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MR Appearance and Clinical Significance of Changes in the Hip Muscles and Iliopsoas Tendon After Arthroscopic Iliopsoas Tenotomy in Symptomatic Patients.

ABSTRACT: BACKGROUND: Iliopsoas tenotomy is a treatment for snapping hip. Does this surgical procedure change the surrounding muscle and tendon anatomy? QUESTIONS/PURPOSES: This study seeks to evaluate the changes in the MR appearance of the hip muscles and iliopsoas tendon in patients following arthroscopic iliopsoas tenotomy. METHODS: One hundred sixty-nine consecutive adults were evaluated after iliopsoas tenotomy at the lesser trochanter. Each MR exam was evaluated independently by three radiologists for muscle edema, atrophy (grade 0-4), compensatory hypertrophy, signal within the iliopsoas tendon (increased on T1 or T2 sequences), and iliopsoas tendon morphology (distorted or disrupted) above, at, and below the iliopectineal eminence. A finding was considered positive if reported by two or three of the radiologists. RESULTS: Twenty subjects met the inclusion criteria. Muscle edema was present in 15% (3/20) of subjects within the iliacus, psoas, and quadratus femoris. Atrophy was observed in the following muscles: iliacus 85% (17/20), psoas 75% (15/20), quadratus femoris 10% (2/20), rectus femoris 5% (1/20), vastus lateralis 5% (1/20), and gluteus maximus 25% (5/20). There was no compensatory hypertrophy. Ninety percent (18/20) had increased T1 and 10% (2/20) had increased T2 signal within the iliopsoas tendon. Thirty-five percent (7/20) of the iliopsoas tendons was disrupted and 85% (17/20) was distorted, most commonly below the iliopectineal eminence. CONCLUSION: The majority of postoperative symptomatic patients has atrophy of the iliacus and psoas muscles and distortion and disruption of the iliopsoas tendon and should be recognized as a normal imaging appearance following iliopsoas tendon release.

SUBMITTER: Hain KS

PROVIDER: S-EPMC3772171 | biostudies-other | 2013 Oct

REPOSITORIES: biostudies-other

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MR Appearance and Clinical Significance of Changes in the Hip Muscles and Iliopsoas Tendon After Arthroscopic Iliopsoas Tenotomy in Symptomatic Patients.

Hain Kendra S KS Blankenbaker Donna G DG De Smet Arthur A AA Keene James S JS Del Rio Alejandro Munoz AM

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20130821 3

<h4>Background</h4>Iliopsoas tenotomy is a treatment for snapping hip. Does this surgical procedure change the surrounding muscle and tendon anatomy?<h4>Questions/purposes</h4>This study seeks to evaluate the changes in the MR appearance of the hip muscles and iliopsoas tendon in patients following arthroscopic iliopsoas tenotomy.<h4>Methods</h4>One hundred sixty-nine consecutive adults were evaluated after iliopsoas tenotomy at the lesser trochanter. Each MR exam was evaluated independently by ...[more]

PMID: 24426875

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Project description:PurposeTo calculate the iliopsoas muscle/tendon ratio at 3 levels of arthroscopic iliopsoas tenotomy sites in fresh cadaveric specimens.MethodsAn anatomic study design was performed using 16 iliopsoas musculotendinous units from the level of the hip joint to their insertion on the lesser trochanter. All specimens came from 16 fresh cadaveric specimens (10 male, 6 female), with a median age of 41 years (range 31-55.25 years). Circumferential measurements of the composite musculotendinous unit and the iliopsoas tendon were then made at the lesser trochanter insertion, the site of transcapsular tenotomy, and the site of tenotomy at the level of the labrum. Anatomical variance of the iliopsoas tendon at the insertion on the lesser trochanter and muscular extension below the lesser trochanter level also were described. The difference between the median circumference of the iliopsoas musculotendinous units or the isolated tendons at the 3 levels was calculated.ResultsThe median circumference of the iliopsoas musculotendinous unit at the level of the labrum, orbicularis zone (transcapsular tenotomy site), and the lesser trochanter was 140.9 mm (range 137.9-148.9), 136.7 mm (range 132.9-140), and 99.5 mm (range 96.5-104.8), respectively. The median circumference of the iliopsoas tendon at these same levels was 25.6 mm (range 22.7-33.7), 28.9 mm (range 25.1-32.2), and 30.9 mm (range 27.9-36.1), respectively. Accordingly, the proportions of the iliopsoas muscle/tendon at the level of the labrum, the transcapsular tenotomy site, and the lesser trochanter insertion were 18% tendon/82% muscle, 21% tendon/79% muscle, and 31% tendon/69% muscle, respectively.ConclusionsThe proportions of the iliopsoas muscle/tendon at the level of the labrum, the transcapsular tenotomy site and the lesser trochanter insertion were 18% tendon/82% muscle, 21% tendon/79% muscle, and 31% tendon/69% muscle, respectively. The distal muscular projection below the tendinous insertion on the lesser trochanter may maintain the functional connection of the iliopsoas between origin and insertion even after releasing the tendon.Clinical relevanceThis finding may have implications for a new understanding of arthroscopic tenotomy of the iliopsoas around the hip, as previously described muscle/tendon proportions were not calculated in fresh cadavers.

Dataset Information

MR Appearance and Clinical Significance of Changes in the Hip Muscles and Iliopsoas Tendon After Arthroscopic Iliopsoas Tenotomy in Symptomatic Patients.

Publications

MR Appearance and Clinical Significance of Changes in the Hip Muscles and Iliopsoas Tendon After Arthroscopic Iliopsoas Tenotomy in Symptomatic Patients.

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