Arthroscopic Femoral Osteochondroplasty With Capsular Plication for Osteochondroma of the Femoral Neck

Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft

The acetabular labrum is essential to maintaining the functional health of the hip joint through contributions to joint congruity, stability, and the negative pressure suction seal. Injury, overuse, long-standing developmental disorders, or failed primary labral repair can eventually lead to functional labral insufficiency requiring management via labral reconstruction. While numerous graft options exist for hip labral reconstruction, there is no current gold standard. The optimal graft should best mimic the native labrum with regard to geometry, structure, mechanical properties, and durability. This has led to the development of an arthroscopic technique for labral reconstruction with fresh meniscal allograft tissue.

Intraoperative Automated Radiographic Visualization Tool Allows for Higher Accuracy of Cam Lesion Resection When Used by Novice Surgeons for Arthroscopic Femoroplasty: Lowering the Learning Curve

PURPOSE

To compare the accuracy of conventional fluoroscopy versus an intraoperative radiographic visualization tool in assisting a novice and experienced hip arthroscopist in comprehensive cam correction to a desired alpha angle (AA).

METHODS

A cadaveric study was performed using 28 hemi-pelvises with cam-type deformity (AA > 55˚) measured on anteroposterior, lateral, and Dunn-view radiographs. Two fellowship-trained hip arthroscopists each performed 14 arthroscopic femoroplasties. The specimens were randomly assigned: 14 of the procedures were performed by the experienced surgeon, with 7 using the automated radiographic visualization tool (Guided Femoroplasty) and 7 using routine fluoroscopy (Control). The same number of hips was assigned to the novice surgeon, completing 7 femoroplasties with and without the visualization tool. Each hip was imaged before and after femoroplasty in 6 different positions using intraoperative fluoroscopy to evaluate head-neck offset. Femoroplasty AAs were compared between groups with and without visualization tool use, as well as between surgeons. One-way analysis of variance analysis was performed to evaluate the consistency of cam resection.

RESULTS

For the experienced hip arthroscopist, comparison of Guide Femoroplasty and Control groups resulted in similar accuracy when compared to the controls, with post-femoroplasty AA averages ranging from 41.4° ± 3.8˚ to 44.8° ± 2.8˚ (P = .511) and 40.2° ± 5.3˚ to 45.6° ± 2.2˚ (P = .225), respectively. For the novice hip arthroscopist, the Guided Femoroplasty group had higher accuracy, with post-femoroplasty AA averages ranging from 42.8° ± 2.6˚ to 46.1° ± 7.2˚(P = .689) with and 39.8° ± 3.1˚ to 51.9° ± 8.1˚ (P = .001) without the visualization tool. Comparison of procedure time did not show any statistically significant difference between the use of the radiographic visualization tool and controls for either surgeon (P > .05 for all).

CONCLUSIONS

Femoroplasty with and without the use of automated radiographic visualization tool results in accurate cam resection when used by both the experienced and novice surgeon. However, higher accuracy was observed when resecting to a desired AA performed by a novice surgeon using the visualization tool. Additionally, use of the visualization tool did not result in longer procedure times for either surgeon.

CLINICAL RELEVANCE

The impact of incomplete cam resections and over-resection on patient outcomes in the literature has led to the recent development of automated intraoperative radiographic visualization tools that allow for assistance of cam resection accuracy for the treatment of femoroacetabular impingement syndrome. This cadaveric study demonstrates that femoroplasty with the use of an intraoperative automated radiographic visualization tool may result in more accurate cam resections.

Arthroscopic Fixation of Os Acetabuli and Labral Repair: Suture-on-Screw Technique

Os acetabuli is thought to be the result of an unfused ossification center or an acetabular rim fracture in the setting of femoral-sided femoroacetabular impingement syndrome. Historically, patients with symptomatic hips have been treated with resection alone; however, in patients with large bone fragments or with reduced acetabular coverage prior to surgical intervention, iatrogenic dysplasia and structural instability may develop after resection. Therefore, for patients with an acetabular os, labral tearing, and cam-type femoroacetabular impingement, internal fixation of the os acetabuli, femoral osteochondroplasty, and labral repair have been described. We propose a "suture-on-screw" arthroscopic technique to simultaneously address both the labral tear and os acetabuli, thereby reducing the number of suture anchors required for labral fixation, leading to an efficient and cost-effective approach for the treatment of these patients.