Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion

Luke Spencer-Gardner, Asheesh Bedi, Michael J. Stuart, Christopher M. Larson, Bryan T. Kelly, Aaron Krych

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Purpose: The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. Methods: All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). Results: Ten patients with a mean age of 18 years (range 14–28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7–3.5), the median post-operative mHHS was 89.7 (65.7–96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal. Conclusion: Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. Level of evidence: IV.

Original languageEnglish (US)
Pages (from-to)55-61
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number1
StatePublished - Jan 1 2017


  • Avulsion fracture
  • Hamstring injury
  • Impingement
  • Ischial tuberosity
  • Ischiofemoral

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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