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Case report: Bifid iliopsoas tendon causing refractory internal snapping hip.

Beatrice Shu1, Marc R Safran

  • 1Department of Orthopaedic Surgery, Stanford University, 450 Broadway, M/C 6342, Redwood City, CA 94063, USA.

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|July 2, 2010
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Summary

A rare bifid iliopsoas tendon can cause persistent snapping hip after surgery. Recognizing this anatomical variant is crucial for successful surgical outcomes in athletes.

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Area of Science:

  • Orthopaedic Surgery
  • Sports Medicine
  • Anatomy

Background:

  • Arthroscopic iliopsoas tendon release is preferred for painful internal snapping hip due to minimal invasiveness and fewer complications.
  • Persistent snapping after arthroscopic release is uncommon but can result from incomplete release or undiagnosed intra-articular issues.
  • Anatomical variations of the iliopsoas tendon are not well-documented in existing literature regarding snapping hip syndrome.

Observation:

  • A case study of an 18-year-old softball player with persistent painful internal snapping hip following arthroscopic iliopsoas release.
  • Repeat arthroscopy revealed a bifid iliopsoas tendon as the cause of refractory symptoms.
  • Surgical resolution was achieved after a revision arthroscopic release addressing the bifid tendon.

Findings:

  • A bifid iliopsoas tendon is identified as a previously unreported cause of persistent internal snapping hip.
  • This anatomical anomaly can lead to clinical failure of standard arthroscopic iliopsoas release procedures.
  • Prevalence of bifid iliopsoas tendon, though uncommon, is supported by prior sonographic and anatomical research.

Implications:

  • Clinicians must consider bifid iliopsoas tendon anatomy in the differential diagnosis of failed internal snapping hip surgery.
  • Ensuring adequate capsulotomy during arthroscopic release is vital to identify and address potential tendon bifurcations.
  • Accurate diagnosis and surgical management of bifid iliopsoas tendon are essential to prevent recurrence and ensure patient recovery.