Iliopsoas Tendon Injuries More Severe With Advancing Age

The objective of a recent study was to determine the prevalence and patterns of iliopsoas tendon and myotendinous junction injuries on MRI, and to correlate these findings with patient symptoms.

The study has concluded that complete tears appear to be related to age and gender and perhaps with associated comorbidity. such as steroid use, diabetes, chronic renal failure, gout, obesity, and rheumatoid arthritis.

Background
Iliopsoas injuries are uncommon. Tendinosus is found in kicking-related sports, and avulsion injuries with lesser trochanter avulsions can be seen in skeletally immature patients. Tendinopathy causes groin pain, which is worse with hip flexion and adduction.

Design
Retrospective review of MRIs and medical charts. Injuries were classified into muscle strain, partial tear, and complete tear.

Participants
32 patients were included, 18 females and 14 males.

Results of the Study
The prevalence of iliopsoas tendon and myotendinous junction injuries was 0.66%. One patient had bilateral involvement, and 10 patients had a muscle strain (31%). One patient had bilateral findings; 14 patients (44%) had partial tears, and 8 patients had complete tears (25%).

The mean age was 34 years for muscle strain, 53 years for partial tears, and 82 years for complete tears.

There were 16 patients under the age of 65 years, 10 of whom had sports-related injuries.

One injury occurred after trauma and 1 after hamstring stretch; 2 patients had no history of injury, and 2 patients had no history available. In the older age group, 2 patients had muscle strains, 6 had partial tears, and 8 had complete tears.

Approximately half of the patients had no history of injury. Complete tears were seen only in older women. There were no bony avulsions.

Tendon retraction averaged 3 cm. Two patients had associated hematomas at the myotendinous junction, and 1 had bone marrow edema at the lesser trochanter.

Conclusions
Iliopsoas tendon injuries become more severe with advancing patient age. Athletic injuries are found more frequently in younger patients, and non-athletic injuries predominate in the older patient population.

Reviewer’s Comments
MRI appearances of iliopsoas tendon and myotendinous junction injuries do not differ in appearance from tendon and myotendinous junction injuries in other parts of the skeletal system.

Author: Cornelia Wenokor, MD

Reference
Bui KL, Ilastan H, et al. Iliopsoas Injury: An MRI Study of Patterns and Prevalence Correlated With Clinical Findings. Skeletal Radiol; 2008; 37: 245-249.