Researchers at Hospital for Special Surgery have identified a group of patients who may not respond favorably to surgery for a snapping psoas tendon, according to a study presented at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine.
“The conclusion from this study is that you should be cautious about releasing the psoas tendon, particularly in cases where there is some structural instability in the hip, specifically decreased femoral anteversion, because although the tendon may be causing pain, it is also providing some dynamic support to the hip so it can cause problems if it is released,” study author Bryan T. Kelly, MD, stated in a Hospital for Special Surgery release.
The study authors investigated 67 patients who underwent arthroscopic lengthening of a symptomatic psoas tendon. Preoperative CT scans on these patients defined proximal femoral morphology. Femoral anteversion was used to categorize patients into two groups — 48 patients with low or normal anteversion (<25°) and 19 patients with high anteversion (>25°).
Modified Harris Hip Scores (HHS) and Hip Outcome Scores (HOS) were used to assess preoperative and postoperative outcomes. The team found significant differences between the groups, with the high anteversion group displaying a strong association with a worse HOS-Sport subscale — but no difference in the HOS-Activities of Daily Living subscale.
The team also found, however, that patients who had high anteversion scored significantly worse on the HHS questionnaire with regard to athletic and daily living activities. Furthermore, twice as many patients who had high anteversion eventually had to undergo revision surgery.
“The results of this study indicate that there are certain groups of patients that respond very favorably to surgical treatment of the psoas tendon; but there are other groups of patients, who due to mechanical reasons, surgeons should exercise extreme caution in proceeding with any tendon release around the hip,” Kelly stated.
For further information: http://www.orthosupersite.com/view.aspx?rid=86618
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