EP108 Surgical Technique Video: Open Ischiofemoral Decompression with Iliopsoas Reattachment
Bibliographic record
Abstract
Abstract Last year, he completed a sports medicine fellowship at the University of Toronto Orthopaedic Sports Medicine Program (UTOSM), and is currently completing a second sports medicine fellowship within the Department of Orthopaedic Surgery at UPMC. After completion of his fellowship in Pittsburgh, he will return to Toronto to practice as a sports surgeon. Ischiofemoral impingement (IFI) is an increasingly recognized cause of deep gluteal and posterior hip pain, resulting from pathological narrowing between the ischium and the lesser trochanter, entrapping the quadratus femoris. It is most commonly seen in middle-aged females and presents with symptoms such as pain radiating to the buttock or medial thigh, and occasionally sciatic-like symptoms due to irritation of the sciatic nerve. Clinical diagnosis is supported by provocative tests including the IFI test and long-stride walking test, in conjunction with MRI evidence of a narrowed ischiofemoral space and associated quadratus femoris muscle edema. Initial management is typically non-operative, incorporating physical therapy, activity modification, and image-guided injections into the ischiofemoral space. While many patients respond to conservative treatment, recalcitrant cases may require surgical decompression. Both open and endoscopic techniques have been described for ischiofemoral decompression, including both anterior and posterior approaches, with or without iliopsoas tenotomy. Although surgical management can yield satisfactory pain relief and patient reported outcome measures, outcomes may be compromised by post-operative hip flexion weakness due to iliopsoas detachment. In our surgical technique video we present an open posterior approach to ischiofemoral decompression with iliopsoas reattachment in order to limit potential post-operative hip flexion weakness. Our technique includes an open decompression of the ischiofemoral space with sciatic nerve neurolysis, combined with complete lesser trochanteric osteotomy. Critically, we incorporate iliopsoas tendon reattachment using suture anchor fixation into the osteotomy bed, aiming to preserve postoperative hip flexion strength. This approach offers direct visualization of the sciatic nerve and short external rotators, allows precise bony resection, limits intraoperative fluoroscopy use, and mitigates the risk of nerve injury or persistent hip flexor dysfunction. Preliminary clinical experience has demonstrated favorable early outcomes in terms of pain relief, patient reported outcomes, and preservation of iliopsoas strength.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.029 | 0.011 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".