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Giai Via R, Giachino M, Elzeiny A, Donis A, De Vivo S, Bosco F, Massè A. Arthroscopic and endoscopic techniques for iliopsoas release in THA are safe and effective: a systematic review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2845-2857. [PMID: 38977435 PMCID: PMC11377508 DOI: 10.1007/s00590-024-04042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Hip replacement surgery is highly effective in relieving pain and improving mobility in patients with various hip conditions. However, some patients develop groin pain after surgery, often due to iliopsoas impingement (IPI), which can be challenging to diagnose. Conservative treatments are initially recommended, but when these are not effective, surgical options may be considered. This study aims to evaluate the clinical outcomes, success and failure rates, revision rates, and complications associated with arthroscopic and endoscopic surgery for IPI, thereby providing a comprehensive understanding of the effectiveness and risks of these surgical interventions. MATERIALS AND METHODS A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including a thorough search of five main databases: PubMed, Scopus, Embase, Medline, and Cochrane. Eligible articles were meticulously evaluated according to predefined criteria for levels of evidence (LoE), with retrospective studies assessed using the Coleman Methodology Score (mCMS). This systematic review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO). RESULTS Among the 16 included studies, 431 patients with 434 hips underwent either endoscopic or arthroscopic tenotomy. Both techniques showed favorable outcomes, with arthroscopic tenotomy demonstrating slightly higher success rates than endoscopic tenotomy. Common complications included mild pain and occasional infections, with recurrence observed in some cases. Both techniques offer direct visualization of prosthetic components and potential preservation of psoas function. CONCLUSIONS Arthroscopic and endoscopic iliopsoas tenotomy are effective treatments for alleviating symptoms and improving hip function in patients with IPI post-total hip arthroplasty (THA). LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Riccardo Giai Via
- Department of Orthopaedic Surgery, Centro Traumatologico Ortopedico (CTO), Turin, Italy
| | - Matteo Giachino
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy
| | - Ahmed Elzeiny
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kafr El Sheikh University, Kafr El-Shaikh, Egypt
| | - Andrea Donis
- Department of Orthopaedic Surgery, Centro Traumatologico Ortopedico (CTO), Turin, Italy
| | - Simone De Vivo
- Department of Orthopaedics and Traumatology, University of Turin, Turin, Italy
| | - Francesco Bosco
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
- Department of Orthopaedics and Traumatology, G.F. Ingrassia Hospital Unit, ASP 6, Palermo, Italy.
- Department of Orthopedic and Traumatology (DICHIRONS), University of Palermo, VIA DEL VESPRO, 129-90127, Palermo, Italy.
| | - Alessandro Massè
- Department of Orthopaedic Surgery, Centro Traumatologico Ortopedico (CTO), Turin, Italy
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Finsterwald M, Mancino F, Waters G, Ebert J, Malik SS, Jones CW, Yates PJ, D'Alessandro P. Endoscopic Tendon Release for Iliopsoas Impingement After Total Hip Arthroplasty-Excellent Clinical Outcomes and Low Failure Rates at Short-Term Follow-Up. Arthroscopy 2024; 40:790-798. [PMID: 37544336 DOI: 10.1016/j.arthro.2023.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To investigate the clinical effectiveness of endoscopic iliopsoas tendon release (IPR) at the lesser trochanter (LT) in patients with iliopsoas impingement (IPI) after total hip arthroplasty (THA). METHODS Between November 2017 and March 2021, a consecutive series of 36 patients were treated with endoscopic IPR for diagnosed IPI. Patients included had acetabular cup position confirmed by functional imaging (OPS, Corin, Pymble, NSW), typical clinical symptoms of IPI, and a positive response to diagnostic injection. Clinical assessment included validated patient-reported outcome measures (PROMs) along with hip flexion strength and active range of motion at different time marks up to 2-year follow-up, as well as surgical complications. RESULTS Overall, 36 consecutive patients (11 males) with a mean age of 62 ± 12 years were included. All patients had failed nonoperative management. Dynamic computed tomography assessment was available in 89% of the patients, edge loading was reported in 10%, and variable cup overhang was reported in 50%. Clinically, PROMs were significantly improved at every time mark when compared with preoperative values (P < .001), showing the biggest improvement within the first 4 weeks after surgery. At the 6-month follow-up, peak isometric hip flexion strength on the operated side was 20% lower than the contralateral side (P < .001). Failure rate of the procedure was 2.8% (1 case). Linear regression showed no association between cup overhang and clinical outcomes. CONCLUSIONS Endoscopic IPR at the LT is a safe and reproducible technique associated with significant and immediate improvement in pain, functional outcomes, and high patient satisfaction. With minimal short-term weakness, no complications, and only a single revision, even in cases with cup malposition and/or edge loading, we believe that endoscopic IPR can be considered as one of the first-line operative options in patients with symptomatic IPI, irrespective of component position. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Michael Finsterwald
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia.
| | - Fabio Mancino
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Georgina Waters
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Jay Ebert
- Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia; HFRC Rehabilitation Clinic, Perth, Western Australia
| | | | - Christopher W Jones
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Curtin University, Perth, Western Australia, Australia
| | - Piers J Yates
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Medical School, Division of Surgery, University of Western Australia, Perth, Australia
| | - Peter D'Alessandro
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia; Orthopaedic Research Foundation Western Australia, Bethesda Hospital, Claremont, Australia; Medical School, Division of Surgery, University of Western Australia, Perth, Australia
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Pour AE, Green JH, Christensen TH, Muthusamy N, Schwarzkopf R. Is It Necessary to Obtain Lateral Pelvic Radiographs in Flexed Seated Position for Preoperative Total Hip Arthroplasty Planning? Arthroplast Today 2023; 21:101133. [PMID: 37234599 PMCID: PMC10206860 DOI: 10.1016/j.artd.2023.101133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/06/2023] [Accepted: 03/08/2023] [Indexed: 05/28/2023] Open
Abstract
Background Many of the current total hip arthroplasty (THA) planning tools only consider sagittal pelvic tilt in the standing and relaxed sitting positions. Considering that the risk of postoperative dislocation is higher when bending forward or in sit-to-stand move, sagittal pelvic tilt in the flexed seated position may be more relevant for preoperative planning. We hypothesized that there was a significant difference in sagittal pelvic tilt between the relaxed sitting and flexed seated positions as measured by the sacral slope in preoperative and postoperative full-body radiographs. Methods This was a multicenter retrospective analysis of the preoperative and postoperative simultaneous biplanar full-body radiographs of 93 primary THA patients in standing, relaxed sitting, and flexed seated positions. The sagittal pelvic tilt was measured using the sacral slope relative to the horizontal line. Results The mean difference between the preoperative sacral slope in the relaxed sitting position and the flexed seated position was 11.3° (-13° to 43°) (P < .0001). This difference was >10° in 52 patients (56%) and >20° in 18 patients (19.4%). The mean difference between the postoperative sacral slope in a relaxed sitting position and the sacral slope in a flexed seated position was 11.3° (P < .0001). This difference was >10° in 51 patients (54.9%) and >30° in 14 patients (15.1%) postoperatively. Conclusions There was a significant difference in sagittal pelvic tilt between the relaxed and flexed seated positions. A flexed seated view provides valuable information that might be more relevant for preoperative THA planning in order to prevent postoperative THA instability.
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Affiliation(s)
- Aidin Eslam Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Jordan H. Green
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas H. Christensen
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Nishanth Muthusamy
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Eslam Pour A, Lazennec JY, Patel KP, Anjaria MP, Beaulé PE, Schwarzkopf R. Small Random Angular Variations in Pelvic Tilt and Lower Extremity Can Cause Error in Static Image-based Preoperative Hip Arthroplasty Planning: A Computer Modeling Study. Clin Orthop Relat Res 2022; 480:818-828. [PMID: 35014975 PMCID: PMC8923586 DOI: 10.1097/corr.0000000000002106] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many THA simulation models rely on a limited set of preoperative static radiographs to replicate sagittal pelvic tilt during functional positions and to recommend an implant orientation that minimizes the risk of prosthetic impingement. However, possible random changes in pelvic or lower extremity angular motions and the effect of coronal and axial pelvic tilt are not included in these preoperative models. QUESTIONS/PURPOSES (1) Can prosthetic impingement occur if the pelvic tilt or lower extremity alignment randomly varies up to ± 5° from what is measured on a single preoperative static radiographic image? (2) Do changes in coronal and axial pelvic tilt or lower extremity alignment angles have a similar effect on the risk of prosthetic impingement? METHODS A de-identified pelvis and lower-body CT image of a male patient without previous THA or lower extremity surgery was used to import the pelvis, femur, and tibia into a verified MATLAB computer model. The motions of standing, pivoting, sitting, sit-to-stand, squatting, and bending forward were simulated. THA implant components included a full hemispherical acetabular cup without an elevated rim, polyethylene liner without an elevated rim, femoral head (diameter: 28 mm, 32 mm, 36 mm, or 40 mm), and a triple-taper cementless stem with three different neck shaft angles (127°, 132°, or 135°) with a trapezoidal neck were used in this model. A static model (cup anatomical abduction 40°, cup anatomical anteversion 20°, stem anatomical anteversion 10°) with a predefined range of sagittal pelvic tilt and hip alignment (0° coronal or axial tilt, without random ± 5° change) was used to simulate each motion. We then randomly varied pelvic tilt in three different pelvic planes and hip alignments (flexion, extension, abduction, adduction, rotation) up to ± 5° and assessed the same motions without changing the implant's anatomical orientation. Prosthetic impingement as the endpoint was defined as mechanical abutment between the prosthetic neck and polyethylene liner. Multiple logistic regression was used to investigate the effect of variation in pelvic tilt and hip alignment (predictors) on prosthetic impingement (primary outcome). RESULTS The static-based model without the random variation did not result in any prosthetic impingement under any conditions. However, with up to ± 5° of random variation in the pelvic tilt and hip alignment angles, prosthetic impingement occurred in pivoting (18 possible combinations), sit-to-stand (106 possible combinations), and squatting (one possible combination) when a 28-mm or a 32-mm head was used. Variation in sagittal tilt (odds ratio 4.09 [95% CI 3.11 to 5.37]; p < 0.001), axial tilt (OR 3.87 [95% CI 2.96 to 5.07]; p < 0.001), and coronal tilt (OR 2.39 [95% CI 2.03 to 2.83]; p < 0.001) affected the risk of prosthetic impingement. Variation in hip flexion had a strong impact on the risk of prosthetic impingement (OR 4.11 [95% CI 3.38 to 4.99]; p < 0.001). CONCLUSION The combined effect of 2° to 3° of change in multiple pelvic tilt or hip alignment angles relative to what is measured on a single static radiographic image can result in prosthetic impingement. Relying on a few preoperative static radiographic images to minimize the risk of prosthetic impingement, without including femoral implant orientation, axial and coronal pelvic tilt, and random angular variation in pelvis and lower extremity alignment, may not be adequate and may fail to predict prosthetic impingement-free ROM. CLINICAL RELEVANCE Determining a safe zone for THA implant positioning with respect to impingement may require a dynamic computer simulation model to fully capture the range of possible impingement conditions. Future work should concentrate on devising simple and easily available methods for dynamic motion analysis instead of using a few static radiographs for preoperative planning.
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Affiliation(s)
- Aidin Eslam Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique–Hopitaux de Paris, UPMC, Paris, France
| | - Kunj P. Patel
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Manan P. Anjaria
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Paul E. Beaulé
- Division of Orthopaedic Surgery, Department of Surgery, the Ottawa Hospital, Ottawa, ON, Canada
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University, New York, NY, USA
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Pour AE, Schwarzkopf R, Patel KPK, Anjaria MP, Lazennec JY, Dorr LD. How much change in pelvic sagittal tilt can result in hip dislocation due to prosthetic impingement? A computer simulation study. J Orthop Res 2021; 39:2604-2614. [PMID: 33749925 PMCID: PMC8455710 DOI: 10.1002/jor.25022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/10/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023]
Abstract
Developing spinal pathologies and spinal fusion after total hip arthroplasty (THA) can result in increased pelvic retroversion (e.g., flat back deformity) or increased anterior pelvic tilt (caused by spinal stenosis, spinal fusion or other pathologies) while bending forward. This change in sagittal pelvic tilt (SPT) can result in prosthetic impingement and dislocation. Our aim was to determine the magnitude of SPT change that could lead to prosthetic impingement. We hypothesized that the magnitude of SPT change that could lead to THA dislocation is less than 10° and it varies for different hip motions. Hip motion was simulated in standing, sitting, sit-to-stand, bending forward, squatting and pivoting in Matlab software. The implant orientations and SPT angle were modified by 1° increments. The risk of prosthetic impingement in pivoting caused by increased pelvic retroversion (reciever operating characteristic [ROC] threshold as low as 1-3°) is higher than the risk of prosthetic impingement with increased pelvic anteversion (ROC threshold as low as 16-18°). Larger femoral heads decrease the risk of prosthetic impingement (odds ratio {OR}: 0.08 [932 mm head]; OR: 0.01 [36 mm head]; OR: 0.002 [40 mm head]). Femoral stems with a higher neck-shaft angle decrease the prosthetic impingement due to SPT change in motions requiring hip flexion (OR: 1.16 [132° stem]; OR: 4.94 [135° stem]). Our results show that overall, the risk of prosthetic impingement due to SPT change is low. In particular, this risk is very low when a larger diameter head is used and femoral offset and length are recreated to prevent bone on bone impingement.
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Affiliation(s)
- Aidin Eslam Pour
- Department of Orthopedic SurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Ran Schwarzkopf
- Department of Orthopedic SurgeryNew York UniversityNewYorkUSA
| | | | - Manan P. Anjaria
- Department of Orthopedic SurgeryUniversity of MichiganAnn ArborMichiganUSA
| | - Jean Yves Lazennec
- Department of Orthopedic and Trauma SurgeryPitié‐Salpétrière Hospital Assistance Publique–Hopitaux de Paris, UPMCParisFrance
| | - Lawrence D. Dorr
- Dorr Institute for Arthritis Research and EducationLos AngelesCaliforniaUSA
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Ovsepyan AL, Smirnov AA, Pustozerov EA, Mokhov DE, Mokhova ES, Trunin EM, Dydykin SS, Vasil'ev YL, Yakovlev EV, Budday S, Paulsen F, Zhivolupov SA, Starchik DA. Biomechanical analysis of the cervical spine segment as a method for studying the functional and dynamic anatomy of the human neck. Ann Anat 2021; 240:151856. [PMID: 34793958 DOI: 10.1016/j.aanat.2021.151856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/11/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traditionally, dynamic and functional anatomy, in particular the dynamic anatomy of the neck, is studied on cadaveric material. However, the development of in vivo visualization technologies and in silico modeling has made it possible to expand these possibilities. Despite significant progress in the study of dynamic and functional anatomy of the neck by means of in silico methods, the issues of validating the developed models and taking into account the pronounced nonlinearity of soft tissues as well as local anisotropy remain open. The aim of this study was to develop a virtual dynamic anatomical model of the human neck and reproduce the dynamic processes in the cervical spine from this model using the finite element method. MATERIALS AND METHODS Reverse engineering was used to generate a dynamic anatomical model of the neck from CT data (both male, 24 and 22 years old). Two segments of the cervical spine (C3-C5, C2-T1) were isolated from the resulting model for finite element analysis. Finite element mesh generation and contact interactions were performed using the HyperMesh software (Altair Engineering Inc, Troy, Michigan, USA). The anisotropic hyperelastic Holzapfel-Gasser-Ogden model was used to describe the material behavior of the fibrous rings of the disc. Material modeling and finite element analysis were performed using Abaqus CAE 6.14 software (Simulia, Johnston, Rhode Island, USA). RESULTS A technique for creating a virtual dynamic anatomical model of the neck was elaborated and implemented. The model includes 79 major anatomical structures of the neck segmented from radiological data. A finite element analysis of the cervical spine was performed. The results of finite element analysis of the C3-C5 segment under axial load were compared with in vitro data. The proposed model shows nonlinear deformation of the disc under static loading; the model predicted displacement values agree well with the experimental ones. The displacement of the С3-С5 central vertebra with an axial load of 800 N reaches a value of 0.65 mm. For the segment C2-T1, data on intradiscal pressure, stress plots and displacements during flexion were obtained. The maximum stress value of 10.036 MPa is observed in the C3-C4 disc. CONCLUSION Simulation results using the proposed methodology are in good agreement with experimental data. The generated biomechanical models allow describing dynamic phenomena in the cervical spine and obtaining a wide range of quantitative properties of anatomical objects, which are otherwise inaccessible to classical methods for studying dynamic and functional anatomy.
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Affiliation(s)
- A L Ovsepyan
- Saint Petersburg Electrotechnical University "LETI", Department of Bioengineering Systems, St. Petersburg, Russia
| | - A A Smirnov
- Moscow Region State University, Moscow, Russia.
| | - E A Pustozerov
- Saint Petersburg Electrotechnical University "LETI", Department of Bioengineering Systems, St. Petersburg, Russia; Almazov National Medical Research Centre, Institute of Endocrinology, St. Petersburg, Russia
| | - D E Mokhov
- North-Western State Medical University Named After I.I. Mechnikov, Department of Osteopathy, St. Petersburg, Russia
| | - E S Mokhova
- Insitute of the Osteopathy, St. Petersburg State University, Russia
| | - E M Trunin
- North-Western State Medical University Named After I.I. Mechnikov, Department of Operative and Clinical Surgery with Topographical Anatomy Named After S.A. Simbirtsev, St. Petersburg, Russia
| | - S S Dydykin
- Sechenov University, Department of Operative Surgery and Topographic Anatomy, Moscow, Russia
| | - Yu L Vasil'ev
- Sechenov University, Department of Operative Surgery and Topographic Anatomy, Moscow, Russia
| | - E V Yakovlev
- Medical Center of JSC "Admiralteyskie Verfi", St. Petersburg, Russia; Department of Psychophysiology of the Institute of Applied Psychoanalysis and Psychology of the "University at the Interparliamentary Assembly of EurAsEC", St. Petersburg, Russia
| | - S Budday
- Friedrich Alexander University Erlangen-Nürnberg, Department of Mechanical Engineering, Erlangen, Germany
| | - F Paulsen
- Sechenov University, Department of Operative Surgery and Topographic Anatomy, Moscow, Russia; Friedrich Alexander University Erlangen-Nürnberg, Institute of Functional and Clinical Anatomy, Erlangen, Germany
| | - S A Zhivolupov
- Military Medical Academy Named After S.M. Kirov of the Ministry of Defense of the Russian Federation (St. Petersburg), Department of Nervous Diseases, St. Petersburg, Russia
| | - D A Starchik
- North-Western State Medical University Named After I.I. Mechnikov, Department of Morphology, St. Petersburg, Russia
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Abstract
As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum’s surface area and showing the first signs of degeneration. The fossa’s function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells. Cite this article: Bone Joint Res 2020;9(12):857–869.
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Affiliation(s)
- Pablo A Slullitel
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Coutu
- Regenerative Medicine Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Martin A Buttaro
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paul Edgar Beaule
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
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May O. Arthroscopic techniques for treating ilio-psoas tendinopathy after hip arthroplasty. Orthop Traumatol Surg Res 2019; 105:S177-S185. [PMID: 30555016 DOI: 10.1016/j.otsr.2018.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 02/02/2023]
Abstract
Impingement of hip arthroplasty components on soft tissues may adversely affect outcomes. An example is impingement of the cup on the ilio-psoas tendon, which has been reported in 0.4% to 8.3% of patients. Contributors to ilio-psoas tendon impingement (IPTI) can be categorised as anatomic (hypoplastic anterior wall), technical (inadequate anteversion and/or lower inclination, oversized cup, cement in contact with the tendon, and intra-muscular screw), and prosthetic (e.g., aggressive cup design, large-diameter head, resurfacing, and collared femoral prosthesis). IPTI manifests as groin pain, raising diagnostic challenges since this symptom lacks specificity. Physical findings of value for the diagnosis include pain exacerbation during active hip flexion, groin pain upon straight-leg raise to 30°, and/or snapping hip syndrome. Confirmation is then provided by ultrasonography and, most importantly, computed tomography. Once the diagnosis is confirmed, non-operative treatment combining physical therapy and local corticosteroid injections is prescribed. When these measures fail, endoscopic or arthroscopic surgery is generally effective. In patients with major cup malposition, revision of the cup is the preferred option, despite the higher complication rate. When cup position is adequate, ilio-psoas tenotomy can be performed either extra-articularly at the lesser trochanter (by endoscopy) or intra-articularly (by arthroscopy). The arthroscopic technique is more demanding but useful when the diagnosis is in doubt, as it allows examination of the prosthetic bearing surfaces. Both techniques and the risks inherent in each are discussed in detail. Tenotomy, whether performed endoscopically or arthroscopically, promptly provides good outcomes in over 85% of patients, usually with full recovery of hip flexor strength over time. These minimally invasive techniques, while as effective as conventional surgery, are associated with lower morbidity rates.
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Affiliation(s)
- Olivier May
- Médipôle Garonne, 45, rue de Gironis, 31300 Toulouse, France.
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Endoscopic or arthroscopic iliopsoas tenotomy for iliopsoas impingement following total hip replacement. A prospective multicenter 64-case series. Orthop Traumatol Surg Res 2017; 103:S207-S214. [PMID: 28917519 DOI: 10.1016/j.otsr.2017.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Impingement between the acetabular component and the iliopsoas tendon is a cause of anterior pain after total hip replacement (THR). Treatment can be non-operative, endoscopic or arthroscopic, or by open revision of the acetabular component. Few studies have assessed these options. The present study hypothesis was that endo/arthroscopic treatment provides rapid pain relief with a low rate of complications. METHODS A prospective multicenter study included 64 endoscopic or arthroscopic tenotomies for impingement between the acetabular component and the iliopsoas tendon, performed in 8 centers. Mean follow-up was 8months, with a minimum of 6months and no loss to follow-up. Oxford score, patient satisfaction, anterior pain and iliopsoas strength were assessed at last follow-up. Complications and revision procedures were collated. Forty-four percent of patients underwent rehabilitation. RESULTS At last follow-up, 92% of patients reported pain alleviation. Oxford score, muscle strength and pain in hip flexion showed significant improvement. The complications rate was 3.2%, with complete resolution. Mean hospital stay was 0.8 nights. In 2 cases, arthroscopy revealed metallosis, indicating revision of the acetabular component. The only predictive factor was acetabular projection on oblique view. Rehabilitation significantly improved muscle strength. CONCLUSION Endoscopic or arthroscopic tenotomy for impingement between the acetabular component and the iliopsoas tendon following THR significantly alleviated anterior pain in more than 92% of cases. The low complications rate makes this the treatment of choice in case of failure of non-operative management. Arthroscopy also reorients diagnosis in case of associated joint pathology. Projection of the acetabular component on preoperative oblique view is the most predictive criterion, guiding treatment.
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Molière S, Dosch JC, Bierry G. Pelvic, acetabular and hip fractures: What the surgeon should expect from the radiologist. Diagn Interv Imaging 2016; 97:709-23. [DOI: 10.1016/j.diii.2016.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/17/2016] [Indexed: 11/26/2022]
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A geometric morphometric analysis of acetabular shape of the primate hip joint in relation to locomotor behaviour. J Hum Evol 2015; 83:15-27. [DOI: 10.1016/j.jhevol.2015.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 03/20/2015] [Accepted: 03/23/2015] [Indexed: 11/22/2022]
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Bonneau N, Baylac M, Gagey O, Tardieu C. Functional integrative analysis of the human hip joint: the three-dimensional orientation of the acetabulum and its relation with the orientation of the femoral neck. J Hum Evol 2014; 69:55-69. [PMID: 24602366 DOI: 10.1016/j.jhevol.2013.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 09/24/2013] [Accepted: 12/22/2013] [Indexed: 01/25/2023]
Abstract
In humans, the hip joint occupies a central place in the locomotor system, as it plays an important role in body support and the transmission of the forces between the trunk and lower limbs. The study of the three-dimensional biomechanics of this joint has important implications for documenting the morphological changes associated with the acquisition of a habitual bipedal gait in humans. Functional integration at any joint has important implications in joint stability and performance. The aim of the study was to evaluate the functional integration at the human hip joint. Both the level of concordance between the three-dimensional axes of the acetabulum and the femoral neck in a bipedal posture, and patterns of covariation between these two axes were analysed. First, inter-individual variations were quantified and significant differences in the three-dimensional orientations of both the acetabulum and the femoral neck were detected. On a sample of 57 individuals, significant patterns of covariation were identified, however, the level of concordance between the axes of both the acetabulum and the femoral neck in a bipedal posture was lower than could be expected for a key joint such as the hip. Patterns of covariation were explored regarding the complex three-dimensional biomechanics of the full pelvic-femoral complex. Finally, we suggest that the lower degree of concordance observed at the human hip joint in a bipedal posture might be partly due to the phylogenetic history of the human species.
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Affiliation(s)
- Noémie Bonneau
- UMR 7179, CNRS - Muséum National d'Histoire Naturelle, 75005 Paris, France; JE 2494, University Paris-Sud Orsay, Paris F-91405, France.
| | - Michel Baylac
- UMR 7205, CNRS - Muséum National d'Histoire Naturelle, 75005 Paris, France
| | - Olivier Gagey
- Bicêtre University Hospital, AP-HP, Paris F-94270, France; JE 2494, University Paris-Sud Orsay, Paris F-91405, France
| | - Christine Tardieu
- UMR 7179, CNRS - Muséum National d'Histoire Naturelle, 75005 Paris, France
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Bonneau N. Three-dimensional analysis of the pelvi-femoral complex: its mechanism and development. Evolutionary and clinical implications. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13219-013-0087-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Bonneau N, Bouhallier J, Baylac M, Tardieu C, Gagey O. Study of the three-dimensional orientation of the labrum: its relations with the osseous acetabular rim. J Anat 2012; 220:504-13. [PMID: 22360458 DOI: 10.1111/j.1469-7580.2012.01486.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Understanding the three-dimensional orientation of the coxo-femoral joint remains a challenge as an accurate three-dimensional orientation ensure an efficient bipedal gait and posture. The quantification of the orientation of the acetabulum can be performed using the three-dimensional axis perpendicular to the plane that passes along the edge of the acetabular rim. However, the acetabular rim is not regular as an important indentation in the anterior rim was observed. An innovative cadaver study of the labrum was developed to shed light on the proper quantification of the three-dimensional orientation of the acetabulum. Dissections on 17 non-embalmed corpses were performed. Our results suggest that the acetabular rim is better represented by an anterior plane and a posterior plane rather than a single plane along the entire rim as it is currently assumed. The development of the socket from the Y-shaped cartilage was suggested to explain the different orientations in these anterior and posterior planes. The labrum forms a plane that takes an orientation in between the anterior and posterior parts of the acetabular rim, filling up inequalities of the bony rim. The vectors V(L) , V(A2) and V(P) , representing the three-dimensional orientation of the labrum, the anterior rim and the posterior rim, are situated in a unique plane that appears biomechanically dependent. The three-dimensional orientation of the acetabulum is a fundamental parameter to understand the hip joint mechanism. Important applications for hip surgery and rehabilitation, as well as for physical anthropology, were discussed.
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Affiliation(s)
- Noémie Bonneau
- CNRS-Muséum National d'Histoire Naturelle, Paris, France.
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Abstract
The human hip is subjected to several hundred million loading cycles during a lifetime. Hip instability and femoro-acetabular impingement cause damage to the rim of the acetabulum. The acetabular rim is a highly specialized structure known as the labro-acetabular complex. A unidirectional flow of synovial fluid has been identified in this region. The synovial fluid circulation is driven by the bellows-like movement of the zona orbicularis and depends on hip flexion and extension. Surgical repair of the damaged labro-acetabular complex should satisfy two goals. First, the labrum should be preserved or reconstructed when possible. Second, the precipitating cause of the labro-acetabular damage must be addressed.
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Affiliation(s)
- Richard E Field
- The South West London Elective Orthopaedic Centre, Dorking Road, Epsom, Surrey KT18 7EG, England.
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16
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Abstract
Despite the curvaceous profile of the acetabulum, orthopaedic surgeons have continued to implant hemispheric cups since the introduction of total hip arthroplasty. The geometric discrepancies between the natural acetabulum and implant can result in painful iliopsoas impingement attributable to prosthetic overlap at the anterior acetabular ridge over which the iliopsoas tendon extends to leave the pelvis. We expanded on previous in vitro observations of acetabular morphology using a large in vivo sample and quantified the dimensions of the psoas valley. We studied computed tomographic scans of 200 healthy hips from 50 men and 50 women. The acetabular ridges were digitized on three-dimensional bone reconstructions and their coordinates were manipulated in spreadsheets to deduce acetabular diameter, anteversion, and inclination and to plot the rim profile. Our results confirm the acetabular rim is an asymmetric succession of three peaks and three troughs. The psoas valley has the following shape distribution: 79% curved, 11% angular, 10% irregular, and 0% straight. The mean depth of the psoas valley is 5 mm and the latitude of its trough is on average 6 mm below the acetabular equator. The use of side-specific cups that replicate the curvaceous acetabular profile could prevent prosthetic overlap and reduce the incidence of iliopsoas impingement.
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Vandenbussche E, Saffarini M, Delogé N, Moctezuma JL, Nogler M. Hemispheric cups do not reproduce acetabular rim morphology. Acta Orthop 2007; 78:327-32. [PMID: 17611844 DOI: 10.1080/174536707100013870] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Iliopsoas impingement is a recurrent complication following THA, caused by muscle friction against a protrusive prosthetic cup.This study was designed to quantify the dimensional variations in acetabular rim profiles, with particular regard to the iliopubic valley, in order to suggest means to prevent iliopsoas impingement. MATERIAL AND METHODS 34 cadaver pelvises were analyzed using a hip navigation system. The morphometric data were processed to plot profiles of all acetabular rims with particular regard to the shape and depth of the psoas valley. RESULTS The acetabular rim is an asymmetric succession of 3 peaks and 3 troughs. The psoas valley is a salient feature in most pelvises and there is only a weak correlation between its depth (mean 3.8 mm, SD 2.0) and acetabular diameter, anteversion, or inclination. INTERPRETATION It would be difficult to obviate the anterior overlap of the acetabulum using a hemispheric cup, a fortiori in certain morphotypes, without compromising range of motion or risk of dislocation. The solution for prevention of iliopsoas impingement would be to adapt cup design to acetabular anatomy, which may require different implants for the right and left sides, and hence a doubled inventory.
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Affiliation(s)
- Eric Vandenbussche
- Department of Orthopaedic Surgery, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, FR-75908 Paris, France.
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Rissech C, Estabrook GF, Cunha E, Malgosa A. Using the acetabulum to estimate age at death of adult males. J Forensic Sci 2006; 51:213-29. [PMID: 16566753 DOI: 10.1111/j.1556-4029.2006.00060.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The acetabular region is often present and adequately preserved in adult human skeletal remains. Close morphological examination of the 242 left male os coxae from the identified collection of Coimbra (Portugal) has enabled the recognition of seven variables that can be used to estimate age at death. This paper describes these variables and argues their appropriateness by analyzing the correlation between these criteria and the age, the intra- and interobserver consistence, and the accuracy in age prediction using Bayesian inference to estimate age of identified specimens. Results show significant close correlation between the acetabular criteria and age, nonsignificant differences in intra- and interobserver test, and 89% accuracy in Bayes prediction. Obtained estimated age of the specimens had similar accuracy in all ages. These results indicate that these seven variables, based on the acetabular area, are potentially useful to estimate age at death for adult specimens.
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Affiliation(s)
- Carme Rissech
- Dept. de Antropologia, Facultad de Ciências, Universidad de Coimbra, 3000-056-Coimbra, Portugal.
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Boszczyk BM, Boszczyk AA, Boos W, Korge A, Mayer HM, Putz R, Benjamin M, Milz S. An immunohistochemical study of the tissue bridging adult spondylolytic defects--the presence and significance of fibrocartilaginous entheses. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 15:965-71. [PMID: 16151708 PMCID: PMC3489425 DOI: 10.1007/s00586-005-0986-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2004] [Revised: 03/09/2005] [Accepted: 06/10/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED Introduction Spondylolytic spondylolisthesis is an osseous discontinuity of the vertebral arch that predominantly affects the fifth lumbar vertebra. Biomechanical factors are closely related to the condition. An immunohistochemical investigation of lysis-zone tissue obtained from patients with isthmic spondylolisthesis was performed to determine the molecular composition of the lysis-zone tissue and enable interpretation of the mechanical demands to which the tissue is subject. METHODS During surgery, the tissue filling the spondylytic defects was removed from 13 patients. Twelve spondylolistheses were at the L5/S1 level with slippage being less than Meyerding grade II. Samples were methanol fixed, decalcified and cryosectioned. Sections were labelled with a panel of monoclonal antibodies directed against collagens, glycosaminoglycans and proteoglycans. RESULTS The lysis-zone tissue had an ordered collagenous structure with distinct fibrocartilaginous entheses at both ends. Typically, these had zones of calcified and uncalcified fibrocartilage labelling strongly for type II collagen and aggrecan. Labelling was also detected around bony spurs that extended from the enthesis into the lysis-zone. The entheses also labelled for types I, III and VI collagens, chondroitin four and six sulfate, keratan and dermatan sulfate, link protein, versican and tenascin. CONCLUSIONS Although the gap filled by the lysis tissue is a pathological feature, the tissue itself has hallmarks of a normal ligament-i.e. fibrocartilaginous entheses at either end of an ordered collagenous fibre structure. The fibrocartilage is believed to dissipate stress concentration at the hard/soft tissue boundary. The widespread occurrence of molecules typical of cartilage in the attachment of the lysis tissue, suggests that compressive and shear forces are present to which the enthesis is adapted, in addition to the expected tensile forces across the spondylolysis. Such a combination of tensile, shear and compressive forces must operate whenever there is any opening or closing of the spondylolytic gap.
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Affiliation(s)
- Bronek M Boszczyk
- Neurosurgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.
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Abstract
INTRODUCTION The embryology and development of the hip joint are complex. The acetabulum is not always of the same shape, width, or depth. Minor anatomical abnormalities in the acetabular shape, joint congruences are frequent. Controversies still exist on the importance of these variations and help to prevent problems following in surgical procedures such as acetabular reconstruction and femoracetabular impingement. MATERIAL AND METHODS The aim of this study is to provide the location of the unusual facets, the acetabular point, and the anterior ridge of the acetabulum based on a morphological study of human pelvic bones. Morphologic features of the acetabulum, particularly determination of unusual facets, were studied in 226 human coxal bones. RESULTS In adult coxal bones the acetabular fossa has an irregular clover-leaf shape, the superior lobe being smaller than the anterior and the posterior lobes. Measured lunate surface area varied between 14.5 and 30.5 cm2. A smooth unusual facet was found anteroinferior to the lunate surface in 62 acetabulums. Measured along the long axis, its size varied between 11 and 17 mm. Three different shapes of the unusual facet were as follows: oval (32.26%), piriform (45.16%), and elongated (22.58%). The prevalence of the piriform facet shape was higher in males. In 59.68% of the bones it extended to the superior ramus of the pubis, and in the remaining 40.32% it was limited within the acetabular margin. It is postulated that this facet could be a consequence of a particular posture, which results in traction of the ligaments attached to this area. Four distinct configurations were identified relative to the anterior acetabular ridge. The majority 98 (43.36%) were curved; 64 (28.33%) were angular; 37 (16.37%) were irregular; and 27 (11.94%) were straight. CONCLUSION There have been no reports on details such as unusual facets, acetabular point, and anterior ridge of the acetabulum in a single research. These findings will be of help in planning reorientation procedures, using spikes, screws, and press-fitting for fixation.
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Affiliation(s)
- Figen Govsa
- Department of Anatomy, Faculty of Medicine, Ege University, Izmir, Turkey.
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Milz S, Boszczyk BM, Boszczyk AA, Putz R, Benjamin M. [The enthesis. Physiological morphology, molecular composition and pathoanatomical alterations]. DER ORTHOPADE 2005; 34:526-32. [PMID: 15909175 DOI: 10.1007/s00132-005-0807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The composition of the extracellular matrix in tendons and ligaments is directly related to the mechanical environment. Local compression triggers functional adaptation that leads to cartilage-specific transformation of the tissue. The molecular composition of the extracellular matrix at the enthesis is related to the amount of stress and to the geometry of the insertion. Comparison of physiologically and non-physiologically loaded entheses shows that only certain molecules occur under relatively high amounts of local compressive stress. The occurrence of certain cartilage specific molecules is clinically relevant, because some of these molecules have been identified as autoantigens during the autoimmune response in patients with rheumatoid arthritis. These molecules constitute potential targets for the manifestation of rheumatoid arthritis at fibrocartilaginous entheses.
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Affiliation(s)
- S Milz
- AO Forschungsinstitut, Davos, Schweiz.
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Milz S, Valassis G, Büttner A, Maier M, Putz R, Ralphs JR, Benjamin M. Fibrocartilage in the transverse ligament of the human acetabulum. J Anat 2001; 198:223-8. [PMID: 11273046 PMCID: PMC1468208 DOI: 10.1046/j.1469-7580.2001.19820223.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Biomechanical experiments on isolated hip joints have suggested that the transverse ligament acts as a bridle for the lunate articular surface of the acetabulum during load bearing, but there are inherent limitations in such studies because the specimens are fixed artificially to testing devices and there are no modifying influences of muscle pull. Further evidence is thus needed to substantiate the theory. Here we argue that if the horns of the lunate surface are forced apart under load, the ligament would straighten and become compressed against the femoral head. It would thus be expected to share some of the features of tendons and ligaments that wrap around bony pulleys and yet previous work has suggested that the transverse ligament is purely fibrous. Transverse ligaments were removed from 8 cadavers (aged 17-39 y) and fixed in 90% methanol. Cryosections were immunolabelled with antibodies against collagens (types I, II, III, VI), glycosaminoglycans (chondroitins 4 and 6 sulphate, dermatan sulphate, keratan sulphate) and proteoglycans (aggrecan, link protein, versican, tenascin). A small sesamoid fibrocartilage was consistently present in the centre of each transverse ligament, near its inner surface at the site where it faced the femoral head. Additionally, a more prominent enthesis fibrocartilage was found at both bony attachments. All fibrocartilage regions, in at least some specimens, labelled for type II collagen, chondroitin 6 sulphate, aggrecan and link protein, molecules more typically associated with articular cartilage. The results suggest that the ligament should be classed as containing a 'moderately cartilaginous' sesamoid fibrocartilage, adapted to withstanding compression. This supports the inferences that can be drawn from previous biomechanical studies. We cannot give any quantitative estimate of the levels of compression experienced. All that can be said is that the ligament occupies an intermediate position in the spectrum of fibrocartilaginous tissues. It is more cartilaginous than some wrap-around tendons at the wrist, but less cartilaginous than certain other wrap-around ligaments, e.g. the transverse ligament of the atlas.
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Affiliation(s)
- S Milz
- Anatomische Anstalt, Ludwig-Maximilians-Universität, München, Germany.
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