Anatomical Study of the Ultrasound-guided Percutaneous Tenotomy of the Iliopsoas Muscle Tendon in Cadavers: A Feasible Technique?

Abstract

Objective To evaluate the efficacy and safety of percutaneous tenotomy of the iliopsoas muscle tendon guided by ultrasound (US) in cadavers.

Methods We conducted an anatomical and descriptive study of the US-guided percutaneous tenotomy technique for the iliopsoas muscle tendon to review our experience performing it and its reproducibility in the clinical practice.

Results Of the 20 tenotomies, 17 were total, at the level of the upper edge of the acetabulum, while 3 were partial. One procedure resulted in a partial injury to the femoral nerve. We measured the distance between the place of blade introduction and the femoral nerve, a noble structure potentially at a higher risk during the procedure; the mean distance was of 8.4 mm.

Conclusion Iliopsoas tendon release procedures guided by US in a cadaveric model are feasible and consistently result in the total release of the tendon, except in cases of obesity, with minimal repercussions on adjacent structures, and their completion requires approximately 4 minutes.

Keywords

cadaver - hip - hip joint - tenotomy - ultrasonography

Financial Support

The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.

Study conducted by the Hip Group, Orthopedics and Traumatology Department, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.

Publication History

Received: 29 May 2024

Accepted: 23 June 2024

Article published online:
11 April 2025

• Referências

• 1 Kalore NV, Maheshwari AV, Cheng EY. Evaluation and management of the painful total hip arthroplasty. J Am Acad Orthop Surg 2016; 24 (04) 231-242
• 2 Trousdale RT, Cabanela ME, Berry DJ. Anterior iliopsoas impingement after total hip arthroplasty. J Arthroplasty 1995; 10 (04) 546-549
• 3 Jacobson T, Allen WC. Surgical correction of the snapping iliopsoas tendon. Am J Sports Med 1990; 18 (05) 470-474
• 4 Taylor GR, Clarke NM. Surgical release of the 'snapping iliopsoas tendon'. J Bone Joint Surg Br 1995; 77 (06) 881-883
• 5 Wettstein M, Jung J, Dienst M. Arthroscopic psoas tenotomy. Arthroscopy 2006; 22 (08) 907.e1-907.e4
• 6 Sampson MJ, Rezaian N, Hopkins JM. Ultrasound-guided percutaneous tenotomy for the treatment of iliopsoas impingement: a description of technique and case study. J Med Imaging Radiat Oncol 2015; 59 (02) 195-199
• 7 Chalmers BP, Sculco PK, Sierra RJ, Trousdale RT, Berry DJ. Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes. J Bone Joint Surg Am 2017; 99 (07) 557-564
• 8 Ilizaliturri Jr VM, Villalobos Jr FE, Chaidez PA, Valero FS, Aguilera JM. Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy 2005; 21 (11) 1375-1380
• 9 Hoskins JS, Burd TA, Allen WC. Surgical correction of internal coxa saltans: a 20-year consecutive study. Am J Sports Med 2004; 32 (04) 998-1001
• 10 Bauer T, Boisrenoult P, Jenny JY. Post-arthroscopy septic arthritis: Current data and practical recommendations. Orthop Traumatol Surg Res 2015; 101 (8, Suppl) S347-S350
• 11 Go CC, Kyin C, Chen JW, Domb BG, Maldonado DR. Cost-Effectiveness of Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome and Labral Tears: A Systematic Review. Orthop J Sports Med 2021; 9 (03) 2325967120987538
• 12 Johnson WO, Sellon JL, Moore BJ, Levy BA, Lachman N, Finnoff JT. Ultrasound-Guided Iliopsoas Tendon Release: A Cadaveric Investigation. PM R 2021; 13 (04) 397-404
• 13 Parker A, Olewnik Ł, Iwanaga J, Dumont AS, Tubbs RS. Iliacus minor and psoas quartus muscles traversing the femoral nerve. Morphologie 2022; 106 (355) 307-309