Snapping iliopsoas tendon in a recreational athlete: a case report.

OBJECTIVE: To describe the evaluation, diagnosis, and conservative treatment of a 31-year-old female recreational athlete with a snapping iliopsoas tendon. BACKGROUND: The iliopsoas tendon has been implicated as an inflamed structure in this unique form of snapping hip. Hip pain, limitation of motion, or both may severely restrict vocational and recreational function and activities of daily living. DIFFERENTIAL DIAGNOSIS: Left snapping hip syndrome secondary to the iliopsoas tendon or the iliotibial band. TREATMENT: The treatment goal was to restore the athlete's pain-free, functional abilities. The primary focus of the treatment program was stretching of the left hip flexors. The patient demonstrated reduced pain and improved function following a 4-week stretching program and was fully functional and symptom free at 6 months. UNIQUENESS: Snapping hip syndrome is a clinical entity that may be described as hip pain associated with an audible snap of the hip during motion. The most common and well-known cause of this syndrome involves the snapping of the iliotibial band over the greater trochanter. A less common cause is the snapping of the iliopsoas tendon over the iliopectineal eminence. CONCLUSIONS: Understanding the anatomy and function of the iliopsoas tendon and related structures provides a basis for evaluation and treatment of this unique problem.

Functional outcome measures for knee dysfunction assessment.

Maximizing the functional abilities of the individual is the primary objective of any therapeutic intervention. Functional outcome data are valuable to those involved in the care of the athlete because such data provides information that helps facilitate the clinical decision-making process and, therefore, helps insure a safe and efficient return to athletics. Functional outcome measures also provide useful data for assessing therapeutic intervention efficacy. The clinician/researcher must consider various factors when selecting an appropriate outcome measure, such as: the patient population, pathology, specific test parameters, psychometric properties, and practicality of the measure. The primary purpose of this paper is to provide the reader with guidelines for either assessing existing measures or developing new measures of functional outcomes for use in clinical practice and research.

Injured stable knee with acute effusion: MRI evaluation.

This study was done to evaluate the magnetic resonance imaging (MRI) findings in acute traumatic effusions of the knee without ligament instability or radiographic abnormality other than the effusion. On reviewing the charts of 927 patients who had MRI of the knee, we found 114 patients who met the following criteria for inclusion in this study: (1) acute effusion by examination or history, (2) ligament stability on examination, and (3) normal findings on radiographs (excluding effusion). The total of 144 pathologic diagnoses made by MRI included bone injury (53%), disruption of the anterior cruciate ligament (19%), sprain of the medial collateral ligament (12%), medial meniscus tear (11%), lateral meniscus tear (5%), and rupture of the posterior cruciate ligament ( < 1%). Eight studies (7%) were read as normal. These MRI data are significantly different from data of previous studies using arthroscopy to evaluate acute knee injuries without ligament instability. The findings more accurately reflect the injury pattern seen in this setting because MRI can show both bone and soft tissue injury. From this study, we conclude that bone injury is the most common cause of acute effusion in the patient with ligament stability and normal radiographs.

Meniscal injuries associated with acute anterior cruciate ligament tears in alpine skiers.

We reviewed the records of 315 patients receiving an arthroscopically assisted stabilizing procedure for an acute anterior cruciate ligament injury incurred while alpine skiing to evaluate associated meniscal injuries. Meniscal injuries were classified by type, location, and treatment of the tear. Of the 317 knees operated on, all demonstrated an anterior cruciate ligament tear at arthroscopy. Ninety-eight percent of the injuries (310) were diagnosed within 3 days of injury, and 97% (307) were reconstructed within 28 days of injury. All tears occurred in the intrasubstance of the ligament; 32% were isolated injuries and 68% were combined with other injuries. In 159 patients with 170 meniscal tears 141 of the tears (83%) were lateral and 29 (17%) were medial. The injury triad of anterior cruciate ligament-medial collateral ligament-lateral meniscus was seen nine times as often as the anterior cruciate ligament-medial collateral ligament-medial mensicus combination.