Editorial Commentary: Balancing Pain Relief and Function With Iliopsoas Tendon Treatment and Concomitant Hip Arthroscopy for the Internal Snapping Hip

Internal snapping hip (ISH) is a relatively rare pathology in which the iliopsoas tendon "snaps" over anterior hip structures, causing pain and debilitation to patients. Although conservative management is routinely successful, patients will occasionally progress past the conservative measures and opt for surgical management. The advent of arthroscopy in treating hip pathology has provided a novel avenue in treating this patient population; however, identifying the specific technique that balances adequate symptomatic relief while preserving biomechanical function has proven difficult in recent literature. The progression of treatment for this pathology has focused on total tenotomies in the past; however, any tenotomizing procedure is not without its complications. Thus, other more preservative approaches have been explored in recent studies, attempting to mitigate as much iatrogenic musculotendinous damage as possible, which theoretically should limit complications and improve patient outcomes. Iliopsoas tunnel deepening with concomitant hip arthroscopy is an exciting new adjunct to hip arthroscopy. It may prove to be an adequate approach for treating ISH in specific patient populations with future studies corroborating its success and complication rates.