Iliopsoas tendon insertion footprint with surgical implications in lesser trochanterplasty for treating ischiofemoral impingement: an anatomic study

Juan Gómez-Hoyos; Ricardo Schröder; Ian J Palmer; Manoj Reddy; Anthony Khoury; Hal David Martin

doi:10.1093/jhps/hnv060

Iliopsoas tendon insertion footprint with surgical implications in lesser trochanterplasty for treating ischiofemoral impingement: an anatomic study

J Hip Preserv Surg. 2015 Sep 9;2(4):385-91. doi: 10.1093/jhps/hnv060. eCollection 2015 Dec.

Authors

Juan Gómez-Hoyos¹, Ricardo Schröder², Ian J Palmer², Manoj Reddy³, Anthony Khoury⁴, Hal David Martin²

Affiliations

¹ 1. Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA ; 2. Department of Orthopaedic Surgery, University of Antioquia, Colombia.
² 1. Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA.
³ 3. Texas A&M Health Science Center, College of Medicine at Dallas, TX, USA.
⁴ 1. Hip Preservation Center, Baylor University Medical Center, Dallas, TX, USA ; 4. Department of Bioengineering, University of Texas at Arlington, TX, USA.

Abstract

The objective of this study was to describe the footprint location of the iliopsoas tendon on the lesser trochanter to clarify the surgical implications of the lesser trochanterplasty for treating ischiofemoral impingement. Ten non-matched, fresh-frozen, cadaveric hemipelvis specimens (average age, 62.4 years; range, 48-84 years; 7 male and 3 female) were included. Registered measures included bony parameters of the lesser trochanter (lesser trochanteric area, distances from the tip to the base in a coordinate system, height and area) and tendinous iliopsoas footprint descriptions (areas and detailed location). The mean height of the lesser trochanter was 13.1 (SD ± 1.8) mm, with female having a smaller lesser trochanter on average (11.3, SD ± 2.0). A double tendinous footprint was found in 7 (70%) specimens. The average area of the single- and double-footprint was 211.2 mm(2) and 187.9 mm(2), respectively. An anterior cortical area with no tendinous insertion on the anterior aspect of lesser trochanter was present in all specimens and measured 4.9 mm (SD ± 0.6) on average. The mean ratio between the bald anterior wall and the lesser trochanter height was 38% (SD ± 0.05). The iliopsoas tendon footprint is double (psoas and iliacus) in most cases and is located on the anteromedial tip of the lesser trochanter. A bald anterior wall on the bottom of the lesser trochanter indicates that a partial or total lesser trochanterplasty for increasing the ischiofemoral space without detaching partially or entirely the iliopsoas tendon is improbable.