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Scientific Article   |    
Surgical Correction of the Snapping Iliopsoas Tendon in Adolescents
Matthew B. Dobbs, MD; J. Eric Gordon, MD; Scott J. Luhmann, MD; Deborah A. Szymanski, RN; Perry L. Schoenecker, MD
View Disclosures and Other Information
Investigation performed at Shriners Hospitals for Children, St. Louis Unit, and Saint Louis Children’s Hospital, St. Louis, Missouri

Matthew B. Dobbs, MD
J. Eric Gordon, MD
Scott J. Luhmann, MD
Perry L. Schoenecker, MD
Department of Orthopaedic Surgery, Saint Louis Children’s Hospital, Washington University School of Medicine, One Children’s Place, St. Louis, MO 63110. E-mail address for M.B. Dobbs: dobbsmatthew@hotmail.com
Deborah A. Szymanski, RN
Shriners Hospitals for Children, 2001 S. Lindbergh Boulevard, St. Louis, MO 63131
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

J Bone Joint Surg Am, 2002 Mar 01;84(3):420-424
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Abstract

Background: There have been very few reports regarding symptomatic snapping of the iliopsoas tendon, and none of those reports have dealt exclusively with an adolescent population. We report our experience with the surgical treatment of this entity in a group of patients who had an average age of fifteen years.

Methods: Nine adolescent patients (eleven hips) underwent fractional lengthening of the iliopsoas tendon at the musculotendinous junction because of persistent painful snapping of the hip. A modified iliofemoral approach to the iliopsoas tendon was used. The diagnosis in all cases was made on the basis of the history and a physical examination. Plain radiographs were made for all patients to rule out an osseous intra-articular loose body. Follow-up consisted of personal interviews and physical examinations performed at least two years postoperatively.

Results: Preoperatively, all patients had audible snapping with pain localized to the anterior part of the groin. The average duration of symptoms was 2.3 years. Prior to the onset of symptoms, all but one of the patients had been involved in competitive athletic activities. Postoperatively, all patients were able to return to the preoperative level of activity without subjective weakness. The average duration of postoperative follow-up was four years. Hip-flexion strength was noted to be nearly equal to that on the contralateral side. All patients reported that they would have the operation again under similar circumstances. One patient had recurrent snapping but stated that it was less frequent and less painful than the preoperative snapping. Two patients had transient sensory loss in the anterolateral aspect of the thigh.

Conclusions: We conclude that fractional lengthening of the iliopsoas tendon at the musculotendinous junction is an effective and safe approach for adolescent patients with persistent symptomatic snapping of the iliopsoas tendon that is unresponsive to conservative measures.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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