Psoas impingement causing labrum tear: a series from three tertiary hip arthroscopy centers

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Hip Arthroscopy

Background:

• Hip impingement is commonly linked to psoas impingement post-arthroplasty or femoroacetabular impingement (FAI).
• A less recognized cause involves the psoas tendon impinging on the acetabular labrum medially, distinct from typical FAI labral lesions.
• The anatomy, pathology, and treatment of this specific psoas-related labral pathology remain largely uncharacterized.

Purpose of the Study:

• To describe the successful arthroscopic treatment for a newly identified cause of hip pain in young athletes.
• To highlight the importance of recognizing this entity for appropriate management of labral and psoas tendon issues.
• To differentiate this condition from bony pathology or coxa saltans.

Main Methods:

• Retrospective review of 700 hip arthroscopies performed by three fellowship-trained hip arthroscopists.
• Inclusion criteria: Athletes with labrum tears (2-3 o'clock position) and exclusion of osteoarthritis, significant bony abnormalities, or coxa saltans.
• All patients underwent arthroscopic hip surgery with psoas tendon release and, when indicated, labrum repair; pre- and postoperative Harris Hip Scores were recorded.

Main Results:

• Twenty-two patients (26 hips) with psoas impingement-induced labral tears and no other significant hip abnormalities were identified; most were female, with an average age of 19.
• Labral repair was performed in 20 patients, averaging 1.2 anchors per hip.
• Significant improvement in hip function was observed, with an average Harris Hip Score increase from 70 preoperatively to 94 postoperatively (minimum 6-month follow-up for 16 patients).
• No major complications were reported.

Conclusions:

• A recently recognized cause of hip pain in athletes involves labrum pathology associated with the psoas tendon, rather than bony abnormalities.
• Arthroscopic treatment, including psoas tendon release and medial labrum repair, offers short-term relief without significant complications.
• Understanding this unique pathoanatomy aids surgeons in informed consent, surgical planning for medial labrum repair, and appropriate patient referral.