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Larson JH, Chapman RS, Allahabadi S, Kaplan DJ, Jan K, Kazi O, Hapa O, Nho SJ. Patients With Lateral and Anterolateral Cam Morphology Have Greater Deformities Versus Typical Anterolateral Deformity Alone but No Differences in Postoperative Outcomes: A Propensity-Matched Analysis at Minimum 5-Year Follow-Up. Arthroscopy 2024:S0749-8063(24)00242-1. [PMID: 38521208 DOI: 10.1016/j.arthro.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/23/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To compare pre- and postoperative findings between patients undergoing hip arthroscopy for femoroacetabular impingement syndrome with lateral impingement versus those without lateral impingement METHODS: Patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between 2012 and 2017 with minimum 5-year follow-up were included. Alpha angle (AA) was measured on preoperative anteroposterior (AP) and 90° Dunn radiographs. Patients with AA >60° on Dunn view but not AP view (no lateral impingement) were propensity matched by sex, age, and body mass index in a 1:3 ratio to patients with AA >60° on both views (lateral impingement). Demographic characteristics, radiographic and intraoperative findings, reoperation rates, and patient-reported outcomes (PROs) were compared between groups. Categorical variables were compared using the Fisher exact testing and continuous variable using 2-tailed Student t tests. RESULTS Sixty patients with lateral impingement (65.0% female, age: 35.3 ± 13.0 years) were matched to 180 patients without lateral impingement (65.0% female, age: 34.7 ± 12.5 years, P ≥ .279). Patients with lateral impingement had larger preoperative AAs on both Dunn (71.0° ± 8.8° vs 67.6° ± 6.1°, P = .001) and AP radiographs (79.0° ± 12.1° vs 48.2° ± 6.5°, P < .001). However, there were no differences in postoperative AAs on either view (Dunn: 39.0° ± 6.1° vs 40.5° ± 5.3°, AP: 45.8° ± 9.0° vs 44.9° ± 7.0°, P ≥ .074). Labral tears began more superiorly in patients with lateral impingement (12:00 ± 0:49 vs 12:17 ± 0:41, P = .030), and they demonstrated greater rates of acetabular and femoral cartilage damage (P = .030 for both); however, there were no differences in PROs or reoperation rates between the groups at 5-year follow-up. CONCLUSIONS Although cam deformities located laterally and anterolaterally are larger than those located anterolaterally alone, both can be resected adequately, resulting in similar postoperative radiographic measurements, PROs, and survivorship. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Jordan H Larson
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Reagan S Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Sachin Allahabadi
- Department of Orthopedic Surgery, Houston Methodist, Houston, Texas, U.S.A
| | - Daniel J Kaplan
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Kyleen Jan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Omair Kazi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Onur Hapa
- Department of Orthopedics and Traumatology, Dokuz Eylül University; Balçova, Izmir, Turkey
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
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Buldo-Licciardi M, Shankar DS, Akpinar B, Montgomery SR, Vasavada KD, Savage-Elliott I, Youm T. A Superolateral Cam Lesion Location Increases Odds of Total Hip Arthroplasty 5 Years After Hip Arthroscopy. Arthroscopy 2024; 40:810-817. [PMID: 37579955 DOI: 10.1016/j.arthro.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To determine if radiographic cam location is associated with hip survivorship and postoperative patient-reported outcomes (PROs) at 5-year follow-up. METHODS We conducted a review of prospectively collected data of patients with cam lesions who underwent hip arthroscopy for femoroacetabular impingement syndrome. Cam lesions were categorized into 3 locations: superolateral, anterolateral, or anterior. Conversion to total hip arthroplasty (THA), revision rates, and reoperation rates were assessed. Patient-reported outcome measures, including modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS), were collected preoperatively and at 5-year follow-up. RESULTS Of the 156-patients, 125 met the final criteria (80.1%). Mean age was 41.1 ± 12.7 years. Seventy-one patients (56.8%) had superolateral cam lesions, 41 (32.8%) had anterolateral lesions, and 13 (10.4%) had anterior lesions. Revision rates within 5 years were 7.7% for anterior, 24.4% for anterolateral, and 14.1% for superolateral lesions; conversions to THAs were 15.4% for anterior), 7.3% for anterolateral, and 8.5% for superolateral. Reoperations were 23.1% for anterior, 29.3% for anterolateral, and 21.1% for superolateral. The superolateral cohort was younger than the anterior and anterolateral cohorts (anterior, 46.6 ± 12.2 years; anterolateral, 44.7 ± 12.2 years; superolateral, 38.1 ± 12.3 years; P = .006). Multivariable analysis showed the anterolateral group was significantly predictive of lower odds of undergoing THA compared to the superolateral group (odds ratio, 0.01; 95% CI, <0.01-0.72; P = .03). There were no differences in the 5-year improvement in mHHS (anterior, 32.4; anterolateral, 36.8; superolateral, 33.0; P = .29) or NAHS (anterior, 34.8; anterolateral, 39.0; superolateral, 37.3; P = .65). CONCLUSIONS A superolateral cam lesion increases the odds of conversion to THA within 5 years of hip arthroscopy compared to those with anterolateral lesions on multivariable analysis. Those with superolateral lesions were significantly younger compared to those with anterior or anterolateral lesions. Cam lesion location did not affect improvement in PROs at 5-year follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative prognostic trial.
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Affiliation(s)
- Michael Buldo-Licciardi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Dhruv S Shankar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Berkcan Akpinar
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Samuel R Montgomery
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kinjal D Vasavada
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Ian Savage-Elliott
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A..
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Owens JS, Saks BR, Fox JD, Jimenez AE, Lall AC, Domb BG. The Circumferential Femoroplasty: An All-Arthroscopic Technique for Addressing a Challenging Hip Deformity. Arthrosc Tech 2022; 11:e1737-e1745. [PMID: 36311314 PMCID: PMC9596604 DOI: 10.1016/j.eats.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/17/2022] [Indexed: 02/03/2023] Open
Abstract
Femoroacetabular impingement is recognized as a common cause of hip pain. Cam-type femoroacetabular impingement results from abnormal contact between an aspherical femoral head and the acetabular rim during hip range of motion, leading to labral tearing, cartilage damage, and, eventually, osteoarthritis. Arthroscopic correction of this bony deformity has been well described, particularly in the anterolateral quadrant of the femoral neck. Some deformities extend well beyond this quadrant, involving most or all of the circumference of the femoral neck, making arthroscopic decompression a challenge. We present a post-less, all-arthroscopic technique for performing a circumferential cam decompression using 3-dimensional preoperative planning software and interactive fluoroscopy-integrated computer vision interface.
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Affiliation(s)
- Jade S. Owens
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Benjamin R. Saks
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - James D. Fox
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | | | - Ajay C. Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA,American Hip Institute, Chicago, Illinois, USA,Address correspondence to Dr. Benjamin G. Domb, M.D., 999 E Touhy Ave., Suite 450, Des Plaines, IL 60018
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Matsuda DK. Editorial Commentary: Incremental Decompression of Cam Femoroacetabular Impingement Must Be Assessed in Real Time by Arthroscopic Dynamic Examination: Playbook for the Perfect Femoroplasty. Arthroscopy 2022; 38:1164-1165. [PMID: 35369919 DOI: 10.1016/j.arthro.2021.11.038] [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: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 02/02/2023]
Abstract
The perfect femoroplasty varies with the individual patient's pathoanatomy and is a prime example of the art and science of surgery. Radiographs are two-dimensional representations of a three-dimensional reality and can miss detection of cam impingement. Cam impingement may occur without cam morphology as femoral retrotorsion and/or supraphysiological range of motion (e.g., dancers and martial artists) may cause cam impingement with normal α-angles and anterior offset. Acetabuloplasty or acetabular reorientation osteotomy may change the dynamic interaction between the proximal femur and acetabular rim and may alter the location and extent of cam decompression. Although much is discussed about the α-angle, restoration of anterior offset is also important. Incremental femoroplasty assessed in real time by arthroscopic dynamic examination is key, as the surgeon sculpts a nonimpinging proximal femur using a burr rather than a chisel in creating a customized surgical masterpiece.
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Ochiai D, Costales T, Riley T, Rosado M, Adib F. Posterior Femoral Cam Decompression Through an Arthroscopic Anterior Approach With Pre-Bent Hip Burrs. Arthrosc Tech 2020; 9:e1871-e1877. [PMID: 33381394 PMCID: PMC7768050 DOI: 10.1016/j.eats.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/10/2020] [Indexed: 02/03/2023] Open
Abstract
Hip arthroscopy has been increasingly used to treat labral tears and cam and pincer lesions found in femoroacetabular impingement. Although the classic impingement with cam deformity at the proximal femoral anterolateral quadrant is most common, there has been evidence of cam impingement extension to the anteromedial and posterior quadrants of the proximal femur. Posterior cam decompression carries a theoretical risk of vascular insult and subsequent osteonecrosis, which have led investigators to approach these posterior lesions through an open surgical correction. Recent improvements have led to the development of pre-bent burs that allow for bonier resection flexibility. Here, we report on an arthroscopic posterior cam decompression using the traditional anterior portals and curved hip burs via a figure-of-four positioning technique.
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Affiliation(s)
- Derek Ochiai
- Nirschl Orthopaedic Center for Sports Medicine & Joint Reconstruction, Virginia Hospital Center, Arlington, Virginia, U.S.A.,Address correspondence to Derek Ochiai, M.D., Nirschl Orthopaedic Center, 1715 N George Mason Dr., #504, Arlington, VA 22205.
| | - Timothy Costales
- University of Maryland Medical Center, Baltimore, Maryland, U.S.A
| | - Thomas Riley
- Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Michelle Rosado
- Nirschl Orthopaedic Center for Sports Medicine & Joint Reconstruction, Virginia Hospital Center, Arlington, Virginia, U.S.A
| | - Farshad Adib
- University of Maryland Medical Center, Baltimore, Maryland, U.S.A
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Wininger AE, Barter LE, Boutris N, Pulido LF, Ellis TJ, Nho SJ, Harris JD. Hip arthroscopy for lateral cam morphology: how important are the vessels? J Hip Preserv Surg 2020; 7:183-194. [PMID: 33163203 PMCID: PMC7605776 DOI: 10.1093/jhps/hnaa027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/17/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
The purpose of this narrative review is to identify the anatomy and relevant blood supply to the femoral head as it pertains to hip arthroscopy and lateral cam morphology. The primary blood supply to the femoral head is the lateral ascending superior retinacular vessels, which are terminal branches of the medial femoral circumflex artery. These vessels penetrate the femoral head at the posterolateral head–neck junction. Surgeons performing posterolateral femoral osteoplasty must respect this vasculature to avoid iatrogenic avascular necrosis (AVN). Avoidance of excessive traction, avoidance of distal posterolateral capsulotomy and avoidance of disruption of the superior retinacular vessels should keep the risk for AVN low. Hip extension, internal rotation and distraction are useful in hip arthroscopy to better visualize lateral/posterolateral cam morphology to facilitate an accurate comprehensive cam correction and avoid vascular disruption.
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Affiliation(s)
- Austin E Wininger
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Lindsay E Barter
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Nickolas Boutris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Luis F Pulido
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
| | - Thomas J Ellis
- Orthopedic One, 4605 Sawmill Road, Upper Arlington, OH 43220, USA
| | - Shane J Nho
- Midwest Orthopedics at Rush, 1611 West Harrison Street, Chicago, IL 60612, USA
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, 6445 Main Street, Outpatient Center, Suite 2500, Houston, TX 77030, USA
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Stoner R, Strambi F, Bohacek I, Smoljanovic T. Femoral Head Avascular Necrosis Is Not Caused by Arthroscopic Posterolateral Femoroplasty. Orthopedics 2016; 39:330. [PMID: 27893921 DOI: 10.3928/01477447-20161020-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Matsuda DK, Gupta N, Burchette RJ, Sehgal B. Arthroscopic surgery for global versus focal pincer femoroacetabular impingement: are the outcomes different? J Hip Preserv Surg 2015; 2:42-50. [PMID: 27011813 PMCID: PMC4718481 DOI: 10.1093/jhps/hnv010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/23/2014] [Accepted: 11/30/2014] [Indexed: 11/17/2022] Open
Abstract
To determine outcomes from arthroscopic surgery for global pincer femoroacetabular impingement (FAI), a large multicenter prospective study investigating arthroscopic surgical outcomes was performed with minimum 2-year follow-up. Global (center-edge angle 40+ degrees) and Focal (center-edge angle 25-39 degrees) cohorts were based on pre-operative radiographs. Pre-operative and intra-operative findings, surgical procedures, post-operative nonarthritic hip score (NAHS) and satisfaction (5-point Likert scale), complications and conversion arthroplasties were compared. A nested case-control study was also performed. The Global cohort consisted of 15 patients (18 hips) of mean age 37.2 years. Pre-operative NAHS was 51.5 and 74.1 at 24+ months post-surgery. The change in NAHS was significant (P = 0.01). Mean satisfaction was 4.2. There was one total hip arthroplasty (THA) conversion (5.6%), no revision surgeries or complications. The Focal cohort consisted of 125 patients (129 hips) of mean age 39.8 years. Pre-operative NAHS was 54.8 and 77.8 at 24+ months post-surgery. The change in NAHS was significant (P < 0.0001). Mean satisfaction was 4.2. There were eight THA conversions (6.2%), three complications (2.3%) and two revision surgeries (1.5%). Cohort comparisons revealed no statistically significant difference in NAHS (P = 0.30), satisfaction (P = 0.92) or THA conversion rate (P = 0.91). The nested case-control study found mean post-operative change in NAHS was +22.2 and +20.4, respectively, at 24+ months (P = 0.76). Arthroscopic treatment of global pincer FAI is a safe and effective procedure. With outcomes comparable to those observed in the arthroscopic treatment of lesser focal deformities, arthroscopic surgery provides a less invasive option for the treatment of global pincer FAI.
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Affiliation(s)
- Dean K. Matsuda
- 1. DISC Sports Medicine and Spine Centers, 13160 Mindanao Way #325, Marina del Rey, CA 90292, USA
| | - Nikhil Gupta
- 2. Jefferson Medical College, 1020 Walnut St, Philadelphia, PA 19107, USA
| | - Raoul J. Burchette
- 3. Kaiser Permanente Department of Research and Evaluation Pasadena, CA 91101, USA
| | - Bantoo Sehgal
- 4. Essentia Health, 3000 32nd Ave S Fargo, ND 58103, USA
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Matsuda DK, Bharam S, White BJ, Matsuda NA, Safran M. Anchor-induced chondral damage in the hip. J Hip Preserv Surg 2015; 2:56-64. [PMID: 27011815 PMCID: PMC4718472 DOI: 10.1093/jhps/hnv001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/24/2014] [Accepted: 01/01/2015] [Indexed: 01/02/2023] Open
Abstract
The purpose of this study is to investigate the outcomes from anchor-induced chondral damage of the hip, both with and without frank chondral penetration. A multicenter retrospective case series was performed of patients with chondral deformation or penetration during initial hip arthroscopic surgery. Intra-operative findings, post-surgical clinical courses, hip outcome scores and descriptions of arthroscopic treatment in cases requiring revision surgery and anchor removal are reported. Five patients (three females) of mean age 32 years (range, 16-41 years) had documented anchor-induced chondral damage with mean 3.5 years (range, 1.5-6.0 years) follow-up. The 1 o'clock position (four cases) and anterior and mid-anterior portals (two cases each) were most commonly implicated. Two cases of anchor-induced acetabular chondral deformation without frank penetration had successful clinical and radiographic outcomes, while one case progressed from deformation to chondral penetration with clinical worsening. Of the cases that underwent revision hip arthroscopy, all three had confirmed exposed hard anchors which were removed. Two patients have had clinical improvement and one patient underwent early total hip arthroplasty. Anchor-induced chondral deformation without frank chondral penetration may be treated with close clinical and radiographic monitoring with a low threshold for revision surgery and anchor removal. Chondral penetration should be treated with immediate removal of offending hard anchor implants. Preventative measures include distal-based portals, small diameter and short anchors, removable hard anchors, soft suture-based anchors, curved drill and anchor insertion instrumentation and attention to safe trajectories while visualizing the acetabular articular surface.
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Affiliation(s)
- Dean K. Matsuda
- 1. DISC Sports and Spine Center, 13160 Mindanao Way, Suite 300, Marina del Rey, CA 90292, USA
| | | | - Brian J. White
- 3. Western Orthopaedics, 1830 Franklin St #450, Denver, CO 80218, USA
| | - Nicole A. Matsuda
- 4. Westchester Enriched Science Magnet, 7400 West Manchester Avenue, Los Angeles, CA 90045, USA
| | - Marc Safran
- 5. Stanford Medical Clinics, 450 Broadway S, Pavilion A, Redwood City, CA 94063, USA
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Matsuda DK, Villamor A. The modified mid-anterior portal for hip arthroscopy. Arthrosc Tech 2014; 3:e469-74. [PMID: 25276606 PMCID: PMC4175545 DOI: 10.1016/j.eats.2014.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 05/08/2014] [Indexed: 02/03/2023] Open
Abstract
The modified mid-anterior portal is a utilitarian hip arthroscopy working portal that permits dual-portal comprehensive surgery for femoroacetabular impingement and related chondrolabral procedures without the need for interportal exchange. Its distal location facilitates labral reparative and reconstructive procedures while minimizing iatrogenic acetabular chondral damage. The relatively lateral location permits instrument navigation not only along the anterosuperior acetabular rim and anterolateral proximal femur typically required for acetabuloplasty and femoroplasty but even to the posterior regions of the hip in cases of global pincer femoroacetabular impingement and posterior extensions of cam morphology and the anteromedial proximal femur while avoiding direct injury to the lateral femoral cutaneous nerve.
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Affiliation(s)
- Dean K. Matsuda
- Kaiser West Los Angeles Medical Center, Los Angeles, California, U.S.A.,Address correspondence to Dean K. Matsuda, M.D., Kaiser West Los Angeles Medical Center, 6041 Cadillac Ave, Los Angeles, CA 90034, U.S.A.
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Matsuda DK, Gupta N, Hanami D. Hip arthroscopy for challenging deformities: global pincer femoroacetabular impingement. Arthrosc Tech 2014; 3:e197-204. [PMID: 24904760 PMCID: PMC4044509 DOI: 10.1016/j.eats.2013.09.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/24/2013] [Indexed: 02/03/2023] Open
Abstract
Pincer femoroacetabular impingement occurs in focal or global forms, the latter having more generalized and typically more extreme acetabular overcoverage. Severe global deformities are often treated with open surgical dislocation of the hip. Arthroscopic technical challenges relate to difficulties with hip distraction; central-compartment access; and instrument navigation, acetabuloplasty, and chondrolabral surgery of the posterior acetabulum. Techniques addressing these challenges are introduced permitting dual-portal hip arthroscopy with central-compartment access, subtotal acetabuloplasty, and circumferential chondrolabral surgery. The modified midanterior portal in combination with a zone-specific sequence of acetabular rim reduction monitored with fluoroscopic templating enables precision subtotal acetabuloplasty. Guidelines for acetabular rim reduction include the following suggested radiographic endpoints: postoperative center-edge angle of 35°, a neutral posterior wall sign, and an anterior margin ratio of 0.5. Arthroscopic zone-specific chondrophobic rim preparation and circumferential labral reparative and reconstructive techniques and tools permit the arthroscopic treatment of these challenging deformities.
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Affiliation(s)
- Dean K. Matsuda
- Kaiser West Los Angeles Medical Center, Los Angeles, California, U.S.A
| | - Nikhil Gupta
- Jefferson Medical School, Philadelphia, Pennsylvania, U.S.A
| | - Dylan Hanami
- Saint Louis University Medical School, St. Louis, Missouri, U.S.A
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