Reconstruction of hip flexion after arthroscopic iliopsoas tendon release using free functional muscle

We present the case of a physically active 50-year-old patient who underwent an arthroscopic release of the iliopsoas tendon due to a snapping hip. Postoperatively, active hip flexion was severely weakened. As a consequence patient had no stable gait pattern and was unable to continue her sports and physical activities. An MRI scan revealed an atrophy of the iliopsoas muscle. We reconstructed the patient's hip flexion function using a free functional muscle transfer of the ipsilateral gracilis muscle. After reinnervation of the microsurgically transferred gracilis muscle, the patient developed a strong hip flexion again, so that her gait pattern returned to normal and she was able to do strength training and ride a bicycle again. This case shows a very rare but serious complication of the frequently performed iliopsoas release. Functional reconstructions of hip flexion have only been described in single cases. To our knowledge, no case of free functional muscle transfer for the reconstruction of the hip flexion has been described in the literature. We can present a successful complex method for active reconstruction.