Iliopsoas Tunnel Deepening and Fractional Lengthening Relieve Painful Internal Snapping During Concomitant Primary Hip Arthroscopy for Treatment of Femoroacetabular Impingement: A Propensity Matched Comparison

Purpose To report minimum 2‐year outcomes of iliopsoas tunnel deepening (ITD) during hip arthroscopy and compare their results to propensity‐matched hip arthroscopies performed with iliopsoas fractional lengthening (IFL) in patients with combined femoroacetabular impingement syndrome and iliopsoas impingement with painful internal snapping. Methods Data were collected between December 2017 and January 2022 and retrospectively reviewed for all patients who underwent primary hip arthroscopy to treat femoroacetabular impingement syndrome, labral tears, and iliopsoas impingement. Hips included had 2‐year minimum postoperative patient reported outcomes (PRO). Subjects receiving ITD were propensity matched to IFLs in a 1:1 ratio based on age, sex, body mass index, Acetabular Outerbridge Grade, labral treatment, and capsular treatment. Patient characteristics, procedures performed, and PROs were compared. Rates of meeting minimum clinically important difference and patient acceptable symptomatic state, revision arthroscopy, and conversion to arthroplasty were compared. Results A total of 33 ITD hips (30 patients) and 33 IFL hips (33 patients) were included in each group. Patients in the IFL cohort had longer follow‐up than ITD cohort (56.3 ± 23.9 vs 27.9 ± 9.6 months respectively, P .05). Similar resolution of painful internal snapping was seen, with 26 (78.79%) ITD and 27 (81.82%) IFL hips seeing resolution ( P = .76). For ITD and IFL groups, rates of achieving minimum clinically important difference and patient acceptable symptomatic state were similar rates ( P > .05). ITDs and IFLs underwent revision arthroscopy at comparable rates (9.1% vs 9.1%; P > .99). No conversions to arthroplasty were reported. Conclusions ITD yielded improvements when treating iliopsoas impingement during hip arthroscopy. ITDs had comparable improvements in PROs, resolution in painful internal snapping, and underwent revision arthroscopy at similar rates when compared to IFLs. Level of Evidence Level III, retrospective comparative study.