Arthroscopic Psoas Management: Techniques for Psoas Preservation and Psoas Tenotomy

The iliopsoas tendon is an important dynamic stabilizer of the hip joint, and it should be carefully identified and preserved during routine hip arthroscopy. However, it may also be a source of hip pain manifesting as iliopsoas tendinitis or a snapping hip or contributing to the development of labral pathology caused by psoas impingement. In the appropriately indicated, refractory cases of iliopsoas-related hip pain, surgical intervention in the form of an iliopsoas tenotomy at the level of the labrum can result in reliable pain relief. We describe a method to identify and protect the iliopsoas tendon during routine hip arthroscopy when preservation is desired. In addition, we detail how to deepen the psoas tunnel if psoas impingement is present but psoas tenotomy is contraindicated. We also describe a reproducible technique of arthroscopic iliopsoas tenotomy using standard portals and minimal equipment when indicated.