tendon: new mechanisms using dynamic sonography. AJR Am J Roentgenol. 2008;190:576–581.CrossRefPubMed
5.
Flanum ME, Keene JS, Blankenbaker DG, Desmet AA. Arthroscopic treatment of the painful “internal” snapping hip: results of a new endoscopic technique and imaging protocol. Am J Sports Med. 2007;35:770–779.CrossRefPubMed
6.
7.
Guillin R, Cardinal E, Bureau NJ. Sonographic anatomy and dynamic study of the normal iliopsoas musculotendinous junction. Eur Radiol. 2009;19:995–1001.CrossRefPubMed
8.
Gruen GS, Scioscia TN, Lowenstein JE. The surgical treatment of internal snapping hip. Am J Sports Med. 2002;30:607–613.PubMed
9.
Hoskins JS, Burd TA, Allen WC. Surgical correction of internal coxa saltans: a 20-year consecutive study. Am J Sports Med. 2004;32:998–1001.CrossRefPubMed
10.
Ilizaliturri VM Jr, Chaidez C, Villegas P, Briseno A, Camacho-Galindo J. Prospective randomized study of 2 different techniques for endoscopic iliopsoas tendon release in the treatment of internal snapping hip syndrome. Arthroscopy. 2009;25:159–163.CrossRefPubMed
11.
Ilizaliturri VM Jr, Villalobos FE Jr, Chaidez PA, Valero FS, Aguilera JM. Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy. 2005;21:1375–1380.CrossRefPubMed
12.
Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med. 1990;18:470–474.CrossRefPubMed
13.
Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign.” J Orthop Res. 2007;25:758–765.CrossRefPubMed
14.
Jelev L, Shivarov V, Surchev L. Bilateral variations of the psoas major and the iliacus muscles and presence of an undescribed variant muscle—accessory iliopsoas muscle. Ann Anat. 2005;187:281–286.CrossRefPubMed
15.
Lyons JC, Peterson LF. The snapping iliopsoas tendon. Mayo Clin Proc. 1984;59:327–329.PubMed
16.
Omeroglu H, Biçimoglu A, Aguş H, Tümer Y. Measurement of center-edge angle in developmental dysplasia of the hip: a comparison of two methods in patients under 20 years of age. Skeletal Radiol. 2002;31:25–29.CrossRefPubMed
17.
Reynolds D, Lucas J. Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.CrossRefPubMed
18.
19.
20.
Tatu L, Parratte B, Vuillier F, Diop M, Monnier G. Descriptive anatomy of the femoral portion of the iliopsoas muscle: anatomical basis of anterior snapping of the hip. Surg Radiol Anat. 2001;23:371–374.CrossRefPubMed
21.
Wettstein M, Jung J, Dienst M. Arthroscopic psoas tenotomy. Arthroscopy. 2006;22:907e1–4.
22.
Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip joint: with special reference to the complication of osteo-arthritis. Acta Chir Scand. 1939;83(suppl 58):1–135.
23.
Winston P, Awan R, Cassidy JD, Bleakney RK. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007;35:118–126.CrossRefPubMed
Metadata
Title
Case Report: Bifid Iliopsoas Tendon Causing Refractory Internal Snapping Hip
Authors
Beatrice Shu, MD
Marc R. Safran, MD
Publication date
01-01-2011
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 1/2011
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-010-1452-z

Other articles of this Issue 1/2011

Clinical Orthopaedics and Related Research® 1/2011 Go to the issue

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Do “Premium” Joint Implants Add Value?: Analysis of High Cost Joint Implants in a Community Registry

Clinical Research

Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial

Surgical Technique

Extraarticular Knee Resection for Sarcomas with Preservation of the Extensor Mechanism: Surgical Technique and Review of Cases

Symposium: Papers Presented at the Annual Meetings of the Knee Society

Wear and Lysis is the Problem in Modular TKA in the Young OA Patient at 10 Years

Clinical Research

Effect of Prior Salter or Chiari Osteotomy on THA with Developmental Hip Dysplasia

Symposium: Papers Presented at the Annual Meetings of the Knee Society

The Chitranjan Ranawat Award: Fate of Two-stage Reimplantation After Failed Irrigation and Débridement for Periprosthetic Knee Infection