Implicating the Iliopsoas in Acetabular Labral Tears: Focus on Anatomy

This post was written by H&W instructor, Ginger Garner, PT, MPT, ATC, PYT, who teaches the Yoga as Medicine for Pregnancy and Labor & Delivery and Postpartum courses, and is teaching her brand new course, Extra-Articular Pelvic and Hip Labrum Injury, in June in Akron, OH.

In my previous two posts, I have discussed The Postpartum Hip and Labral Tear Risk and The Importance of Early Intervention in Labral Tears. Today I want to highlight the importance of the iliopsoas and its potential contribution to intraarticular injury sequelae at the hip joint.

A recent collaborative paper including Harvard University’s Department of Orthopaedic Surgery, New York’s Hospital for Special Surgery and the Midwest Bone and Joint Institute in Illinois took on the task of a 3-D cross-sectional analysis of the iliopsoas in order to explain its relationship to the acetabular labrum. The findings are important not only for athletes, the targeted population who most frequently experiences labral tears, but also for the postpartum population I discussed in a previous blog post, The Postpartum Hip. This study represented the first attempt of 3-D analysis of the iliopsoas musculotendinous unit, and here is what the study found from dissection of 8 joints:

• The iliopsoas is found anterior to, and at the level of, the anterosuperior capsulolabral complex at the 2-3 o’clock position, or slightly lateral.

• The iliopsoas is comprised of about 44.5% tendon and 55.5% muscle belly at the exact level of the anterior labrum.

• An inflexible, not just a snapping, iliopsoas could possibly increase labral tear risk and prevalence in athletes.

• A labral tear associated with FAI (femoroacetabular impingement) is typically found at the 11:30-1 o’clock position, as opposed to an iliopsoas-induced tear, which is found at the 2-3 o’clock position.

• The researchers were led to study the iliopsoas’ contribution because the 2-3 o’clock position labral tear was being found with similar frequency as the typically expected 11:30-1 o’clock position during hip arthroscopy.

The acetabular labrum is responsible for not only maintaining joint congruity but also for pressurization. This means that In the absence of an intact labrum, contact forces are greatly increased in the hip joint, leading to premature aging of the hip and early osteoarthritis. In addition, repeat hip arthroscopy can be reduced and hip labral injury prevented or even mediated by addressing the iliopsoas length/tension relationship conservatively. The option also exists to release the tendon surgically at the level of the labrum (rather than the trochanter), and for athletes, early intervention using a team approach could mean the difference between hip joint preservation or hip joint degeneration.

Ginger's new Hip Labrum Injury course emphasizes evidence-based assessment and management of the hip in an interdisciplinary educational environment. Her courses are known for their interprofessional focus on partnership in medicine and welcome physical therapists, physicians, physician assistants, midwives, physical therapy assistants, nurses, and anyone who works with populations where hip labral injury could be a concern. The course will address differential diagnosis and assessment of extra-articular factors that implicate hip labral injury. Ginger will discuss both conventional rehabilitation and integrative medicine techniques for management and preservation of the hip.