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Iliopsoas impingement and tendinopathy

47 citationsUpdated Oct 2026
Illustration: hip

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Overview

Anterior iliopsoas impingement and tendinopathy are significant causes of persistent groin pain and disability following total hip arthroplasty, often resulting from mechanical irritation or impingement of the tendon [1, 8]. This pathology is also underdiagnosed in the athletic population, where efficient examination and accurate diagnosis are essential for management [2]. Patients with symptomatic femoroacetabular impingement typically present with insidious onset of groin pain, limited hip motion, and a significant delay in diagnosis, frequently having received inaccurate prior diagnoses [3]. Anterior iliopsoas impingement caused by large-diameter metal-on-metal femoral heads represents a potential failure mechanism for persistent groin pain [7].

Treatment options for symptomatic iliopsoas pathology include conservative management, iliopsoas tenotomy or fractional lengthening, and revision total hip arthroplasty with acetabular implant revision [6]. Surgical intervention is usually highly successful for the relief of groin pain and disability resulting from anterior iliopsoas impingement and tendinitis after total hip arthroplasty [1]. Ultrasound-guided corticosteroid injection appears to be safe and effective in the diagnosis and treatment of iliopsoas tendonitis following primary total hip arthroplasty [11]. Arthroscopic release of the iliopsoas tendon was effective in alleviating pain and persistent clicking associated with a snapping hip [5].

Central transcapsular iliopsoas tendon release has excellent clinical results [14]. Endoscopic iliopsoas tenotomy provides good mid-term clinical outcomes in patients with iliopsoas tendinopathy following total hip arthroplasty [15], and arthroscopic tenotomy for refractory iliopsoas tendinopathy may be appealing because of its less invasive nature [16]. Endoscopic or arthroscopic tenotomy for impingement between the acetabular component and the iliopsoas tendon following total hip replacement significantly alleviated anterior pain in more than 92% of cases [21]. Cup revision is effective in resolving the pain due to ilio-psoas impingement in selected patients, with 85% of patients satisfied at last follow-up [17]. An anatomical acetabular component could prove valuable in the correction of iliopsoas impingement in highly selected patients [4]. Surgeons should employ a high threshold when selecting patients for arthroscopic iliopsoas release in the comprehensive treatment of femoroacetabular impingement with internal snapping hip [12]. Tenotomy in patients with iliopsoas pathology undergoing arthroscopic surgery for femoroacetabular impingement is infrequently performed and is associated with poorer outcomes [9]. A minimum capsulotomy length of 10 mm or greater is recommended when performing an iliopsoas release from the peripheral compartment to ensure the iliopsoas has been appropriately lengthened [19]. Endoscopic tenotomy should be considered as a treatment option in patients with iliopsoas impingement after total hip arthroplasty [18].

Anatomy & Pathophysiology

Bony Anatomy and Joint Structure

The hip is a multiaxial ball-and-socket diarthrodial joint formed by the articulation between the pelvis and femur, connecting the axial skeleton and the lower extremity [48]. Stability is based primarily on the bony architecture [45]. The hemipelvis comprises the ilium, ischium, and pubis, which unite at the triradiate cartilage within the concave acetabulum [48]. The acetabulum consists of an articular crescent-moon–shaped lunate surface and a nonarticular central fossa that serves as the attachment point for the ligamentum teres [48]. The acetabular labrum is a fibrocartilaginous ring attached to the rim of the acetabulum that extends the articulating surface area and increases femoral head coverage [48]. Triangular in cross section, the labrum creates a pressurized seal of the central compartment during loading [48]. Only the external one-third of the labrum contains blood vessels, leaving the majority avascular and limiting healing ability following injury [48].

The femoral head forms two-thirds of a sphere, with a small central depression from which the ligamentum teres extends to connect to the acetabular notch [48]. The neck-shaft angle averages 125° [48] or 127° [54], beginning at 141° in the fetus [54]. This angle allows for greater mobility by placing the head and neck more perpendicular to the acetabulum in a neutral position [48]. Normal version, defined as the head-neck angle in the frontal plane, averages 15 to 20° [48]. The femoral neck is normally anteverted approximately 14 degrees in relation to the femoral condyles, with a range of 1 to 40 degrees [54]. The angular projection of the femoral head and neck in relation to the obliquely placed acetabulum allows for rotary movements and prevents impingement [48].

The acetabulum is normally anteverted 15 degrees and obliquely oriented in the coronal plane 45 degrees caudally [54]. The posterosuperior articular surface is thickened to accommodate weight bearing [54]. The inferior surface contains the acetabular (cotyloid) notch, which is bound by the transverse acetabular ligament [54]. The iliopsoas muscle and tendon traverse a groove between the iliopectineal eminence and the anterior inferior iliac spine (AIIS) [54]. The hip joint capsule extends anteriorly to the intertrochanteric crest but posteriorly only partially across the femoral neck, leaving the basicervical and intertrochanteric crest regions extracapsular [45].

Ligaments and Capsule

The hip is surrounded by a dense fibrous capsule extending from the periphery of the acetabulum to the intertrochanteric line of the femoral neck, which enhances joint stability by preventing translation of the femoral head [48]. The Y-shaped iliofemoral ligament is the thickest and strongest of the three main ligaments supporting the hip [48]. Its medial portion connects the anterior inferior iliac spine to the anterior intertrochanteric line, while the lateral portion originates slightly superior to the medial arm and attaches to the anterior greater trochanter [48]. The iliofemoral ligament functions to limit external rotation, while in isolation, the lateral arm limits extension of the joint [48]. It becomes taut in full extension, preventing anterior dislocation and hyperextension [49]. The twisted orientation of the hip ligaments provides a screw mechanism for the hip in full extension [49].

The ischiofemoral ligament extends from the ischial margin of the acetabulum to the greater trochanter of the femur, providing support posteriorly and restricting internal rotation motion [48]. The pubofemoral ligament extends from the obturator crest of the pubic bone to the femoral neck and acts to limit abduction of the joint [48]. Deep fibers from the iliofemoral, ischiofemoral, and pubofemoral ligaments merge to form the zona orbicularis, which circumvents the femoral neck [48]. The ligamentum teres originates in the cotyloid fossa and attaches on the fovea of the femoral head [49]. It transmits an arterial branch of the posterior division of the obturator artery to the femoral head, which is less significant in adults [45].

Muscular Anatomy

The primary hip flexor muscles are the iliopsoas, rectus femoris, and sartorius [56]. The iliopsoas muscle has a large origin along the iliac crest, iliac fossa, sacra ala, iliolumbar ligaments, and sacroiliac ligaments [56]. It also originates along the bodies of the T12 through L4 thoracic lumbar vertebra, the transverse process of the first through fifth lumbar vertebra, and the intervertebral disks [56]. The rectus femoris crosses the hip and knee joints, with the straight head originating from the AIIS and the reflected head originating from the supra-acetabular tubercle at the superior-anterior edge of the acetabulum [56]. The sartorius originates on the ASIS, crosses the hip and knee joints, and inserts on the medial aspect of the tibia and the pes anserine complex [56]. The tensor fasciae latae originates laterally on the anterolateral edge of the iliac crest, with its fibers combining with the fasciae latae to form the iliotibial band [56]. Its action is to flex, abduct, and rotate the hip [56]. Other flexors include the pectineus, adductor longus, adductor brevis, magnus, and gracilis muscles [56].

The iliopsoas tendon flips back and forth across the anterior hip and pectineal eminence, lying lateral to the center of the femoral head with flexion and shifting medial to the center of the femoral head with extension [20]. The iliopsoas muscle fibers run parallel to the iliopsoas tendon, and the bulk of this remaining muscle attaches directly onto the proximal femoral shaft without a tendon [40].

Pathophysiology and Clinical Presentation

Patients with symptomatic femoroacetabular impingement typically present with insidious onset of groin pain, limited hip motion, and a significant delay in diagnosis with frequent inaccurate prior diagnoses [3]. In one study of athletes, 60% were treated for an average of 7 months before it was recognized that the joint may be the source of symptoms [20]. Hip joint disease and lumbar spine disease often coexist in athletes, particularly in sports where rotational velocity is a premium, such as baseball or golf [20]. Athletic pubalgia can be confused with a hip joint problem because the symptoms emanate from the groin area, and there is a significant prevalence of coexistent hip disorders along with athletic pubalgia [20]. Reduced rotational motion of the hip is compensated by increased pelvic motions, which put greater stress on the pelvic stabilizers and can result in a breakdown of these soft tissue pelvic structures characterized as athletic pubalgia [20].

Increased joint hypermobility, quantified by the Beighton score, is associated with an increased risk of iliopsoas tendinitis developing in the hip arthroscopy postoperative period in patients treated for femoroacetabular impingement and labral pathology [13]. At 5 years, young athletes with limited hip range of motion showed increased progressive degenerative changes on MRI and radiographs compared with matched controls [23]. The iliopsoas tendon may be an important passive and dynamic stabilizer of the hip, and release may result in a greater alteration of kinematics with high-demand activities [27]. After arthroscopic tenotomy in patients with internal snapping hip, most patients are asymptomatic and recover flexion force with a regeneration of over 80% of the circumference of the psoas tendon [40]. In developmental dysplasia of the hip, the iliopsoas tendon is pulled tight across the capsular isthmus, contributing to narrowing and acting as a barrier to closed reduction [53]. The factors and mechanisms that define the effect of loading as “healthy” versus overuse for particular tendons are largely unknown [73]. The change in crimp amplitude in tendon is strongly correlated to mechanical tissue laxity at all loads and regions evaluated [74].

Classification

Diagnostic Challenges and Presentation

Disability resulting from iliopsoas pain and dysfunction remains underdiagnosed in the athletic population, making efficient examination and accurate diagnosis essential [2]. Diagnostic accuracy is further complicated by the lack of correlation between physical examination findings or imaging results from ultrasound and MRI and a positive response to peritendinous iliopsoas corticosteroid injections in patients with suspected iliopsoas tendinopathy [22]. The HEC test serves as an accurate diagnostic maneuver for iliopsoas tendinopathy, offering improved sensitivity and specificity compared with conventional tests [25]. Additionally, iliopsoas bursitis, although uncommon, can complicate a well-functioning total hip arthroplasty with a ceramic bearing and cause significant morbidity if complicated by femoral neuropathy or venous thrombosis [34].

Anatomical and Pathological Variants

A bifid iliopsoas tendon can cause refractory internal snapping hip [19]. When performing an iliopsoas release from the peripheral compartment, an adequate capsulotomy of at least 10 mm or greater is recommended as the minimum length to visualize both tendons and ensure the iliopsoas has been appropriately lengthened by sectioning one or both tendons, if two exist [19]. The psoas tendon may act as an important passive and dynamic stabilizer of the hip; consequently, release may result in a greater alteration of kinematics with high-demand activities [27].

Coexistent and Compensatory Conditions

Athletic pubalgia, also known as "sports hernia," is a condition that often occurs in athletes and can be confused with a hip joint problem because the symptoms emanate from the groin area [20]. There is a significant prevalence of coexistent hip disorders along with athletic pubalgia [20]. Diagnosis and appropriate treatment of coexisting femoroacetabular impingement syndrome are crucial to a successful return to athletic activity [24].

Clinical Presentation

General Presentation and Diagnosis

Hip joint disorders frequently remain undetected for prolonged periods; in one study of athletes, 60% were treated for an average of 7 months before the joint was recognized as the pain source [20]. Athletic pubalgia, a condition common in athletes, often mimics hip joint pathology because symptoms emanate from the groin area [20]. Diagnosis and appropriate treatment of coexisting femoroacetabular impingement syndrome are crucial for a successful return to athletic activity in patients with athletic pubalgia [24].

Physical examination maneuvers that isolate the iliopsoas demonstrate high sensitivity and positive predictive value for diagnosing iliopsoas tendinitis when benchmarked against responses to an imaging-guided injection [26]. These specific maneuvers include: * Seated hip flexion weakness * Pain with seated hip flexion * Tenderness to palpation of the iliopsoas tendon

Neither physical examination nor ultrasound or MRI findings were associated with a positive response to peritendinous iliopsoas corticosteroid injections in patients with suspected iliopsoas tendinitis [22]. Dynamic ultrasound is a useful tool to detect pathological abnormalities, and diagnostic hip injections can be helpful to differentiate between the sources of pain [30].

Coexistent and Complicating Conditions

Iliopsoas bursitis, although uncommon, can complicate a well-functioning total hip arthroplasty with a ceramic bearing and cause significant morbidity if complicated by femoral neuropathy or venous thrombosis [34]. Non-infective iliopsoas bursitis may occur as a complication of hip replacement, potentially as a reactive phenomenon to polyethylene wear even without direct communication with the joint [35].

Investigations

Clinical Examination

Physical examination maneuvers that isolate the iliopsoas, specifically seated hip flexion (SHF) weakness, pain with SHF, and tenderness to palpation (TTP) of the IP tendon, demonstrate high sensitivity and positive predictive value for diagnosing IP tendinitis when benchmarked against responses to an imaging-guided injection [26]. A thorough understanding of normal anatomy and biomechanics is necessary to identify pathology and determine the appropriate course of treatment for hip pain [37]. Clinical examination tests and imaging findings should be used to confirm a suspected clinical diagnosis of hip pain [37].

Imaging

Plain radiography: Conventional radiographs remain critical in the initial imaging evaluation of the hip [38]. A complete hip series usually is composed of a combination of views, including an anterior-posterior (AP) pelvis, a centered AP hip, a lateral view (frog-leg, cross-table, Dunn 45° or 90°), and a false-profile (Lequesne) view [38]. The femoral head-neck junction morphology is often assessed using the alpha angle on radiographs [38]. Some studies have shown that radiographs, in particular the Dunn 45° view, may be more accurate for determining the alpha angle measurement than CT or MRI [38].

MRI: For patients suspected of soft tissue or intra-articular pathology, MRI is the modality of choice, given its superior sensitivity and specificity [65]. Conventional MRI is effective at identifying osteochondral injuries, musculotendinous pathologies, and inflammation [65]. The soft-tissue contrast of MRI is superior to other imaging modalities in assessing both intra-articular and extra-articular hip pathology [50]. Noncontrast MRI at 3T is generally adequate for diagnosing intra-articular pathology [68]. If 3T imaging is unavailable, MRA can be considered at 1.5T for increased diagnostic accuracy [68]. Magnetic resonance arthrography (MRA) is more appropriate to determine injuries to the labrochondral structures and the ligamentum teres and identify the presence of loose bodies and synovial chondromatosis [65]. MRA can further increase conspicuity of intra-articular lesions and is useful following hip preservation surgeries [50]. A dynamic radial 2D-GRE sequence can be added to standard hip MR arthrogram protocols in routine clinical practice [32]. In the accurate detection and staging of articular cartilage lesions, the utility of MRA is reduced, with sensitivity reported to be less than 50% compared with arthroscopic findings [65].

CT: CT scans are effective for examining cortical and cancellous bone and can be used to create three-dimensional reconstructions of the hip for use in surgical planning [65]. Measurements of femoral head coverage and acetabular and femoral impingement can also be performed reliably using CT images [65]. CT overcomes the limitations of radiography by providing three-dimensional assessment of bony morphology and, to some degree, assessment of soft-tissue abnormalities [50].

Ultrasonography: Ultrasonography can be an effective modality to identify musculotendinous disruptions, effusions associated with intra-articular pathology, or inflammatory conditions, such as bursitis [65]. Ultrasonography provides real-time dynamic assessment of the hip and is useful in diagnosing soft-tissue abnormalities about the hip joint [50]. Dynamic ultrasound is a useful tool to detect pathological abnormalities such as groin hernias and adductor tendinopathy in patients with femoroacetabular impingement [30]. Ultrasonography provides dynamic assessment of structures such as tendon and nerve subluxation [69]. Ultrasonography is also being increasingly used for targeted injections into muscles, tendons, or intra-articularly around the hip [65]. Diagnostic hip injections can be helpful to differentiate between the sources of pain in patients with femoroacetabular impingement [30]. Ultrasonography cannot image inside bone because bone cortex reflects almost all sound waves [69]. Internal joint structures are not well visualized by ultrasonography unless they are in a superficial location [69]. Elastography is an ultrasonography technique that can assess the elasticity of soft tissues and identify pathology that changes the elasticity of soft-tissue structures, like tendinopathy, but this technology is used mostly in research studies and not for clinical use at this point [69].

Other Considerations: MRI is helpful in assessing complications of conventional and resurfacing hip arthroplasties, particularly those with metal-on-metal bearing systems [68]. Major findings on MRI that help predict histologic ALVAL scores include synovial thickening, synovitis, synovial volume, abductor disruption, and soft-tissue edema [68].

Treatment

Non-Operative

Conservative management constitutes a component of the treatment spectrum for symptomatic iliopsoas pathology [6]. Nonoperative treatment for iliopsoas impingement includes modification of activities, physical therapy, and oral nonsteroidal anti-inflammatory drugs [28]. Ultrasound-guided corticosteroid injections appear to be safe and effective in the diagnosis and treatment of iliopsoas tendonitis following primary total hip arthroplasty [11].

Operative

Surgical Approach / Technique: Tenotomy in patients with iliopsoas pathology undergoing arthroscopic surgery for femoroacetabular impingement is infrequently performed and is associated with poorer outcomes [9]. The psoas tendon may be an important passive and dynamic stabilizer of the hip, and release may result in a greater alteration of kinematics with high-demand activities [27]. When performing an iliopsoas release from the peripheral compartment, an adequate capsulotomy of at least 10 mm or greater is recommended as a minimum to ensure the iliopsoas has been appropriately lengthened by sectioning one or both tendons if two exist [19].

Revision: Revision total hip arthroplasty with acetabular implant revision is a treatment option for symptomatic iliopsoas pathology [6]. Cup revision is effective in resolving the pain due to ilio-psoas impingement in selected patients, with 85% of patients satisfied at last follow-up [17].

Complications

Postoperative Iliopsoas Pathology After Total Hip Arthroplasty

The provided evidence base does not contain specific data regarding postoperative iliopsoas pathology following total hip arthroplasty.

Postoperative Iliopsoas Pathology After Hip Arthroscopy

Tenotomy Outcomes: Tenotomy in patients with iliopsoas pathology undergoing arthroscopic surgery for femoroacetabular impingement is infrequently performed and is associated with poorer outcomes [9].

Rare Complications

Instability: Anterior dislocation of total hip arthroplasty after iliopsoas tenotomy in the setting of spinopelvic imbalance is a rare complication [16].

Recovery

Operative: Surgical intervention is usually highly successful for the relief of groin pain and disability resulting from anterior iliopsoas impingement and tendinitis [1]. Athletes that did not return to their pre-injury sport had a higher frequency of positive hip impingement test and inferior functional outcome compared with the athletes that did return to their pre-injury sport [42].

Key Evidence

  • [L5] Surgical intervention is usually highly successful for the relief of groin pain and disability resulting from anterior iliopsoas impingement and tendinitis. [1] (10.5435/00124635-200906000-00002)
  • [L5] Disability due to iliopsoas pain and dysfunction is underdiagnosed in the athletic population, and efficient examination and accurate diagnosis are essential. [2] (10.5435/jaaos-d-23-01166)
  • [L2] Patients with symptomatic femoroacetabular impingement typically present with insidious onset of groin pain, limited hip motion, and a significant delay in diagnosis with frequent inaccurate prior diagnoses. [3] (10.1007/s11999-008-0680-y)
  • [L4] Although our experience is limited and clinical follow-up of this patient is short, we believe that this component could prove valuable in the correction of iliopsoas impingement in highly selected patients. [4] (10.1016/j.arth.2010.12.020)
  • [L4] Arthroscopic release of the iliopsoas tendon was effective in alleviating pain and persistent clicking associated with a snapping hip. [5] (10.1177/0363546520922551)
  • [L5] Treatment for symptomatic iliopsoas pathology includes conservative management, iliopsoas tenotomy or fractional lengthening, and revision total hip arthroplasty with acetabular implant revision. [6] (10.5435/jaaos-d-25-00476)
  • [L4] Anterior iliopsoas impingement caused by large-diameter metal-on-metal femoral heads is a potential failure mechanism resulting in persistent groin pain. [7] (10.1016/j.arth.2010.10.002)
  • [L4] Mechanical irritation and impingement of the iliopsoas tendon is an important diagnosis to be considered in persistent groin pain after total hip arthroplasty. [8] (10.1007/s00402-020-03623-z)
  • [L3] Tenotomy in patients with iliopsoas pathology undergoing arthroscopic surgery for FAI is infrequently performed and is associated with poorer outcomes. [9] (10.1016/j.arthro.2021.02.018)
  • [L4] US-CSI appears to be safe and effective in the diagnosis and treatment of iliopsoas tendonitis following primary THA. [11] (10.1016/j.arth.2022.12.015)
  • [L3] Surgeons should employ a high threshold when selecting patients for this procedure in the comprehensive treatment of femoroacetabular impingement with internal snapping hip. [12] (10.1177/0363546515626173)
  • [L3] Increased joint hypermobility, quantified by the Beighton score, is associated with an increased risk of iliopsoas tendinitis developing in the hip arthroscopy postoperative period in patients treated for femoroacetabular impingement and labral pathology. [13] (10.1016/j.arthro.2022.02.015)
  • [L4] Central transcapsular iliopsoas tendon release has excellent clinical results. [14] (10.1016/j.arthro.2015.04.083)
  • [L4] Endoscopic iliopsoas tenotomy provides good mid‐term clinical outcomes in patients with iliopsoas tendinopathy following THA. [15] (10.1002/ksa.12103)
  • [Case_report] Arthroscopic tenotomy for refractory iliopsoas tendinopathy may be appealing because of its less invasive nature. [16] (10.1186/s12891-020-03711-6)
  • [L3] Cup revision is effective in resolving the pain due to ilio-psoas impingement in selected patients, with 85% of patients satisfied at last follow-up. [17] (10.1016/j.otsr.2017.07.021)
  • [L4] Endoscopic tenotomy should be considered as a treatment option in patients with iliopsoas impingement after THA. [18] (10.1016/j.arth.2019.03.030)
  • [L4] Performing an adequate capsulotomy of at least 10 mm or greater made it possible to see both tendons, and we recommend this length as a minimum capsulotomy when performing an iliopsoas release from the peripheral compartment to ensure the iliopsoas has been appropriately lengthened by sectioning one or both tendons, if two exist. [19] (10.1007/s11999-010-1452-z)
  • [L5] [20] (10.1177/0363546513499136)
  • [L4] Endoscopic or arthroscopic tenotomy for impingement between the acetabular component and the iliopsoas tendon following THR significantly alleviated anterior pain in more than 92% of cases. [21] (10.1016/j.otsr.2017.09.007)
  • [L3] Neither physical examination nor US or MRI findings were associated with a positive response to peritendinous iliopsoas corticosteroid injections in patients with suspected IPT. [22] (10.1016/j.arthro.2020.12.184)
  • [L2] At 5 years, young athletes with limited hip range of motion showed increased progressive degenerative changes on MRI and radiographs compared with matched controls. [23] (10.1177/0363546517719460)
  • [L5] Diagnosis and appropriate treatment of coexisting femoroacetabular impingement syndrome are crucial to a successful return to athletic activity. [24] (10.1016/j.arthro.2020.09.022)
  • [L2] The HEC test is an accurate diagnostic maneuver for iliopsoas tendinopathy offering improved sensitivity and specificity compared with conventional tests. [25] (10.1097/corr.0000000000003520)
  • [L3] Physical examination maneuvers that isolate the iliopsoas, specifically seated hip flexion (SHF) weakness, pain with SHF, and tenderness to palpation (TTP) of the IP tendon, demonstrated high sensitivity and positive predictive value for diagnosing IP tendinitis when benchmarked against responses to an imaging-guided injection. [26] (10.1177/03635465261428681)
  • [L4] The psoas tendon may be an important passive and dynamic stabilizer of the hip in these patients, and release may result in a greater alteration of kinematics with high-demand activities. [27] (10.1016/j.arthro.2011.11.028)
  • [L4] [28] (10.1177/0363546514531037)
  • [L4] Dynamic ultrasound is a useful tool to detect such pathological abnormalities, and diagnostic hip injections can be helpful to differentiate between the sources of pain. [30] (10.1177/0363546515591259)
  • [L4] A dynamic radial 2D-GRE sequence can be added to standard hip MR arthrogram protocols in routine clinical practice. [32] (10.1016/j.arthro.2019.02.049)
  • [L5] Iliopsoas bursitis, although uncommon, can complicate a well-functioning THA with a ceramic bearing and cause significant morbidity if complicated by femoral neuropathy or venous thrombosis. [34] (10.1016/j.arth.2008.06.006)
  • [L5] Non-infective iliopsoas bursitis may occur as a complication of hip replacement, potentially as a reactive phenomenon to polyethylene wear even without direct communication with the joint. [35] (10.1007/s00402-004-0751-9)
  • [L4] [40] (10.1016/j.arthro.2013.05.002)
  • [L4] The athletes that did not return to their pre-injury sport had higher frequency of positive hip impingement test and inferior functional outcome compared with the athletes that did return to their pre-injury sport. [42] (10.1007/s00167-013-2738-y)
  • [L5] The factors and mechanisms that define the effect of loading as “healthy” versus overuse for particular tendons are largely unknown. [73] (10.1002/jor.22869)
  • [L5] The change in crimp amplitude was strongly correlated to mechanical tissue laxity at all loads and regions evaluated. [74] (10.1002/jor.22875)

See Also

References

[1] Anterior Iliopsoas Impingement and Tendinitis After Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200906000-00002

[2] The Iliopsoas: Anatomy, Clinical Evaluation, and Its Role in Hip Pain in the Athlete: A Scoping Review. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-01166

[3] Clinical Presentation of Patients with Symptomatic Anterior Hip Impingement. Clinical Orthopaedics & Related Research. 2009. DOI: 10.1007/s11999-008-0680-y

[4] Use of an Anatomical Acetabular Component for Treatment of Iliopsoas Impingement. The Journal of Arthroplasty. 2011. DOI: 10.1016/j.arth.2010.12.020

[5] Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of Postoperative Outcomes. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520922551

[6] Iliopsoas Tendonitis and Impingement After Total Hip Arthroplasty. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00476

[7] Failure of Larger-Diameter Metal-on-Metal Total Hip Arthroplasty Resulting from Anterior Iliopsoas Impingement. The Journal of Arthroplasty. 2011. DOI: 10.1016/j.arth.2010.10.002

[8] Results after arthroscopic treatment of iliopsoas impingement after total hip arthroplasty. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03623-z

[9] Tenotomy for Iliopsoas Pathology is Infrequently Performed and Associated with Poorer Outcomes in Hips Undergoing Arthroscopy for Femoroacetabular Impingement. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.02.018

[11] Ultrasound-Guided Iliopsoas Bursal Injections for Management of Iliopsoas Bursitis After Total Hip Arthroplasty. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2022.12.015

[12] The Functional and Structural Outcomes of Arthroscopic Iliopsoas Release. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546515626173

[13] Joint Hypermobility Is Associated With Increased Risk of Postoperative Iliopsoas Tendinitis After Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy. 2022. DOI: 10.1016/j.arthro.2022.02.015

[14] Internal Snapping Hip Syndrome: Incidence of Multiple‐Tendon Existence and Outcome After Endoscopic Transcapsular Release. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.04.083

[15] Satisfactory mid‐term clinical outcomes of endoscopic tenotomy for iliopsoas tendinopathy following total hip arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12103

[16] Anterior dislocation of THA after Iliopsoas tenotomy in spinopelvic imbalance: a rare case report. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03711-6

[17] Outcomes of cup revision for ilio-psoas impingement after total hip arthroplasty: Retrospective study of 46 patients. Orthopaedics & Traumatology: Surgery & Research. 2017. DOI: 10.1016/j.otsr.2017.07.021

[18] Evaluation of Endoscopic Iliopsoas Tenotomy for Treatment of Iliopsoas Impingement After Total Hip Arthroplasty. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2019.03.030

[19] Case Report: Bifid Iliopsoas Tendon Causing Refractory Internal Snapping Hip. Clinical Orthopaedics & Related Research. 2011. DOI: 10.1007/s11999-010-1452-z

[20] Femoroacetabular Impingement in Athletes. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513499136

[21] Endoscopic or arthroscopic iliopsoas tenotomy for iliopsoas impingement following total hip replacement. A prospective multicenter 64-case series. Orthopaedics & Traumatology: Surgery & Research. 2017. DOI: 10.1016/j.otsr.2017.09.007

[22] The Limited Reliability of Physical Examination and Imaging for Diagnosis of Iliopsoas Tendinitis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.12.184

[23] Cam Deformities and Limited Hip Range of Motion Are Associated With Early Osteoarthritic Changes in Adolescent Athletes: A Prospective Matched Cohort Study. The American Journal of Sports Medicine. 2017. DOI: 10.1177/0363546517719460

[24] Athletic Pubalgia (Sports Hernia): Presentation and Treatment. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.09.022

[25] Evaluation of Clinical Tests to Diagnose Iliopsoas Tendinopathy. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003520

[26] Can a Clinician Accurately Diagnose Iliopsoas Tendinitis on a Physical Examination?. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261428681

[27] Clinical Outcomes After Arthroscopic Psoas Lengthening: The Effect of Femoral Version. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2011.11.028

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