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Celiksoz AH, Bayram B, Yozgatli TK, Yilmaz E, Yassin A, Kayaalp A, Kocaoglu B. Comparison of Knotless Versus Knot-Tying Suture Anchors for Arthroscopic Repair of Hip Labral Tears. Orthop J Sports Med 2024; 12:23259671241265737. [PMID: 39221045 PMCID: PMC11363226 DOI: 10.1177/23259671241265737] [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: 03/16/2024] [Accepted: 04/04/2024] [Indexed: 09/04/2024] Open
Abstract
Background Both knotless and knot-tying anchors are commonly employed in the arthroscopic repair of hip labral tears. Purpose To compare the midterm clinical results of arthroscopic hip labral repair using knot-tying versus knotless suture anchors. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent arthroscopic hip labral repair between January 2017 and January 2021 and who had at least 2 years of follow-up were included. The patients were divided into 2 groups based on the suture anchor type: a 2.9-mm knotless suture anchor (knotless group) or a 1.8-mm knot-tying suture anchor (knot-tying group). All patients underwent femoroplasty for cam lesions and acetabular rim trimming for pincer lesions. The modified Harris Hip Score (mHHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain were administered both preoperatively and postoperatively. The consistency of the outcome scores was assessed using the minimal clinically important difference and Patient Acceptable Symptom State. The statistical significance between groups was evaluated using the Mann-Whitney test and quantile-based analysis of variance. Results A total of 413 patients were included: 256 patients in the knotless group (median age, 35 years [interquartile range, 31-38 years]; median follow-up, 34 months) and 157 patients in the knot-tying group (median age, 34 years [interquartile range, 30-38 years]; median follow-up, 25 months). There were no significant differences in postoperative mHHS, HOS-ADL, or iHOT-12 scores between the 2 groups. However, there were significant differences, favoring the knotless group over the knot-tying group, in postoperative HOS-SSS (87 ± 2 vs 86 ± 1, respectively) and VAS pain (1 vs 2, respectively) scores (P < .0001 for both). Postoperative synovitis was found in significantly more patients in the knot-tying group than in the knotless group (17 vs 5, respectively; P = .01). Conclusion In this study, patients who underwent arthroscopic hip labral repair with knotless suture anchors had slightly better postoperative HOS-SSS and VAS pain scores and a lower incidence of postoperative synovitis compared with patients who underwent repair with knot-tying suture anchors.
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Affiliation(s)
| | - Berhan Bayram
- Department of Orthopaedics and Traumatology, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Tahir Koray Yozgatli
- Department of Orthopaedics and Traumatology, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Edip Yilmaz
- Department of Orthopaedics and Traumatology, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Ali Yassin
- Department of Orthopaedics and Traumatology, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Asim Kayaalp
- Department of Orthopaedics and Traumatology, Cankaya Hospital for Orthopedic Care, Ankara, Turkey
| | - Baris Kocaoglu
- Department of Orthopaedics and Traumatology, Acibadem Altunizade Hospital, Istanbul, Turkey
- Department of Orthopaedics and Traumatology, Acibadem University Faculty of Medicine, Istanbul, Turkey
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Dean MC, Cherian NJ, McBroom TJ, Eberlin CT, Torabian KA, Dowley KS, LaPorte ZL, Kucharik MP, Martin SD. Preoperative Paralabral Cysts Predict More Significant Chondral Damage but Not 2-Year Functional Outcomes Following Arthroscopic Labral Repair. Arthroscopy 2024; 40:1475-1487.e1. [PMID: 37865131 DOI: 10.1016/j.arthro.2023.10.009] [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: 05/31/2023] [Revised: 09/20/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE To investigate whether paralabral cysts identified incidentally on preoperative magnetic resonance imaging/arthrography predict 2-year functional outcomes after arthroscopic acetabular labral repair. METHODS Prospectively collected data for patients undergoing primary hip arthroscopy by a single surgeon from 2014 to 2020 were retrospectively reviewed. Included patients were ≥18 years and completed baseline patient-reported outcome measures (PROMs) with additional follow-up at 3, 6, 12, and 24 months. Exclusion criteria were labral debridement, hip dysplasia, advanced hip osteoarthritis (Tönnis > 1), or previous ipsilateral hip surgery. Patients were stratified based on the presence of paralabral cysts identified on magnetic resonance imaging/arthrography. Primary outcomes were International Hip Outcome Tool and modified Harris Hip Score. Secondary outcomes included other PROMs and the visual analog pain scale. Outcomes were compared between cohorts using linear mixed-effects models and Fisher's exact tests. Sensitivity analyses accounted for preoperative PROMs, nonlinear improvement trajectories, and relevant baseline characteristics. RESULTS Of the 182 included hips (47.8% female; mean ± standard deviation age, 36.9 ± 11.4), 30 (16.4%) had paralabral cysts. During the 2-year study period, there were no significant differences between patients with and without paralabral cysts in terms of International Hip Outcome Tool scores (weighted difference = 1.60; 95% confidence interval [CI], -5.09, 8.28; P = .64), modified Harris Hip Scores (weighted difference = 0.56; 95% CI, -4.16, 5.28; P = .82), or any secondary outcomes (except for HOS-Sports Subscale at 3 months [mean difference = -11.85; 95% CI, -22.85, -0.84; P = .035]). Furthermore, there were no significant differences in clinically meaningful outcomes (P > .05 for all), revision rates (P > .99), or conversion to total hip arthroplasty between cohorts (P > .99). These results held across all sensitivity analyses. CONCLUSIONS Although preoperative paralabral cysts were associated with worse cam impingement and more severe chondral damage observed intraoperatively, they did not predict 2-year functional outcomes or clinically meaningful improvements, suggesting that incidentally discovered paralabral cysts are not a contraindication for arthroscopic labral repair. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Michael C Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A..
| | - Nathan J Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, U.S.A
| | | | - Christopher T Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| | - Kaveh A Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Kieran S Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Zachary L LaPorte
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Michael P Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Scott D Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.; Harvard Medical School, Boston, Massachusetts, U.S.A
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Girardi NG, Kraeutler MJ, Jesse MK, Lee JH, Genuario JW, Mei-Dan O. The Windshield Wiper Sign Is an Instability-Related Osteochondral Defect of the Anterolateral Femoral Head. Arthroscopy 2024:S0749-8063(24)00307-4. [PMID: 38697329 DOI: 10.1016/j.arthro.2024.04.012] [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: 01/07/2024] [Revised: 03/25/2024] [Accepted: 04/07/2024] [Indexed: 05/04/2024]
Abstract
PURPOSE To investigate a radiographic sign believed to be indicative of hip instability and acetabular suction seal disruption in the native hip, coined the "windshield wiper" (WSW) sign. METHODS A retrospective review was performed for patients who underwent periacetabular osteotomy (PAO) with the senior author between March 2021 and September 2023. A WSW sign was identified on plain films as a concave or flat osteochondral defect on the anterolateral femoral head extending medial to the head-neck junction with resultant loss of femoral head sphericity in the native hip. Every patient underwent a standardized series of radiographs, as well as computed tomography and magnetic resonance imaging. All patients underwent arthroscopy before PAO to address intra-articular pathology and other indicated procedures. The osteochondral defect and resultant suction seal disruption were verified during arthroscopy. These patients were then compared with a control group of arthroscopically treated hips without hip instability. RESULTS Of 250 patients reviewed, a total of 19 hips in 17 patients (prevalence of 7.6%) demonstrated radiographic evidence of the WSW sign. All patients with a WSW sign presented with symptomatic clinical hip instability requiring a PAO. The mean patient age was 31.2 years, with a mean lateral center-edge angle (LCEA) of 14.3°. There were 13 hips (68.4%) with dysplasia, 4 (21.1%) with borderline dysplasia, and 2 (10.5%) with a normal LCEA. All patients with a WSW sign and LCEA ≥ 20° displayed significant femoral antetorsion abnormalities. All arthroscopic videos and images demonstrated a compromised suction seal. Of the 50 control group hips reviewed, the WSW sign was not identified. CONCLUSIONS The WSW sign is an uncommon radiographic finding in patients with hip instability. When identified, it can be predictive of substantial instability, especially in cases which are otherwise considered borderline dysplasia or normal based on LCEA. LEVEL OF EVIDENCE Level III, retrospective comparative case control study.
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Affiliation(s)
- Nicholas G Girardi
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Matthew J Kraeutler
- Departments of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A.; Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, MöIndal, Sweden
| | - Mary K Jesse
- Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Jessica H Lee
- Departments of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - James W Genuario
- UC Health Steadman Hawkins Clinic-Denver, Englewood, Colorado, U.S.A
| | - Omer Mei-Dan
- Departments of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A..
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Dean MC, Cherian NJ, LaPorte ZL, Eberlin CT, Wang C, Torabian KA, Dowley KS, Kucharik MP, Abraham PF, Nazal MR, Martin SD. Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up. Am J Sports Med 2024; 52:1153-1164. [PMID: 38476016 PMCID: PMC10986152 DOI: 10.1177/03635465241234258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/20/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied. PURPOSE To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion. RESULTS In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ (P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators (P < .001 for all). CONCLUSION Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.
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Affiliation(s)
- Michael C. Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathan J. Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska, USA
| | - Zachary L. LaPorte
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher T. Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Charles Wang
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kaveh A. Torabian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kieran S. Dowley
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida, USA
| | - Paul F. Abraham
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Mark R. Nazal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Li J, Xu J, Chen Z, Lu Y, Hua X, Jin Z. Computational modelling of articular joints with biphasic cartilage: recent advances, challenges and opportunities. Med Eng Phys 2024; 126:104130. [PMID: 38621832 DOI: 10.1016/j.medengphy.2024.104130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 04/17/2024]
Abstract
Biphasic models have been widely used to simulate the time-dependent biomechanical response of soft tissues. Modelling techniques of joints with biphasic weight-bearing soft tissues have been markedly improved over the last decade, enhancing our understanding of the function, degenerative mechanism and outcomes of interventions of joints. This paper reviews the recent advances, challenges and opportunities in computational models of joints with biphasic weight-bearing soft tissues. The review begins with an introduction of the function and degeneration of joints from a biomechanical aspect. Different constitutive models of articular cartilage, in particular biphasic materials, are illustrated in the context of the study of contact mechanics in joints. Approaches, advances and major findings of biphasic models of the hip and knee are presented, followed by a discussion of the challenges awaiting to be addressed, including the convergence issue, high computational cost and inadequate validation. Finally, opportunities and clinical insights in the areas of subject-specific modeling and tissue engineering are provided and discussed.
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Affiliation(s)
- Junyan Li
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, PR China.
| | - Jinghao Xu
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, PR China
| | - Zhenxian Chen
- Key Laboratory of Road Construction Technology and Equipment (Ministry of Education), Chang'an University, Xi'an, PR China
| | - Yongtao Lu
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, PR China
| | - Xijin Hua
- Faculty of Environment, Science and Economy, University of Exeter, Exeter, United Kingdom
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, PR China; Sate Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, PR China; Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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Kaplan DJ, Fenn TW, Gursoy S, Mameri ES, Rice MW, Chapman RS, Shewman EF, Nho SJ. Labral Augmentation With Either Iliotibial Band Allograft or Dermis Allograft Perform Similarly Regarding Peak Force, Displacement, and Work to Labral Repair in Suction Seal Restoration: A Biomechanical Study. Arthroscopy 2024:S0749-8063(24)00073-2. [PMID: 38311265 DOI: 10.1016/j.arthro.2024.01.029] [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: 05/19/2023] [Revised: 01/01/2024] [Accepted: 01/14/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To investigate whether allograft substitutes may be used to restore suctional seal properties with labral augmentation, the purpose of the current study was to evaluate the biomechanical properties of the labral suction seal under several scenarios, including: (1) intact labrum, (2) rim preparation, (3) labral repair, (4) labral augmentation with iliotibial band (ITB), and (5) labral augmentation with a dermis allograft. METHODS Eleven hemi-pelvises were dissected to the level of the labrum and placed in a material testing system for biomechanical axial distraction. Each specimen was compressed to 250 newtons (N) and distracted at 10 mm/s while load, crosshead displacement, and time were continuously recorded. For each of the 5 labral states, 3 testing repetitions were performed. Peak force (N, newtons), displacement at peak force (mm, millimeter), and work (N-mm, newton, millimeter) were calculated and normalized to the intact state of each specimen. RESULTS Eleven specimens were tested and 8 specimens (age: 58.6 ± 5.4 years, body mass index: 28.6 ± 6.8 kg/m2; 4 female patients; 5 right hips) were included in final analyses. Expressed as a percentage relative to the intact state, the average normalized peak force, displacement at peak force, and work for each labral state were as follows: intact (100.0% ± 0% for all), rim preparation (89.0% ± 9.2%, 93.3% ± 20.6%, 85.1% ± 9.0%), repair (61.3% ± 17.9%, 88.4% ± 36.9%, 58.1% ± 16.7%), ITB allograft (62.7% ± 24.9%, 83.9% ± 21.6%, 59.4% ± 22.4%), and dermis allograft (57.8% ± 27.2%, 88.2% ± 29.5%, 50.0% ± 20.1%). Regarding peak force, intact state was significantly greater compared with the labral repair, augmentation with ITB, and augmentation with the dermis allograft states (P < .001). No significant differences were demonstrated between displacement at peak force (P = .561). Regarding work, both intact state and rim preparation states were significantly greater than the repair, ITB augmentation, and dermis allograft augmentation states (P < .001). In all outcome measures, the dermis allograft augmentation performed with no statistical difference to the ITB augmentation state. CONCLUSIONS Labral repair and labral augmentation with either ITB allograft or the dermis allograft resulted in significantly lower peak force and work to equilibrium compared with the intact and rim prep states. There was no statistical difference between repair and augmentation states as well as no statistical difference between ITB allograft and dermal allograft at time zero. CLINICAL RELEVANCE This study compares biomechanical properties of the suction seal of the hip comparing labral states including intact, rim preparation, repair, and augmentation, which can be used for surgical decision-making.
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Affiliation(s)
- Daniel J Kaplan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Safa Gursoy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.; Department of Orthopaedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey
| | - Enzo S Mameri
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A.; Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil; Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, RJ, Brazil
| | - Morgan W Rice
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic 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 Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth F Shewman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
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Nolte E, Blommer J, Som M, Parsa S, Kim P, Hasan S, Boissonneault A, O’Hara NN, Slobogean GP, O’Toole RV. Frequency and Characteristics of Posterior Labral Injuries in Operative Acetabular Fractures Treated Through a Posterior Approach: A Prospective Observational Study. J Orthop Trauma 2024; 38:83-87. [PMID: 38032226 PMCID: PMC10843808 DOI: 10.1097/bot.0000000000002736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/17/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES The association between labral injuries and acetabular fractures is unknown. This study aimed to identify the frequency and characteristics of labral injuries in operatively treated acetabular fractures that cannot be identified on preoperative imaging. METHODS . DESIGN Prospective observational cohort. SETTING Level I trauma center. PATIENT SELECTION CRITERIA Adult patients with an acetabular fracture operatively treated through a posterior approach. OUTCOME MEASURES AND COMPARISONS The frequency and characteristics of labral injuries. RESULTS Fifty-three of 71 acetabular fractures (75%; 95% confidence interval, 63%-83%) demonstrated a labral injury visible via the posterior approach. Posterior labral injuries occurred in 89% of operative acetabular fracture patterns involving the posterior wall and most commonly represent a detachment of the posteroinferior labrum (n = 39, 75%). Fractures with a labral injury were more likely to have gluteus minimus damage (93% vs. 61%, P = 0.02), femoral head lesions (38% vs. 17%, P = 0.03), joint capsule detachment (60% vs. 33%, P = 0.05), and fracture patterns involving the posterior wall (89% vs. 50%, P = 0.05). CONCLUSIONS This study describes the high rate (89%) of posterior labral injuries in posterior wall fractures, the most common injury pattern being a detachment of the posteroinferior labrum. Labral injuries in acetabular fractures may have important clinical implications and this study is the first to identify the frequency and characteristics of these injuries. Further studies should assess the relationship between labral injuries, treatment strategies, and the progression to post-traumatic osteoarthritis. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Elizabeth Nolte
- Department of Orthopaedic Surgery, The Medical College of Wisconsin, Milwaukee, WI
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph Blommer
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Maria Som
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Shirin Parsa
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Peter Kim
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Sania Hasan
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Adam Boissonneault
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Nathan N. O’Hara
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Gerard P. Slobogean
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
| | - Robert V. O’Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD
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Radha S, Hutt J, Lall A, Domb B, Lynch TS, Griffin D, Field RE, Chuck-Cakic J. Best practice guidelines for clinical and radiological assessment of patients with femoroacetabular impingement. Results from the ISHA International Delphi Consensus Project-Phase 2. J Hip Preserv Surg 2024; 11:44-50. [PMID: 38606327 PMCID: PMC11005775 DOI: 10.1093/jhps/hnad028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/11/2023] [Accepted: 08/16/2023] [Indexed: 04/13/2024] Open
Abstract
In 2018, the International Society for Hip Preservation Surgery (ISHA) initiated a series of Delphi consensus studies to identify the global hip preservation community's current opinion on best practices for different facets of hip preservation surgery. Arthroscopic procedures to treat hip pathologies, such as femoroacetabular impingement syndrome (FAIS) are now established in mainstream orthopaedic practice. This study establishes recommendations for the investigation of patients with suspected FAIS. The investigation has focused on the three phases of the diagnostic process-patient history, physical examination and special investigations. Our expert panel consisted of 174 international orthopaedic surgeons with expertise in hip preservation surgery, thereby making recommendations generalisable across the globe. After three rounds of survey and analysis with 174 participants per round, our study achieved consensus at a minimum agreement threshold of 80.0% on 55 statements pertaining to the assessment of patients with FAIS. We encourage our junior and senior hip arthroscopy colleagues internationally to consider these statements both to standardize the clinical and radiological assessment of patients with FAIS and to aid in the design of future research.
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Affiliation(s)
- Sarkhell Radha
- Trauma and Orthopaedics, Croydon University Hospital, 530 London Road, London CR7 7YE, UK
- Al-Kindy University, Mohamed Al-Qasim Expy, Baghdad, Iraq
| | - Jonathan Hutt
- Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Ajay Lall
- America Hip Institute, 999 E Touhy Ave # 450, Chicago 60018, USA
| | - Benjamin Domb
- America Hip Institute, 999 E Touhy Ave # 450, Chicago 60018, USA
| | - T Sean Lynch
- Northwestern University, 633 Clark Street, Chicago, IL 60208, USA
| | - Damian Griffin
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Richard E Field
- South West London Elective Orthopaedic Centre, Dorking Road, London KT18 7EG, UK
| | - Josip Chuck-Cakic
- Rosebank Centre for Sports Medicine and Orthopaedics and Fourways Life Hospital, 9 Sturdee Avenue, Johannesburg, South Africa
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9
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Cherian NJ, Eberlin CT, Kucharik MP, Abraham PF, Nazal MR, Dean MC, Martin SD. Labral Reconstruction via Capsular Augmentation Maintains Perfusion to the Acetabular Labrum and Locally Transferred Autograft: An in Vivo Laser Doppler Flowmetry Analysis. JB JS Open Access 2023; 8:e23.00026. [PMID: 37753110 PMCID: PMC10516391 DOI: 10.2106/jbjs.oa.23.00026] [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] [Indexed: 09/28/2023] Open
Abstract
Background The purpose of the present study was to examine the effects of arthroscopic labral repair with capsular augmentation on blood flow in vivo with use of laser Doppler flowmetry (LDF) to measure microvascular perfusion of the labrum and autograft tissue. Methods The present prospective case series included patients ≥18 years old who underwent arthroscopic acetabular labral repair with capsular augmentation; all procedures were performed by a single surgeon between 2018 and 2022. The LDF probe measured microvascular blood flow flux within 1 mm3 of the surrounding labral and capsular tissue of interest. Mean baseline measurements of flux were compared with readings immediately following capsular elevation and after completing labral augmentation. Blood flux changes were expressed as the percent change from the baseline measurements. Results The present study included 41 patients (24 men [58.5%] and 17 women [41.5%]) with a mean age (and standard deviation) of 31.3 ± 8.4 years, a mean BMI of 24.6 ± 3.4 kg/m2, a mean lateral center-edge of angle 35.3° ± 4.9°, a mean Tönnis angle of 5.8° ± 5.8°, and a mean arterial pressure of 93.7 ± 10.9 mm Hg. Following capsular elevation, the mean percent change in capsular blood flow flux was significantly different from baseline (-9.24% [95% confidence interval (CI), -18.1% to -0.04%]; p < 0.001). Following labral augmentation, the mean percent change in labral blood flow flux was significantly different from baseline both medially (-22.3% [95% CI, -32.7% to -11.9%]; p < 0.001) and laterally (-32.5% [95% CI, -41.5% to -23.6%]; p = 0.041). There was no significant difference between the changes in medial and lateral perfusion following repair (p = 0.136). Conclusions Labral repair with capsular augmentation sustains a reduced blood flow to the native labrum and capsular tissue at the time of fixation. The biological importance of this reduction is unknown, but these findings may serve as a benchmark for other labral preservation techniques and support future correlations with clinical outcomes. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nathan J. Cherian
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, Nebraska
| | - Christopher T. Eberlin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of Iowa, Iowa City, Iowa
| | - Michael P. Kucharik
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of South Florida, Tampa, Florida
| | - Paul F. Abraham
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California
| | - Mark R. Nazal
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Michael C. Dean
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Scott D. Martin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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10
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Huber S, Ladner Y, Stoddart MJ, Leunig M, Ferguson SJ. The acetabular labrum tissue shows unique transcriptome signatures compared to cartilage and responds to combined cyclic compression and surface shearing. Gene 2023; 856:147140. [PMID: 36574933 DOI: 10.1016/j.gene.2022.147140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
The labrum is a fibrocartilaginous ring surrounding the acetabulum. Loss of labrum function contributes to the degeneration of the hip joint, leading to osteoarthritis. Successful labrum restoration requires profound knowledge about the tissue being replaced. The aim of this study was to characterize the transcriptome and the mechanobiological function of the labrum. RNA-seq was performed to compare the transcriptome of bovine labrum against articular cartilage tissue. Differential expression and gene ontology (GO) term pathway analysis were applied using the SUSHI framework. Bovine labrum explants were cultured for 5 days with / without mechanical loading and targeted gene expression was analyzed by real time quantitative polymerase chain reaction. More than 6'000 genes were significantly differentially expressed in the labrum compared to cartilage. Up- and downregulated genes were associated with the GO term extracellular matrix organization. The study established an extracellular matrix gene expression profile of healthy labrum tissue and identified significantly upregulated extracellular matrix related genes compared to cartilage tissue. Mechanical loading significantly upregulated aggrecan (ACAN), cartilage oligomeric matrix protein (COMP), fibronectin (FN1) and proteoglycan 4 (PRG4). MMP1/3/9 and IL6, which were upregulated by an inflammatory stimulus (IL-1b), were statistically unaffected by the loading, although IL6 was upregulated in each donor immediately after the loading. Unique ECM related features may guide the development of labrum tissue-engineering solutions. Despite the transcriptome differences between labrum and cartilage tissue, gene expression response to mechanical loading showed similarities with previously reported responses in cartilage, indicating a preserved tissue adaptation mechanism to mechanical loading. Running title: Acetabular Labrum Mechanobiology.
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Affiliation(s)
- Stephanie Huber
- ETH Zurich, Institute for Biomechanics, Zurich, Switzerland.
| | - Yann Ladner
- ETH Zurich, Institute for Biomechanics, Zurich, Switzerland; AO Research Institute, Davos, Switzerland.
| | | | - Michael Leunig
- Schulthess Clinic, Department of Orthopaedic Surgery, Zurich, Switzerland.
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11
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Yang F, Maimaitimin M, He Z, Zhang X, Huang H, Wang J. The Cartilage Protective Effect of Labrum Reconstruction Using Meniscus Allograft Compared with Labrum Resection in a Porcine Model. Cartilage 2023; 14:76-85. [PMID: 36484319 PMCID: PMC10076893 DOI: 10.1177/19476035221141419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aimed to verify the femoral head cartilage protective effect of labral reconstruction in a porcine model. METHODS Twelve pigs (24 hips) were divided into 3 groups: labrum defect group, lateral meniscus (LM) allograft group, and LM allograft wrapped with acellular peritoneum matrix (LM-APM) group before undergoing bilateral hip surgery. The pigs were sacrificed at 12 and 24 weeks postoperatively, while the femoral head cartilage was retrieved and then subjected to imaging measurement, macroscopic observations, and biomechanical and histological assessment. RESULTS Imaging measurement and macroscopic observations revealed that the defect area of the labrum was filled in LM and LM-APM allograft groups after 24 weeks, whereas the labrum defect remained at 24 weeks in the control group. The femoral head cartilage corresponding to the area of labral resection in the labral defect group had worse macroscopic Osteoarthritis Research Society International (OARSI) scores, uneven and discontinuous cartilage on hematoxylin and eosin (H&E) staining and Safranin O staining, decreased histopathology OARSI Osteoarthritis Cartilage Histopathology Assessment System (OOCHAS) scores, and decreased elastic modulus and hardness at 12 and 24 weeks after surgery compared with the meniscus allograft groups. CONCLUSION This study demonstrated that the LM allograft with or without APM for labral reconstruction had a chondroprotective effect on the femoral head in a porcine model.
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Affiliation(s)
- Fan Yang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Maihemuti Maimaitimin
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Ziyi He
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Xin Zhang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Hongjie Huang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
| | - Jianquan Wang
- Beijing Key Laboratory of Sports Injuries, Department of Sports Medicine, Institute of Sports Medicine of Peking University, Peking University Third Hospital, Beijing, China
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12
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Capurro B, Tey-Pons M, Carrera A, Marqués-López F, Marín-Peña O, Torres-Eguía R, Monllau JC, Reina F. Polyurethane Scaffold vs Fascia Lata Autograft for Hip Labral Reconstruction: Comparison of Femoroacetabular Biomechanics. Orthop J Sports Med 2023; 11:23259671221150632. [PMID: 36846818 PMCID: PMC9944198 DOI: 10.1177/23259671221150632] [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] [Indexed: 03/01/2023] Open
Abstract
Background The integrity of the acetabular labrum is critical in providing normal function and minimizing hip degeneration and is considered key for success in today's hip preservation algorithm. Many advances have been made in labral repair and reconstruction to restore the suction seal. Purpose/Hypothesis To compare the biomechanical effects of segmental labral reconstruction between the synthetic polyurethane scaffold (PS) and fascia lata autograft (FLA). Our hypothesis was that reconstruction with a macroporous polyurethane implant and autograft reconstruction of fascia lata would normalize hip joint kinetics and restore the suction seal. Study Design Controlled laboratory study. Methods Ten cadaveric hips from 5 fresh-frozen pelvises underwent biomechanical testing with a dynamic intra-articular pressure measurement system under 3 conditions: (1) intact labrum, (2) reconstruction with PS after a 3-cm segmental labrectomy, then (3) reconstruction with FLA. Contact area, contact pressure, and peak force were evaluated in 4 positions: 90º of flexion in neutral, 90º of flexion plus internal rotation, 90º of flexion plus external rotation, and 20º of extension. A labral seal test was performed for both reconstruction techniques. The relative change from the intact condition (value = 1) was determined for all conditions and positions. Results PS restored contact area to at least 96% of intact (≥0.96; range, 0.96-0.98) in all 4 positions, and FLA restored contact area to at least 97% (≥0.97; range, 0.97-1.19). Contact pressure was restored to ≥1.08 (range, 1.08-1.11) with the PS and ≥1.08 (range, 1.08-1.10) with the FLA technique. Peak force returned to ≥1.02 (range, 1.02-1.05) with PS and ≥1.02 (range, 1.02-1.07) with FLA. No significant differences were found between the reconstruction techniques in contact area in any position (P > .06), with the exception that FLA presented greater contact area in flexion plus internal rotation as compared with PS (P = .003). Suction seal was confirmed in 80% of PSs and 70% of FLAs (P = .62). Conclusion Segmental hip labral reconstruction using PS and FLA reapproximated femoroacetabular contact biomechanics close to the intact state. Clinical Relevance These findings provide preclinical evidence supporting the use of a synthetic scaffold as an alternative to FLA and therefore avoiding donor site morbidity.
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Affiliation(s)
- Bruno Capurro
- Department of Orthopaedic Surgery and Traumatology, Hospital del
Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Orthopaedic Surgery and Sport Traumatology, ReSport
Clinic, Barcelona, Spain.,Clinical Anatomy, Embryology and Neuroscience Research Group,
Medical Sciences Department, Faculty of Medicine, University of Girona, Girona,
Spain.,Grupo Ibérico de Cirugía de Preservación de Cadera, Portugal and
Spain.,Bruno Capurro Soler, PhD, Department of Orthopaedic Surgery and
Traumatology, Hospital del Mar, Passeig Marítim de la Barceloneta, 25, 08003,
Barcelona, Spain () (Twitter:
@DrBrunoCapurro)
| | - Marc Tey-Pons
- Department of Orthopaedic Surgery and Traumatology, Hospital del
Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grupo Ibérico de Cirugía de Preservación de Cadera, Portugal and
Spain
| | - Anna Carrera
- Clinical Anatomy, Embryology and Neuroscience Research Group,
Medical Sciences Department, Faculty of Medicine, University of Girona, Girona,
Spain
| | - Fernando Marqués-López
- Department of Orthopaedic Surgery and Traumatology, Hospital del
Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oliver Marín-Peña
- Grupo Ibérico de Cirugía de Preservación de Cadera, Portugal and
Spain.,Department of Orthopaedic Surgery and Traumatology, Hospital Infanta
Leonor, Madrid, Spain
| | - Raúl Torres-Eguía
- Grupo Ibérico de Cirugía de Preservación de Cadera, Portugal and
Spain.,Department of Orthopaedic Surgery and Traumatology, Clínica Cemtro,
Madrid, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery and Traumatology, Hospital del
Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco Reina
- Clinical Anatomy, Embryology and Neuroscience Research Group,
Medical Sciences Department, Faculty of Medicine, University of Girona, Girona,
Spain
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13
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Shirogane Y, Homma Y, Yanagisawa N, Higano M, Hirasawa Y, Nakamura S, Baba T, Kaneko K, Taneda H, Ishijima M. Relationship between labral length and symptoms in patients with acetabular dysplasia before rotational acetabular osteotomy. J Hip Preserv Surg 2022; 9:240-251. [PMID: 36908550 PMCID: PMC9993447 DOI: 10.1093/jhps/hnac045] [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: 05/16/2022] [Revised: 08/03/2022] [Accepted: 09/06/2022] [Indexed: 03/14/2023] Open
Abstract
The aim of this study was to investigate the relationship between acetabular labral length and symptoms in patients with acetabular dysplasia. In a retrospective medical record review, 218 patients with acetabular dysplasia who had undergone rotational acetabular osteotomy were identified. After implementing the inclusion and exclusion criteria, 53 patients were analyzed for preoperative symptoms measured by the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ), acetabular bone morphology parameters by anteroposterior pelvic radiographs and labral parameters by radial magnetic resonance imaging. Spearman's correlation coefficients were calculated among JHEQ scores, bone morphologic parameters and labral parameters. Multiple linear regression models to determine the predictive variables of JHEQ score and labral length were obtained. There was no correlation between bone morphologic parameters and JHEQ scores. Labral length measured anteriorly correlated with JHEQ pain {r [95% confidence interval (CI)] = -0.335 (-0.555, -0.071), P = 0.014}, movement subscale [r (95% CI) = -0.398 (-0.603, -0.143), P = 0.003], mental subscale [r (95% CI) = -0.436 (-0.632, -0.188), P = 0.001] and total JHEQ score [r (95% CI) = -0.451 (-0.642, -0.204), P = 0.001]. The multiple linear regression results showed that anterior labral length was independently associated with JHEQ subscales in some models. Meanwhile, age, acetabular head index and total JHEQ score were independently associated with anterior labral length in all models. Labral length, notably in anterosuperior area, in patients with symptomatic acetabular dysplasia was related to patient's symptom. Labral length may be an important objective image finding that can be used to assess the severity of cumulative hip instability.
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Affiliation(s)
- Yuichi Shirogane
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan.,Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Yasuhiro Homma
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan.,Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Naotake Yanagisawa
- Clinical Research and Trial Center, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Masanori Higano
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Yoichiro Hirasawa
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Shigeru Nakamura
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Kazuo Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
| | - Hitoshi Taneda
- Department of Orthopaedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19 Shibakubocho, Nishitokyo-shi, Tokyo 188-0014,Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 133-8421, Japan.,Department of Orthopaedic, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-ku, Tokyo 133-8431, Japan
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14
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Sabetian PW, Paraschos OA, Harris WT, Padilla PP, Maldonado DR, Domb BG. Anchor Arthropathy Caused by Cartilage Penetration: An Approach to Revision Hip Arthroscopy With Removal of Problematic Anchors. Arthrosc Tech 2022; 11:e1689-e1694. [PMID: 36311313 PMCID: PMC9596390 DOI: 10.1016/j.eats.2022.06.003] [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: 03/29/2022] [Accepted: 06/06/2022] [Indexed: 02/03/2023] Open
Abstract
Hip arthroscopy has been proven to effectively treat labral tears in the setting of femoroacetabular impingement. Anchors used for this treatment have constantly evolved and improved to ensure safety and minimal invasion. However, acetabular drilling and anchor placement are technically challenging due to the concavity of the acetabular articular surface, limited angles for anchor insertion, and finite bone availability in the anterior and posterior column. Inadequate technique can result in protruding anchors, which may lead to full-thickness articular cartilage damage, manifesting in pain, mechanical symptoms, and impaired function. This Technical Note demonstrates arthroscopic removal of protruding anchors and management of the iatrogenic grade IV cartilage damage. In this description, the technical pearls and pitfalls of acetabular anchor placement to treat labral pathology are presented along with the aforementioned technique.
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Affiliation(s)
- Payam W. Sabetian
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | | | - W. Taylor Harris
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - Paulo P. Padilla
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
| | - David R. Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.,American Hip Institute, Chicago, Illinois, U.S.A
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A.,American Hip Institute, Chicago, Illinois, U.S.A.,Address correspondence to Dr. Benjamin G. Domb, M.D., 999 E Touhy Ave., Suite 450, Des Plaines, IL 60018.
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15
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Capurro B, Reina F, Carrera A, Monllau JC, Marqués-López F, Marín-Peña O, Torres-Eguía R, Tey-Pons M. Hip Labral Reconstruction With a Polyurethane Scaffold: Restoration of Femoroacetabular Contact Biomechanics. Orthop J Sports Med 2022; 10:23259671221118831. [PMID: 36119123 PMCID: PMC9478710 DOI: 10.1177/23259671221118831] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Many advances have been made in hip labral repair and reconstruction and in
the restoration of the suction seal. Purpose/Hypothesis: The purpose of this study was to evaluate the biomechanical effects of
segmental labral reconstruction with a synthetic polyurethane scaffold (PS)
in comparison with segmental labrectomy. Our hypothesis was that
reconstruction with a icroporous polyurethane implant would normalize joint
kinetics of the hip and restore the suction seal. Study Design: Controlled laboratory study. Methods: We used 10 hips from 5 fresh-frozen pelvises with an intact acetabular labrum
without osteoarthritis. Using an intra-articular pressure measurement
system, the contact area, contact pressure, and peak force were assessed for
the following conditions: intact labrum, partial anterosuperior labrectomy,
and PS reconstruction. For each condition, all specimens were analyzed in 4
positions (90° of flexion, 90° of flexion and internal rotation, 90° of
flexion and external rotation, and 20° of extension) and underwent a labral
seal test. The relative change from the intact condition was determined for
all conditions and positions. Results: Compared with the intact labrum, labrectomy resulted in a significant
decrease in the contact area (P < .001) and a
significant increase in the peak force (P < .001) and
contact pressure (P < .001) across all positions.
Compared with labrectomy, PS reconstruction resulted in a significant
increase in the contact area (P < .001) and a
significant decrease in the contact pressure (P ≤ .02) and
peak force (P < .001) across all positions. Compared
with the intact labrum, PS reconstruction restored the contact area and peak
force to normal values in all positions (P > .05),
whereas the contact pressure was significantly decreased compared with
labrectomy (P < .05) but did not return to normal
values. The labral seal was lost in all specimens after labrectomy but was
restored in 80% of the specimens after PS reconstruction. Conclusion: Femoroacetabular contact biomechanics significantly worsened after partial
labrectomy; reconstruction using a PS restored the contact area and peak
force to the intact state and improved the contact pressure increases seen
after partial labrectomy. The contact area and peak force were normalized,
and the labral seal was re-established in most cases. Clinical Relevance: This study provides biomechanical evidence for the use of a scaffold for
labral reconstruction.
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Affiliation(s)
- Bruno Capurro
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Orthopaedic Surgery and Sport Traumatology, ReSport Clinic, Barcelona, Spain.,NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Spain.,GIPCA - Grupo Ibérico de cirugía Preservación de Cadera, Spain - Portugal
| | - Francisco Reina
- NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Spain
| | - Anna Carrera
- NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fernando Marqués-López
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oliver Marín-Peña
- GIPCA - Grupo Ibérico de cirugía Preservación de Cadera, Spain - Portugal.,Department of Orthopaedic Surgery and Traumatology, Hospital Infanta Leonor, Universidad Complutense de Madrid, Madrid, Spain
| | - Raúl Torres-Eguía
- GIPCA - Grupo Ibérico de cirugía Preservación de Cadera, Spain - Portugal.,Department of Orthopaedic Surgery and Traumatology, Clínica CEMTRO, Madrid, Spain
| | - Marc Tey-Pons
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.,GIPCA - Grupo Ibérico de cirugía Preservación de Cadera, Spain - Portugal
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16
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Maldonado DR, Banffy MB, Huang D, Nelson TJ, Kanjiya S, Metzger MF. An Increased Allograft Width for Circumferential Labral Reconstruction Better Restores Distractive Stability of the Hip: A Cadaveric Biomechanical Analysis. Am J Sports Med 2022; 50:2462-2468. [PMID: 35722810 DOI: 10.1177/03635465221101126] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Questions remain about whether circumferential labral reconstruction (CLR) using an iliotibial band (ITB) allograft can effectively restore the labral suction seal of the hip. HYPOTHESES (1) CLR with an ITB allograft >6.5 mm would restore distractive stability force to that of the intact labrum. (2) CLR with an ITB allograft >6.5 mm would achieve significantly superior distractive stability force compared with CLR with an ITB allograft <6.5 mm. STUDY DESIGN Controlled laboratory study. METHODS A total of 6 fresh-frozen pelves with attached femurs (n = 12 matched hemipelves) from male donors were procured and dissected free of all soft tissue, including the hip capsule but preserving the native labrum, transverse acetabular ligament, and ligamentum teres. Potted hemipelves were placed in a saline bath and securely fixed to the frame of a hydraulic testing system. A 500-N compressive load was applied, followed by femoral distraction at a rate of 5.0 mm/s until the suction seal ruptured. Force and femoral displacement were continually recorded. Force versus displacement curves were plotted, the maximum force was recorded, and the amount of femoral distraction to rupture the suction seal was determined. After intact testing, the labrum was excised, and specimens were retested using the same protocol. CLR was subsequently performed twice in a randomized fashion using (1) an ITB allograft with a width >6.5 mm (7.5-9.0 mm) and (2) an ITB allograft with a width <6.5 mm (4.5-6.0 mm). Specimens were retested after each CLR procedure. Force (in Newtons) and femoral distraction (in millimeters) required to rupture the suction seal were measured and compared between the 4 testing states (intact, deficient, CLR <6.5 mm, and CLR >6.5 mm) using repeated-measures analysis of variance. RESULTS On average, intact specimens required 148.4 ± 33.1 N of force to rupture the hip suction seal, which significantly decreased to 44.3 N in the deficient state (P < .001). CLR with ITB allografts <6.5 mm did not improve the maximum force (63 ± 62 N) from the deficient state (P = .42) and remained significantly lower than the intact state (P < .01). CLR with ITB allografts >6.5 mm recorded significantly greater force to rupture the suction seal (135.8 ± 44.6 N) compared with both the deficient and CLR <6.5 mm states (P < .01), with a mean force comparable with the intact labrum (P = .59). The amount of femoral distraction to rupture the suction seal demonstrated similar findings. CONCLUSION In a cadaveric model, CLR using ITB allografts >6.5 mm restored the distractive force and distance to the suction seal rupture to values comparable with hips with an intact labrum. CLR using ITB allografts >6.5 mm outperformed CLR with ITB allografts <6.5 mm, demonstrated by a significantly higher force to rupture the suction seal and increased distraction before the rupture. CLINICAL RELEVANCE The results of this cadaveric investigation suggest that using wider labral allografts during CLR will provide the distractive force required to rupture the suction seal and immediate postoperative stability of the hip, although further studies are required to determine if these results translate to improved clinical outcomes.
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Affiliation(s)
| | - Michael B Banffy
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Dave Huang
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Trevor J Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shrey Kanjiya
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Melodie F Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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17
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Martin H, Robinson PG, Maempel JF, Hamilton D, Gaston P, Safran MR, Murray IR. Pre- and intraoperative decision-making challenges in hip arthroscopy for femoroacetabular impingement. Bone Joint J 2022; 104-B:532-540. [PMID: 35491576 DOI: 10.1302/0301-620x.104b5.bjj-2021-1553.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article: Bone Joint J 2022;104-B(5):532-540.
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Affiliation(s)
- Hannah Martin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | | | - David Hamilton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
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18
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Holleyman RJ, Lyman S, Bankes MJK, Board TN, Conroy JL, McBryde CW, Andrade AJ, Malviya A, Khanduja V. Comparison of early outcomes of arthroscopic labral repair or debridement. Bone Jt Open 2022; 3:291-301. [PMID: 35369718 PMCID: PMC9044091 DOI: 10.1302/2633-1462.34.bjo-2022-0003.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Methods Data on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months post-operatively. Due to concerns over differential questionnaire non-response between the two groups, a combination of random sampling, propensity score matching, and pooled multivariable linear regression models were employed to compare iHOT-12 improvement. Results A total of 2,025 labral debridements (55%) and 1,659 labral repairs (45%) were identified. Both groups saw significant (p < 0.001) EQ-5D and iHOT-12 gain compared to preoperative scores at 12 months (iHOT-12 improvement: labral repair = +28.7 (95% confidence interval (CI) 26.4 to 30.9), labral debridement = +24.7 (95% CI 22.5 to 27.0)), however there was no significant difference between procedures after multivariable modelling. Overall, 66% of cases achieved the minimum clinically important difference (MCID) and 48% achieved substantial clinical benefit at 12 months. Conclusion Both labral procedures were successful in significantly improving early functional outcome following hip arthroscopy, regardless of age or sex. Labral repair was associated with superior outcomes in univariable analysis, however there was no significant superiority demonstrated in the multivariable model. Level of evidence: III Cite this article: Bone Jt Open 2022;3(4):291–301.
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Affiliation(s)
| | - Stephen Lyman
- Hospital for Special Surgery, New York, New York, USA
- Kyushu University School of Medicine, Fukuoka, Japan
| | - Marcus J. K. Bankes
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Fortius Clinic, London, UK
| | | | | | | | | | - Ajay Malviya
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Vikas Khanduja
- Addenbrooke’s Hospital - The Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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19
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Lee G, Morikawa L, Andrews SN, Livingstone JP, Crawford SN. Outcomes After Hip Labral Reconstruction Using Peroneus Longus Graft: A Novel Graft Experience. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:25-29. [PMID: 35340941 PMCID: PMC8941616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Currently, there is no consensus on the ideal graft for hip labral reconstruction. The purpose of this study was to describe the surgical technique and report the short-term outcomes after hip labral reconstruction using a peroneal longus allograft. Eleven patients diagnosed with femoracetabular impingement and irreparable damage to the acetabular labrum underwent labral reconstruction with a peroneus longus allograft. The average follow-up time was 227 days (range: 26-457 days). Pre-operative radiographic measurements included an average pre-operative center edge angle of 29.0° (range: 19° to 37°) and an average alpha angle of 62.9° (range: 55° to 71°). All patients underwent femoroplasty, with additional procedures including 7 acetabuloplasties and 6 microfractures. The average visual analogue score for pain improved from 4.91±2.17 preoperatively to 3.85±2.0 postoperatively but this was not significant (P=.26). No patients sustained post-operative complications or allograft failures during follow up. Compared to other acetabular labral reconstruction options, the strength and shape of thedcd peroneus tendon may best replicate the native hip labrum. The current findings of no immediate post-operative complications or early failures suggests the peroneus longus allograft may be a viable option for hip labrum reconstruction.
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Affiliation(s)
- Gordon Lee
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Landon Morikawa
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Samantha N. Andrews
- Department of Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - John P. Livingstone
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Scott N. Crawford
- Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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20
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Larson CM, Dean RS, McGaver RS, Seiffert KJ, Giveans MR. Arthroscopic Debridement Versus Refixation of the Acetabular Labrum Associated With Femoroacetabular Impingement: Updated Mean 7-Year Follow-up. Am J Sports Med 2022; 50:731-738. [PMID: 35099305 DOI: 10.1177/03635465211067818] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Short- and midterm follow-up studies suggest that arthroscopic labral refixation/preservation leads to superior outcomes compared with labral excision/debridement. PURPOSE To update the previous early (16 months) and midterm (mean, 42 months) follow-up of this cohort, which reported better patient-reported outcome measures and lower failure rates in the repair/refixation group. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors identified patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. A consecutive group of patients within the labral debridement group thought to be repairable with the authors' current arthroscopic techniques were compared with a group of consecutive patients who underwent labral repair/refixation. In 46 hips, the labrum was focally excised/debrided consistent with pincer- or combined pincer- and cam-type impingement; in 54 hips, the labrum was repaired/refixed. Subjective outcomes were measured with the modified Harris Hip Score (mHHS), 12-Item Short Form Health Survey (SF-12), and visual analog scale (VAS) for pain preoperatively and postoperatively. RESULTS The mean age was 34.0 years in the debridement group and 28.3 years in the repair/refixation group, with a mean follow-up of 7.3 years (range, 2-13.6 years). At the mean follow-up of 7.3 years, subjective outcomes were significantly improved (P < .01) for both groups compared with preoperative scores. The mHHS (P = .008), SF-12 score (P = .012), and VAS pain score (P = .002) were all significantly better for the repair/refixation group compared with the debridement group. Although most recent outcomes for both groups fell slightly at the mean follow-up of 7.3 years in comparison with the 16-month and 3.5-year follow-ups, these differences were not significant. However, the failure rate in the debridement group did get significantly worse (P = .014). Good to excellent results were 47.7% in the debridement group and 86.3% in the refixation group (P < .001), and failure rates were 30.4% (debridement) and 13% (refixation) (P = .033). There were 4 revisions in the debridement group and 3 revisions in the refixation group. CONCLUSION Longer term, >7-year follow-up comparing focal labral excision/debridement with repair/refixation revealed better patient-reported outcomes and lower failure rates in the labral repair/refixation cohort. Additionally, despite an absolute decrease in patient-related outcome scoring and number of good/excellent results in both groups compared with the 3.5-year report, there was a significantly greater increase in failure rates over time for the excision/debridement group with better maintenance of good to excellent results in the repair/refixation group.
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21
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Shapira J, Chen JW, Yelton MJ, Rosinsky PJ, Maldonado DR, Meghpara MB, Lall AC, Domb BG. The Inverse Relationship Between Labral Size and Acetabular Coverage: Does It Protect the Cartilage in the Dysplastic Hip? Arthroscopy 2022; 38:385-393. [PMID: 33964389 DOI: 10.1016/j.arthro.2021.04.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/21/2021] [Accepted: 04/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were to confirm the relationship between osseous coverage and labral size and to investigate the severity of intra-articular damage in borderline dysplastic hips in correlation to labral size. METHODS Patients treated with primary hip arthroscopy for symptomatic labral tears between 2010 and 2018 were considered for this study. Patients were included if they had preoperative radiographic measures and intraoperative assessments of the labra and cartilage. The study group was divided into borderline dysplastic and nondysplastic groups via 3 measurements: lateral center edge angle (LCEA), acetabular index (Ax), and anterior center edge angle (ACEA). Undercoverage was defined as LCEA ≤ 25°, Ax ≥ 10°, and ACEA ≤ 20°. The labrum was measured in four quadrants: anterosuperior (AS), anteroinferior (AI), posterosuperior (PS), and posteroinferior (PI). Additionally, to assess cartilage damage in borderline dysplastic hips, hips with average labral size in the top quartile were compared to hips with average labral size in the bottom quartile. RESULTS A total of 1765 hips (1589 patients) were included in the study. The mean LCEA, Ax, and ACEA between the borderline dysplastic and nondysplastic groups were significantly different (P < .001). According to the Ax classification, there was significant evidence that borderline dysplastic hips had larger labra (P < .05). Among the dysplastic group, there was significantly more cartilage damage according to the Outerbridge classifications along both the acetabulum and femoral head in hips with labra in the upper quartile (P =.011 and .005, respectively). CONCLUSION An inverse relationship may exist between acetabular depth and labral size. Additionally, specifically in borderline dysplastic hips, a relatively large labrum correlates with worse intra-articular damage compared to borderline dysplastic hips with a relatively small labrum. Larger labral size may indicate a higher degree of instability in patients with borderline dysplasia. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois
| | - Jeffrey W Chen
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois; American Hip Institute, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois; American Hip Institute, Chicago, Illinois; AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A..
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22
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Abstract
It is essential to be aware of the anatomy and biomechanics of the acetabular labrum in order to understand why it should be conserved. Vascularization comes from the capsule and also from the bone. The joint side contains numerous nerve endings, which explains why labral lesions are painful. It is involved in joint stabilization by maintaining a negative pressure inside the joint able to resist distraction. It acts as a seal. There are two main suture techniques: trans- and peri-labral. Translabral suture is better suited to a wide and solid labrum free of degenerative lesions. Both techniques should be known, and may be associated. Results are comparable. It is essential to manage the underlying pathology responsible for the labral lesion. Joint degeneration is associated with poor prognosis. It needs to be recognized and discussed with the patient, to avoid unrealistic expectations.
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23
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Bodendorfer BM, Alter TD, Carreira DS, Wolff AB, Kivlan BR, Christoforetti JJ, Salvo JP, Matsuda DK, Nho SJ. Multicenter Outcomes After Primary Hip Arthroscopy: A Comparative Analysis of Two-Year Outcomes After Labral Repair, Segmental Labral Reconstruction, or Circumferential Labral Reconstruction. Arthroscopy 2022; 38:352-361. [PMID: 34052367 DOI: 10.1016/j.arthro.2021.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To report minimum 2-year follow-up patient-reported outcome measures in patients undergoing labral repair (LR), segmental labral reconstruction (SLR), or circumferential labral reconstruction (CLR) in the primary setting; and (2) to compare minimum 2-year follow-up patient-reported outcome measures among these groups. METHODS A retrospective review of a prospectively maintained multicenter database of patients undergoing hip arthroscopy was performed. Inclusion criteria were patients undergoing hip arthroscopy for treatment of labral tear and femoroacetabular impingement syndrome between January 2014 and October 2017, and completion of minimum 2-year postoperative outcome scores. Exclusion criteria were patients undergoing revision hip surgery, labral treatment limited to debridement, lateral center-edge angle <20°, osteoarthritis (Tönnis grade > 1), slipped capital femoral epiphysis, workers compensation status, and patients undergoing concomitant gluteus medius and/or minimus repair. Labral reconstruction patients were matched (1:3) with labral repair patients on age, sex, and body mass index. The labral reconstruction group was further stratified into SLR, and CLR groups. Patient demographic characteristics and clinical outcomes including Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sport Subscale, modified Harris Hip Score, international Hip Outcome Tool, and visual analog scale for pain were analyzed, as well as achievement of the minimal clinical improvement difference (MCID). A P-value less than .05 indicated statistical significance. RESULTS A total of 416 patients were included (LR, n = 312; SLR, n = 53; CLR, n = 51). The age, body mass index, and sex of the matched cohort were 42.3 ± 11.2 years, 24.7 ± 3.7, and 55.0% female. At a minimum of 2-year after hip arthroscopic surgery, no differences were found in preoperative, postoperative, or the delta visual analog scale for pain, modified Harris Hip Score, Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sport Subscale, or international Hip Outcome Tool. Subsequently, the proportion of patients achieving the MCID and the PASS at latest follow-up were analyzed. This analysis revealed that no significant differences in the rate of MCID or PASS achievement for any outcome measure existed based on labral treatment. CONCLUSIONS In this multicenter study on labral treatment in the primary setting, patients undergoing LR, SLR, and CLR demonstrated no difference in preoperative or postoperative scores, nor the proportion of patients achieving clinically significant outcome improvement. LEVEL OF EVIDENCE III; therapeutic outcome study with controls.
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Affiliation(s)
- Blake M Bodendorfer
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas D Alter
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - Andrew B Wolff
- Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, DC, U.S.A
| | - Benjamin R Kivlan
- Rangos School of Health Sciences, Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, U.S.A
| | - John J Christoforetti
- Center for Athletic Hip Injury, Allegheny Health Network, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Drexel University College of Medicine, Pittsburgh, Pennsylvania, U.S.A.; American Hip Institute, Chicago, Illinois, U.S.A
| | - John P Salvo
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.; Hip Arthroscopy Program, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Dean K Matsuda
- DISC Sports and Spine Center, Marina del Rey, California, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A..
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24
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Ni M, Wen X, Chen W, Zhao Y, Yuan Y, Zeng P, Wang Q, Wang Y, Yuan H. A Deep Learning Approach for MRI in the Diagnosis of Labral Injuries of the Hip Joint. J Magn Reson Imaging 2022; 56:625-634. [PMID: 35081273 DOI: 10.1002/jmri.28069] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The diagnosis of labral injury on MRI is time-consuming and potential for incorrect diagnoses. PURPOSE To explore the feasibility of applying deep learning to diagnose and classify labral injuries with MRI. STUDY TYPE Retrospective. POPULATION A total of 1016 patients were divided into normal (n = 168, class 0) and abnormal labrum (n = 848) groups. The abnormal group consisted of n = 111 with class 1 (degeneration), n = 437 with class 2 (partial or complete tear), and n = 300 with unclassified injury. Patients were randomly divided into training, validation, and test cohort according to the ratio of 55%:15%:30%. FIELD STRENGTH/SEQUENCE Fat-saturation proton density-weighted fast spin-echo sequence at 3.0 T. ASSESSMENT Convolutional neural network-6 (CNN-6) was used to extract, discriminate, and detect oblique coronal (OCOR) and oblique sagittal (OSAG) images. Mask R-CNN was used for segmentation. LeNet-5 was used to diagnose and classify labral injuries. The weighting method combined the models of OCOR and OSAG. The output-input connection was used to correlate the whole diagnosis/classification system. Four radiologists performed subjective diagnoses to obtain the diagnosis results. STATISTICAL TESTS CNN-6 and LeNet-5 were evaluated by area under the receiver operating characteristic (ROC) curve and related parameters. The mean average precision (MAP) evaluated the Mask R-CNN. McNemar's test was used to compare the radiologists and models. A P value < 0.05 was considered statistically significant. RESULTS The area under the curve (AUC) of CNN-6 was 0.99 for extraction, discrimination, and detection. MAP values of Mask R-CNN for OCOR and OSAG image segmentation were 0.96 and 0.99. The accuracies of LeNet-5 in the diagnosis and classification were 0.94/0.94 (OCOR) and 0.92/0.91 (OSAG), respectively. The accuracy of the weighted models in the diagnosis and classification were 0.94 and 0.97, respectively. The accuracies of radiologists in the diagnosis and classification of labrum injuries ranged from 0.85 to 0.92 and 0.78 to 0.94, respectively. DATA CONCLUSION Deep learning can assist radiologists in diagnosing and classifying labrum injuries. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Xiaoyi Wen
- Institute of Statistics and Big Data, Renmin University of China, 59 Zhongguancun Street, Haidian District, Beijing, China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Yuan Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Piaoe Zeng
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Qizheng Wang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
| | - Yong Wang
- Department of Radiology, He Bei Gu Cheng Xian Yi Yuan, 55 East Kangning Road, Zhengkou Town, Gucheng County, Hebei, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, China
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25
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Menger MM, Braun BJ, Herath SC, Küper MA, Rollmann MF, Histing T. Fractures of the femoral head: a narrative review. EFORT Open Rev 2021; 6:1122-1131. [PMID: 34909230 PMCID: PMC8631236 DOI: 10.1302/2058-5241.6.210034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fractures of the femoral head are rare injuries, which typically occur after posterior hip dislocation. The Pipkin classification, developed in 1957, is the most commonly used classification scheme to date. The injury is mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a significant height. Emergency treatment consists of urgent closed reduction of the hip joint, followed by non-operative or operative treatment of the femoral head fracture and any associated injuries. There is an ongoing controversy about the suitable surgical approach (anterior vs. posterior) for addressing fractures of the femoral head. Fracture location, degree of displacement, joint congruity and the presence of loose fragments, as well as concomitant injuries are crucial factors in choosing the adequate surgical approach. Long-term complications such as osteonecrosis of the femoral head, posttraumatic osteoarthritis and heterotopic ossification can lead to a relatively poor functional outcome.
Cite this article: EFORT Open Rev 2021;6:1122-1131. DOI: 10.1302/2058-5241.6.210034
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Affiliation(s)
- Maximilian M Menger
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Benedikt J Braun
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Steven C Herath
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Markus A Küper
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Mika F Rollmann
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
| | - Tina Histing
- Department of Trauma and Reconstructive Surgery, Eberhard Karls University Tuebingen, BG Trauma Center Tuebingen, Germany
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26
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Espinosa MG, Otarola GA, Hu JC, Athanasiou KA. Vibrometry as a noncontact alternative to dynamic and viscoelastic mechanical testing in cartilage. J R Soc Interface 2021; 18:20210765. [PMID: 34932927 PMCID: PMC8692039 DOI: 10.1098/rsif.2021.0765] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
Physiological loading of knee cartilage is highly dynamic and may contribute to the progression of osteoarthritis. Thus, an understanding of cartilage's dynamic mechanical properties is crucial in cartilage research. In this study, vibrometry was used as a fast (2 h), noncontact and novel alternative to the slower (30 h), traditional mechanical and biochemical assays for characterization of cartilage from the condyle, patella, trochlear groove and meniscus. Finite-element models predicted tissue resonant frequencies and bending modes, which strongly correlated with experiments (R2 = 0.93). Vibrometry-based viscoelastic properties significantly correlated with moduli from stress relaxation and creep tests, with correlation strengths reaching up to 0.78. Loss modulus also strongly correlated with glycosoaminoglycan (GAG) content. Dynamic properties measured by vibrometry significantly differed among various knee cartilages, ranging between 6.1 and 56.4 MPa. Interestingly, meniscus viscoelastic properties suggest that contrary to common belief, it may lack shock absorption abilities; instead, condylar hyaline cartilage may be a better shock absorber. These data demonstrate for the first time that vibrometry is a noncontact approach to dynamic mechanical characterization of hyaline and fibrocartilage cartilage with concrete relationships to standard quasi-static mechanical testing and biochemical composition. Thus, with a single tool, vibrometry greatly facilitates meeting multiple regulatory recommendations for mechanical characterization of cartilage replacements.
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Affiliation(s)
- M. Gabriela Espinosa
- Department of Biomedical Engineering, University of California, 3131 Engineering Hall, Irvine, CA 92617, USA
- Department of Engineering, Concordia University Irvine, 1530 Concordia West, Irvine, CA 92612, USA
| | - Gaston A. Otarola
- Department of Biomedical Engineering, University of California, 3131 Engineering Hall, Irvine, CA 92617, USA
| | - Jerry C. Hu
- Department of Biomedical Engineering, University of California, 3131 Engineering Hall, Irvine, CA 92617, USA
| | - Kyriacos A. Athanasiou
- Department of Biomedical Engineering, University of California, 3131 Engineering Hall, Irvine, CA 92617, USA
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27
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Cooper JD, Dekker TJ, Ruzbarsky JJ, Pierpoint LA, Soares RW, Philippon MJ. Autograft Versus Allograft: The Evidence in Hip Labral Reconstruction and Augmentation. Am J Sports Med 2021; 49:3575-3581. [PMID: 34665988 DOI: 10.1177/03635465211042633] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Labral augmentation and labral reconstruction have emerged as essential procedures for restoring the anatomic and functional characteristics of the hip joint in patients with a deficient hip labrum or irreparable labral tear. HYPOTHESIS/PURPOSE The purpose of this study was to compare allograft and autograft hip labral reconstruction and augmentation. We hypothesized that autografts would entail fewer revision arthroscopic procedures. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients were identified who underwent labral reconstruction or labral augmentation using iliotibial band (ITB) allograft or ITB autograft performed by a single surgeon between 2011 and 2017. Patient-reported outcome measures collected before surgery and at minimum 2-year follow-up included the following: Hip Outcome Score Activities of Daily Living and Hip Outcome Score Sports-Specific Subscale and, at follow-up, patient satisfaction (range, 1-10, with 10 being very satisfied). Patients followed a standardized rehabilitation protocol after surgery with relative individualization to address each patient's needs. For continuous variables, comparisons between allografts and autografts were made using Student t tests or Mann-Whitney tests. Categorical comparisons were assessed using chi-square or Fisher exact test. Multiple logistic regression was performed to determine the influence of graft choice on risk of revision or THA. RESULTS A total of 205 hips met 2-year inclusion criteria. ITB allografts were used for 55 patients (37 augmentations, 18 reconstructions) and ITB autografts for 150 patients (34 augmentations, 116 reconstructions). Females represented a greater proportion of allograft versus autograft patients (71% vs 46%, respectively; P = .001). Overall, autograft patients had larger alpha angles (66.6° vs 59.1°; P = .001) and longer grafts (46 vs 41 mm; P = .03) compared with allograft patients. A total of 13 (23.6%) patients required revision surgery in the allograft group compared with 11 (7.3%) in the autograft group (P < .001). After controlling for sex, procedure (reconstruction vs augmentation), and previous surgery, the odds of revision were higher for allograft patients (OR, 4.1; 95% CI, 1.5-11.6). No significant differences in conversion to THA were observed between groups (allograft = 9%; autograft = 6%; P = .50), even after adjustment for the above covariates (OR, 2.3; 95% CI, 0.6-7.9). No differences in postoperative patient-reported outcome measures or patient satisfaction were observed between groups. CONCLUSION Labral augmentation or reconstruction with autograft has a significantly lower revision rate than labral augmentation or reconstruction with allograft.
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Affiliation(s)
| | | | | | | | - Rui W Soares
- Steadman Philippon Research Institute, Vail, Colorado, USA
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Acetabular labral tears in the adolescent athlete: results of a graduated management protocol from therapy to arthroscopy. J Pediatr Orthop B 2021; 30:549-555. [PMID: 32826727 DOI: 10.1097/bpb.0000000000000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study sought to determine outcomes of a graduated management protocol from therapy to arthroscopy for adolescents presenting with hip pain and an associated acetabular tear. Thirty-seven hips with an MRI confirmed labral tear were prospectively enrolled in a graduated management protocol created for adolescents. The protocol began with activity modification and focused physical therapy. Patients with persistent symptoms were offered an intraarticular corticosteroid injection. Those with continued symptoms were treated with arthroscopic surgery. The modified Harris hip score (mHHS) and nonarthritic hip score (NAHS) were recorded at the initial visit. Patients were contacted by telephone at 1, 2, and 5 years from enrollment for repeat assessment with mHHS and NAHS. At presentation, the mean mHHS and NAHS for the entire cohort was 66.4 ± 11.4 and 70.2 ± 12.6, and these values improved significantly to 89.3 ± 10.6 and 87.0 ± 11.4 at a mean follow-up of 35.7 ± 18.3 months (range 11.7-64.4 months). Forty-two percent of hips were managed with physical therapy and activity modifications alone, 28% of hips progressed to a steroid injection but did not require surgery, and 31% required arthroscopic intervention. Seventy-three percent of hips treated with activity modification alone, 80% treated with an injection, and 82% of hips treated with arthroscopic repair met the minimal clinically significant difference (MCID) (P = 0.859). At an average of 36 months follow-up, the majority (78%) of adolescent patients with an acetabular labral tear will achieve the MCID utilizing a graduated management protocol.
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Repair versus Debridement for Acetabular Labral Tears-A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e1569-e1576. [PMID: 34712994 PMCID: PMC8527267 DOI: 10.1016/j.asmr.2021.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to systematically review the evidence in the literature to ascertain whether acetabular labral repair (ALR) or debridement (ALD) resulted in superior patient outcomes. Methods The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed studies comparing ALR and ALD published in English with full text available were included. Patients undergoing both open and arthroscopic surgery in randomized controlled trials, prospective cohort studies, retrospective cohort studies, and case-control studies were included. Studies were quantified for methodological quality using the MINORS criteria. Clinical outcomes were compared, with qualitative analysis, and quantitative analyses were performed using GraphPad Prism version 7. A P value <.05 was considered to be statistically significant. Results There were 8 studies included (level of evidence [LOE] I = 1; LOE II = 2; LOE III = 5). The 7 studies compared 364 patients (369 hips) with ALR to 318 patients (329 hips) with ALD, with a mean follow-up time ranging between 32-120 months. Five studies found significantly improved patient reported outcomes with ALR (Harris Hip Score, Merle d'Aubigné, Pain, SF-12). Several studies compared the outcomes after ALR and ALD and found statistical significance in all investigated metrics in favor of ALR. One study found a significant improvement in abduction but no other study found any difference in range of motion. No study found any difference in complication rate, revision rate or conversion to total hip arthroplasty. Although, 2 studies found ALR reduced the rate of osteoarthritic progression. Conclusion Current literature suggests that acetabular labral repair may result in superior patient reported outcomes. However, there appears to be no significant difference in the rate of progression to total hip arthroplasty at up to 10-year follow-up. Level of Evidence Level III, systematic review of Level I, II, and III studies.
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Aichmair A, Sutter R, Dietrich TJ, Dora C, Zingg PO. Magnetic Resonance Arthrographic Findings After Hip Labrum Resection Versus Refixation. Orthopedics 2021; 44:e607-e613. [PMID: 34292826 DOI: 10.3928/01477447-20210618-25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to evaluate whether new tissue formation occurs after labral debridement/excision, and, if so, which morphological features are typical for a neo-labrum. The authors further compared the findings after labrum resection with those seen after labrum refixation. Patients with femoroacetabular impingement who underwent hip arthroscopy or surgical hip dislocation to address a labrum pathology were retrospectively included, and postoperative magnetic resonance arthrography studies were assessed. Forty-two patients had undergone either labrum resection (n=25) or refixation (n=17), performed arthroscopically (47.6%) or via surgical hip dislocation (52.4%). In the subgroup of patients after debridement/resection, there was anterosuperior/superior scar tissue in 83.5%, with amorphous configuration in 92%, irregular surface in approximately two-thirds of the cases, and a mean±SD thickness of 7.0±2.7 mm. A labrum-like shape of the scar plate was seen in 7.7%. Regarding the subgroup of patients who had undergone labral refixation, an irregular or rounded labrum shape was noted in 26.5% and 51.3% of cases, respectively, with a triangular shape in less than one-fourth of cases. Labrum re-tears (35.7%) were mainly observed at the base (71.7%), rather than within the labral substance (28.4%). New tissue formation can be observed in the majority of cases after excision of the hip labrum, with amorphous and irregular surface configuration compared with a native labrum. This new tissue should therefore be referred to as scar tissue rather than as neo-labrum. Whether scar tissue is inferior to a refixed labrum needs to be further elucidated in follow-up studies. [Orthopedics. 2021;44(4):e607-e613.].
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Lazaro LE, Lim DP, Nelson TJ, Eberlein SA, Banffy MB, Metzger MF. Proximal Overresection During Femoral Osteochondroplasty Negatively Affects the Distractive Stability of the Hip Joint: A Cadaver Study. Am J Sports Med 2021; 49:2977-2983. [PMID: 34319841 DOI: 10.1177/03635465211028979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Contact between the acetabular labrum and articular cartilage of the femoral head creates a suction seal that helps maintain stability of the femoral head in the acetabulum. A femoral osteochodroplasty may occasionally extend proximally into the femoral head, diminishing the articular surface area available for sealing contact. PURPOSE To determine whether proximal overresection decreases the rotational and distractive stability of the hip joint. STUDY DESIGN Controlled laboratory study. METHODS Six hemipelvises in the following conditions were tested: intact, T-capsulotomy, osteochondroplasty to the physeal scar, and 5- and 10-mm proximal extension. The pelvis was secured to a metal plate, and the femur was potted and attached to a multiaxial hip jig. Specimens were axially distracted using a load from 0 to 150 N. For rotational stability testing, 5 N·m of internal and external torque was applied. Both tests were performed at different angles of flexion (0°, 15°, 30°, 60°, 90°). Displacement and rotation were recorded using a 3-dimensional motion tracking system. RESULTS The T-capsulotomy decreased the distractive stability of the hip joint. A femoral osteochondroplasty up to the physeal scar did not seem to affect the distractive stability. However, a proximal extension of the resection by 5 and 10 mm increased axial instability at every angle of flexion tested, with the greatest increase observed at larger angles of flexion (P < .01). External rotation increased significantly after T-capsulotomy in smaller angles of flexion (0°, P = .01; 15°, P = .01; 30°, P = .03). Femoral osteochondroplasty did not create further external rotational instability, except when the resection was extended 10 mm proximally and the hip was in 90° of flexion (P = .04). CONCLUSION This cadaveric study demonstrated that proximal extension of osteochondroplasty into the femoral head compromises the distractive stability of the hip joint but does not affect hip rotational stability. CLINICAL RELEVANCE Clinically, this study highlights the importance of accuracy when performing femoral osteochondroplasty to minimize proximal extension that may increase iatrogenic instability of the hip joint.
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Affiliation(s)
- Lionel E Lazaro
- Cedar-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA.,Miami Orthopedic and Sports Medicine Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Daniel P Lim
- Cedar-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA.,Orthopedic Associates of Hawaii, Honolulu, Hawaii, USA
| | - Trevor J Nelson
- Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sam A Eberlein
- Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Melodie F Metzger
- Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Ismailoglu AV, Ozdogmus O, Karaman MI, Kayaalp A, Kocaoglu B. Perpendicular drill bit alignment provides a practical guidance to determine the appropriate suture anchor insertion angle during acetabular labral repair. J Hip Preserv Surg 2021; 8:185-191. [PMID: 35145716 PMCID: PMC8825775 DOI: 10.1093/jhps/hnab055] [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: 05/10/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
The safe acetabular rim angle is an anatomical measurement used to determine the safety margin when inserting suture anchors. The purpose of the present study was to find out whether aligning the drill bit perpendicularly during arthroscopic surgery can provide a reference point for determining an appropriate angle to facilitate the suture anchor insertion and to prevent extra- and intra-articular perforations. One hundred computed tomographic hips were used to reconstruct three-dimensional acetabular hip models. Each model was radially sectioned at the 4 o’clock, 3 o’clock and anterior inferior iliac spine (AIIS) positions (that corresponded mainly to the 2:20 clock position). A perpendicular reference line, representing a perpendicular drill bit alignment, was drawn for each position within the acetabular model, and its relation to the safe acetabular rim angle was measured. The length of the perpendicular reference line and the effect of gender on measurements were also evaluated. The mean safe acetabular rim angle at the 3 o’clock position was significantly smaller compared to other clock positions (P < 0.001). The perpendicular reference line was located out of the safe acetabular rim angle in 28 cases (%28), mostly in female acetabula at the 3 o’clock position, and relative to the perpendicular reference line the required minimal angle was 4° ± 2.3° to place the anchor in the safe acetabular rim angle to avoid extra-articular perforation. The perpendicular reference line was shortest at the 3 o’clock position, and its mean length was shorter in female acetabula at all clock positions (P < 0.001). Aligning the drill bit perpendicular to the acetabular opening plane during an arthroscopic anchor placement is a practical way to estimate and target the position of the safe acetabular rim angle to avoid anchor perforations. Based on measurements from a perpendicularly aligned drill bit, the drill bit should be directed towards the joint minimally by 4° to avoid extra-articular perforations and maximally by 30° to avoid intra-articular perforations.
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Affiliation(s)
- Abdul Veli Ismailoglu
- Department of Anatomy, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Kayisdagi Cad. No: 32, Atasehir, Istanbul 34752, Turkey
| | - Omer Ozdogmus
- Department of Anatomy, Faculty of Medicine, Marmara Univesity, Maltepe Basibuyuk Yolu, No: 9, Maltepe, Istanbul 34854, Turkey
| | - Muhammed Ilkay Karaman
- Department of Orthopedic Surgery, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Kayisdagi Cad. No: 32, Atasehir, Istanbul 34752, Turkey
| | - Asim Kayaalp
- Department of Orthopedic Surgery, Ankara Cankaya Hospital, Barbaros Sk. No: 44, Cankaya, Ankara 06700, Turkey
| | - Baris Kocaoglu
- Department of Orthopedic Surgery, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Kayisdagi Cad. No: 32, Atasehir, Istanbul 34752, Turkey
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Lall AC, Annin S, Chen JW, Diulus S, Ankem HK, Rosinsky PJ, Shapira J, Meghpara MB, Maldonado DR, Hartigan DE, Krych AJ, Levy BA, Domb BG. Consensus-based classification system for intra-operative management of labral tears during hip arthroscopy-aggregate recommendations from high-volume hip preservation surgeons. J Hip Preserv Surg 2021; 7:644-654. [PMID: 34377508 PMCID: PMC8349576 DOI: 10.1093/jhps/hnab043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to survey high-volume hip preservation surgeons regarding their perspectives on intra-operative management of labral tears to improve decision-making and produce an effective classification system. A cross-sectional survey of high-volume hip preservation surgeons was conducted in person and anonymously, using a questionnaire that is repeated for indications of labral debridement, repair and reconstruction given the torn labra are stable, unstable, viable or non-viable. Twenty-six high-volume arthroscopic hip surgeons participated in this survey. Provided the labrum was viable (torn tissue that is likely to heal) and stable, labral debridement would be performed by 76.92% of respondents for patients >40 years of age and by >84% of respondents for stable intra-substance labral tears in patients without dysplasia. If the labrum was viable but unstable, labral repair would be performed by >80% of respondents for patients ≤40 years of age and > 80% of respondents if the labral size was >3 mm and located anteriorly. Presence of calcified labra or the Os acetabuli mattered while deciding whether to repair a labrum. In non-viable (torn tissue that is unlikely to heal) and unstable labra, labral reconstruction would be performed by 84.62% of respondents if labral size was <3 mm. The majority of respondents would reconstruct calcified and non-viable, unstable labra that no longer maintained a suction seal. Surgeons performing arthroscopic hip labral treatment may utilize this comprehensive classification system, which takes into consideration patient age, labral characteristics (viability and stability) and bony morphology of the hip joint. When choosing between labral debridement, repair or reconstruction, consensus recommendations from high-volume hip preservation surgeons can enhance decision-making.
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Affiliation(s)
- Ajay C Lall
- American Hip Institute, Chicago, IL 60018, USA.,American Hip Institute Research Foundation, Chicago, IL 60018, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
| | - Shawn Annin
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Jeff W Chen
- Vanderbilt Medical School, Nashville, TN, 37232, USA
| | - Samantha Diulus
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, IL 60018, USA
| | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, IL 60018, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
| | | | - David E Hartigan
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, 85054, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin G Domb
- American Hip Institute, Chicago, IL 60018, USA.,American Hip Institute Research Foundation, Chicago, IL 60018, USA.,AMITA Health St. Alexius Medical Center, Hoffman Estates, IL 60169, USA
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Heerey JJ, Srinivasan R, Agricola R, Smith A, Kemp JL, Pizzari T, King MG, Lawrenson PR, Scholes MJ, Souza RB, Link T, Majumdar S, Crossley KM. Prevalence of early hip OA features on MRI in high-impact athletes. The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study. Osteoarthritis Cartilage 2021; 29:323-334. [PMID: 33387651 PMCID: PMC8900484 DOI: 10.1016/j.joca.2020.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/03/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare early hip osteoarthritis (OA) features on magnetic resonance imaging (MRI) in high-impact athletes with and without hip and/or groin pain, and to evaluate associations between early hip OA features, the International Hip Outcome Tool (iHOT33) and Copenhagen Hip and Groin Outcome Score (HAGOS). DESIGN This case-control study evaluated data of the femoroacetabular impingement and hip osteoarthritis cohort (FORCe). One hundred and eighty-two symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 pain-free high-impact athletes (soccer or Australian football (AF)) without definite radiographic hip OA underwent hip MRI. The Scoring Hip Osteoarthritis with MRI (SHOMRI) method quantified and graded the severity of OA features. Each participant completed the iHOT33 and HAGOS. RESULTS Hip and/or groin pain was associated with higher total SHOMRI (0-96) (mean difference 1.4, 95% CI: 0.7-2.2), labral score (adjusted incidence rate ratio (aIRR) 1.33, 95% CI: 1.1-1.6). Differences in prevalence of cartilage defects, labral tears and paralabral cysts between symptomatic and pain-free participants were inconclusive. There was a lower prevalence of effusion-synovitis in symptomatic participants when compared to pain-free participants (adjusted odds ratio (aOR) 0.46 (95% CI: 0.3-0.8). Early hip OA features were not associated with iHOT33 or HAGOS. CONCLUSIONS A complex and poorly understood relationship exists between hip and/or groin pain and early hip OA features present on MRI in high-impact athletes without radiographic OA. Hip and/or groin pain was associated with higher SHOMRI and labral scores.
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Affiliation(s)
- J J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - R Srinivasan
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, CA, USA.
| | - R Agricola
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A Smith
- School of Physiotherapy and Exercise Science, Curtain University, Perth, Australia.
| | - J L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - T Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - M G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | | | - M J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - R B Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, CA, USA; Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, CA, USA.
| | - T Link
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, CA, USA.
| | - S Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, CA, USA.
| | - K M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
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Martin-Carreras T, Sebro R, Weintraub S. Hip Alpha Angle is Associated with Anterior-Superior Labral Tears but not Anterior Labral Tears. Curr Probl Diagn Radiol 2021; 50:159-163. [DOI: 10.1067/j.cpradiol.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/24/2019] [Accepted: 09/03/2019] [Indexed: 11/22/2022]
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Beck EC, Chahla J, Suppauksorn S, Cancienne JM, Krivicich LM, Nho SJ. Author Reply to "Letter to the Editor Regarding 'Comparison of Suction Seal and Contact Pressures Between 270° Labral Reconstruction, Labral Repair, and the Intact Labrum'". Arthroscopy 2020; 36:2947-2948. [PMID: 33276882 DOI: 10.1016/j.arthro.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Jorge Chahla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | | | - Laura M Krivicich
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Philippon MJ, Arner JW, Crawford MD, Bolia IK, Briggs KK. Acetabular Labral Reconstruction with Iliotibial Band Autograft: Outcome and Survivorship at a Minimum 10-Year Follow-up. J Bone Joint Surg Am 2020; 102:1581-1587. [PMID: 32675477 DOI: 10.2106/jbjs.19.01499] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Labral reconstruction has been shown to result in improved patient-reported outcomes (PROs) at mid-term follow-up in patients with a deficient labrum. The purpose of this study was to determine survivorship and PROs at a minimum 10-year follow-up. METHODS A retrospective evaluation of a prospectively collected single-surgeon database included 91 hips (89 patients) that underwent arthroscopic labral reconstruction with iliotibial band autograft between 2006 and 2008. The primary PRO was the Hip Outcome Score (HOS)-activities of daily living (ADL). The modified Harris hip score (mHHS), HOS-sports, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and patient satisfaction (on a scale of 1 to 10) were also collected at a 10-year minimum follow-up. Survivorship analysis curves were evaluated. RESULTS Eighty-two hips were evaluated at a 10-year minimum follow-up. Overall survivorship, with revision hip arthroscopy or total hip arthroplasty (THA) as the end point, was 70% at 5 years and 61% at 10 years, and the mean survival time was 9 years (95% confidence interval = 7.6 to 10 years). For the patients who did not undergo subsequent surgery, on average the mHHS increased from 60 preoperatively to 82 at the 10-year follow-up (p = 0.001), the HOS-ADL improved from 69 to 90 (p = 0.004), the HOS-sports improved from 43 to 76 (p = 0.001), and the median patient satisfaction was 10 of 10. Eighty percent of the patients achieved the minimal clinically important difference (MCID) in the HOS-ADL, and 87% obtained a patient acceptable symptom state (PASS). CONCLUSIONS Following arthroscopic labral reconstruction with iliotibial band autograft, 9% of the hips underwent revision arthroscopy and 27% underwent THA. At 10 years, the survival rate, with revision hip arthroscopy or THA as the end point, was 61%; however, for those with >2 mm of joint space, the current indication for labral reconstruction, the 10-year survival rate was 90%. Excellent PROs and patient satisfaction were reported by those who did not require revision or THA. With appropriate patient selection and prevention of postoperative adhesions, labral reconstruction results in excellent outcomes and high patient satisfaction that is sustained at a minimum 10-year follow-up. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Marc J Philippon
- The Steadman Clinic (M.J.P. and J.W.A.), Steadman Philippon Research Institute (M.J.P., J.W.A., and K.K.B.), Vail, Colorado
| | - Justin W Arner
- The Steadman Clinic (M.J.P. and J.W.A.), Steadman Philippon Research Institute (M.J.P., J.W.A., and K.K.B.), Vail, Colorado
| | | | - Ioanna K Bolia
- Department of Orthopaedics, University of Southern California, Los Angeles, California
| | - Karen K Briggs
- The Steadman Clinic (M.J.P. and J.W.A.), Steadman Philippon Research Institute (M.J.P., J.W.A., and K.K.B.), Vail, Colorado
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Rahl MD, LaPorte C, Steinl GK, O'Connor M, Lynch TS, Menge TJ. Outcomes After Arthroscopic Hip Labral Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:1748-1755. [PMID: 31634004 DOI: 10.1177/0363546519878147] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The acetabular labrum is critical to maintenance of hip stability and has been found to play a key role in preservation of the hip fluid seal. For irreparable labral damage, arthroscopic labral reconstruction is an evolving technique that has been shown to decrease hip pain and restore function. PURPOSE To provide a comprehensive review of current literature for arthroscopic hip labral reconstruction, with a focus on determining if outcomes differ between autograft or allograft tissue. STUDY DESIGN Systematic review and meta-analysis. METHODS PubMed and Scopus online databases were searched with the key terms "hip,""labrum,""reconstruction," and "graft" in varying combinations. Procedures performed, complications, failures, and functional outcome measures were included in this analysis. The inverse variance method was used to calculate pooled estimates and 95% CIs. RESULTS Eight studies with 537 hips were included. Mean age was 37.4 years (95% CI, 34.5-40.4 years), and mean follow-up time was 29 months (95% CI, 26-33 months). Survivorship after autograft reconstruction ranged from 75.7% to 100%, as compared with 86.3% to 90.0% in the allograft cohort. In the autograft cohort, failures included 0% to 13.2% conversion to total hip arthroplasty and 0% to 11.0% revision hip arthroscopy. Failures in the allograft cohort included 0% to 12.9% total hip arthroplasty conversion, 0% to 10.0% revision arthroscopy, and 0% to 0.8% open revision surgery. Based on 6 studies, the modified Harris Hip Score improved by a mean 29.0 points after labral reconstruction (P < .0001). CONCLUSION Arthroscopic hip labral reconstruction results in clinically significant improvements in patient-reported outcomes. Our analysis indicates that there are no significant differences in outcomes based on graft type alone. A number of factors may determine graft choice, including patient preference, surgeon experience, operative time, morbidity, and cost. Proper patient selection based on age and severity of degenerative joint disease will also optimize outcomes after labral reconstruction.
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Affiliation(s)
- Michael D Rahl
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Collin LaPorte
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Gabrielle K Steinl
- College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - T Sean Lynch
- Irving Medical Center, Columbia University, New York, New York, USA
| | - Travis J Menge
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA.,Spectrum Health Medical Group Orthopedic Sports Medicine and Hip Arthroscopy, Grand Rapids, Michigan, USA
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Di Benedetto P, Giovanni G, Luigi C, Francesco M, Piero G, Causero A. All-suture anchors in arthroscopic acetabular labral repair: our experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:85-91. [PMID: 32555081 PMCID: PMC7944822 DOI: 10.23750/abm.v91i4-s.9661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
Abstract
Background: Over the past years, the role of the acetabular labrum in hip joint biomechanics and its relations with joint health has been of particular interest. There is a good clinical improvement of patients in whom the acetabular labrum is preserved during arthroscopic hip surgery. The purpose of this study is to report the results of arthroscopic repair of labral tears at a medium term follow up. Materials and methods: We performed a retrospective review of all cases that underwent hip arthroscopy at our Institution from January 2013 until December 2018. There were 24 patients, 13 males and 11 females, and their mean age at the time of surgery was 29, 42 years (range, 19 to 43 years). All patients were treated by the same surgeon with an extracapsular OUT-IN approach. Suture was performed using a non-absorbable suture anchor all-suture. Clinical assessment was performed at December 2019 using a modified Harris hip score (mHHS), hip outcomes score activities of daily living (HOS ADL), hip outcomes score activities of sport scale (HOS SS). All patients with acetabular labrum injury had femoro-acetabular impingement. Results: The mean overall values in the preoperative period were 67.21 ± 10.31 for mHHS, 70.04 ± 12.11 for HOS-ADL and 60.06 ± 14.58 for HOS –SS. The results obtained in the re-evaluations of patients in December 2019 with a mean follow-up of 38, 3 months (minimum 1 year) are on average 82.17 ± 11.36 for mHHS, 83.00 ± 12.80 for HOS-ADL and 76.09 ± 18.52 for HOS-SS. Conclusions: The progress of knowledge and the advancement of diagnostic and therapeutic skills has led to a greater awareness of the importance of treating acetabular labrum tears. Arthroscopic treatment with suture appear to be a good option for these patients and we had encouraging results in our center. (www.actabiomedica.it)
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Affiliation(s)
| | - Gorasso Giovanni
- Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC) - Udine, Italy.
| | - Castriotta Luigi
- Institute of Hygiene and Clinical Epidemiology Friuli Centrale Healthcare and University Trust (ASU FC) - Udine.
| | - Mancuso Francesco
- Orthopaedics and Traumatology Unit, ASUFC - Tolmezzo General Hospital, Tolmezzo (UD), Italy.
| | - Giardini Piero
- Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC) - Udine, Italy.
| | - Araldo Causero
- Clinic of Orthopaedics, Friuli Centrale Healthcare and University Trust (ASUFC) - Udine, Italy; DAME - University of Udine.
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Audretsch CK, Schmidutz F, Küper MA. Asymptomatic and Unnoticed Intra-articular Screw Over 18 Years after Fracture of the Posterior Wall of the Acetabulum - a Question of Stability? ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:298-303. [PMID: 32016929 DOI: 10.1055/a-1085-2717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Fractures of the posterior wall of the acetabulum occur in a frequency of 25 - 30%. Multifragmentary fractures involving 40 - 50% of the acetabular surface, the quality of reduction as well as involvement of cartilage and acetabular labrum are considered to have an impact on the development of a reduced posterior stability of the hip joint. This results in a shift of the main weight bearing area with development of a posttraumatic osteoarthritis. In the presented case, a 42-year old male patient was operated on 18 years ago due to a posterior acetabular wall fracture. Retrospectively, one of the screws was located partially intraarticular. However, the patient was asymptomatic over the 18-year period. The first consultation was due to unspecific symptoms of osteoarthritis of the right hip joint especially during flexion and external rotation. Due to only mild radiological signs of osteoarthritis, we indicated only the removal of the intraarticular screw. The symptoms postoperatively switched to a feeling of instability, so a total hip arthroplasty was performed. Since the operation, the patient is asymptomatic regarding the hip joint. The intraarticular screw seemed to stabilize the hip joint. This case demonstrates the importance of a good posterior guidance for the stability of the hip joint on one hand. On the other hand, it demonstrates the minor stress load of the posterior acetabular region, especially after fracture of the posterior wall. Therefore, a good posterior guidance should be one major aim of treatment of posterior acetabular wall fractures.
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Affiliation(s)
- Christof K Audretsch
- Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen
| | - Florian Schmidutz
- Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen.,Klinik und Poliklinik für Orthopädie, Physikalische Medizin und Rehabilitation, Universität München (LMU)
| | - Markus Alexander Küper
- Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen
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Radha S, Hutt J, Lall A, Domb B, Lynch TS, Griffin D, Field RE, Chuck-Cakic J. Best practice guidelines for arthroscopic intervention in femoroacetabular impingement syndrome: results from an International Delphi Consensus Project-Phase 1. J Hip Preserv Surg 2019; 6:326-338. [PMID: 32015889 PMCID: PMC6990387 DOI: 10.1093/jhps/hnz055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 12/26/2022] Open
Abstract
Arthroscopic procedures to treat hip pathologies such as femoroacetabular impingement (FAI) syndrome are now established in mainstream orthopaedic practice. Surgical techniques, rehabilitation protocols and outcomes are widely published. However, consensus on standards of practice remains to be determined. The International Hip Preservation Society (ISHA) has undertaken a research study to identify current areas of consensus across the global hip preservation community. The study focussed on consensus statements on the operative steps in the arthroscopic treatment of FAI syndrome. The study methodology was an online Delphi consensus method to collect aggregate opinions from hip preservation surgeons worldwide. Phase 1 of the planned three-phase study is presented here—focusing on consensus statements on the operative steps in the arthroscopic treatment of FAI syndrome. Ninety-nine statements achieved >80% consensus from a panel of 165 surgeons from six continents. This study is the first to evaluate global consensus on the arthroscopic treatment of FAI syndrome, as well as highlighting areas of contention and avenues for future research.
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Affiliation(s)
- Sarkhell Radha
- Trauma and Orthopaedics, Croydon University Hospital, Croydon District, London CR7 7YE, UK
| | - Jonathan Hutt
- Hip Reconstruction Unit, University College Hospital London, Bloomsbury, London NW1 2BU, UK
| | - Ajay Lall
- America Hip Institute, Chicago, IL 60018, USA
| | | | | | - Damian Griffin
- University Hospitals Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, UK
| | - Richard E Field
- Research Department, South West London Elective Orthopaedic Centre, London KT18 7EG, UK
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Malahias MA, Alexiades MM. The clinical outcome of chondrolabral-preserving arthroscopic acetabuloplasty for pincer- or mixed-type femoroacetabular impingement: A systematic review. Musculoskelet Surg 2019; 103:207-214. [PMID: 30850935 DOI: 10.1007/s12306-019-00594-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/02/2019] [Indexed: 06/09/2023]
Abstract
While preservation and repair of the acetabular labrum are increasingly being recognized as important goals in hip arthroscopy, controversies still exist regarding the clinical outcome of arthroscopic acetabuloplasty with chondrolabral preservation. A systematic review was conducted and implemented by two independent reviewers, who used the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews for their search. These databases were queried with the terms "arthroscopic acetabuloplasty" and "chondrolabral preservation" and "arthroscopic acetabular recession." From the 55 initial studies the reviewers finally chose and assessed five clinical studies which were eligible to their inclusion-exclusion criteria. The reviewed studies included in total 444 patients, mainly young, between 30 and 40 years old. The follow-up evaluation varied between 24 and 41 months, while all studies utilized at least a 24-month final end-point assessment. All five studies illustrated improved outcome with the use of chondrolabral preservation acetabuloplasty without labral detachment. The rate of complications was very low. The different techniques of arthroscopic acetabuloplasty combined with chondrolabral preservation illustrated encouraging results in patients suffering from pincer-type or mixed-type FAI. However, the available clinical evidence was limited and insufficient to establish any superiority of these techniques over the traditional labral detachment and sequential reattachment. In relation to the optimal treatment of FAI without isolated CAM, further research of higher quality is recommended to be conducted in order to lead to definitive conclusions.
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Affiliation(s)
- M-A Malahias
- International Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS Hospital Heidelberg, Schlossberg 21, 69117, Heidelberg, Germany.
| | - M M Alexiades
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Rehabilitation, Hospital for Special Surgery, Weill Cornell Medical College, 523 East 72 Street, New York, NY, 10021, USA
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44
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Nakashima H, Tsukamoto M, Ohnishi Y, Utsunomiya H, Kanezaki S, Sakai A, Uchida S. Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement. Am J Sports Med 2019; 47:2029-2037. [PMID: 31233328 DOI: 10.1177/0363546519856018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The acetabular labrum plays important roles in proprioception, nociception, synovial fluid seal effect, and static and dynamic joint stability and as a shock absorber. Clinical and radiographic risk factors for unsalvageable labral tear in femoroacetabular impingement (FAI) are not well established. PURPOSE To identify predictors of unsalvageable labral tear during initial hip arthroscopic management of FAI. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients were included who underwent primary hip arthroscopic treatment for FAI between March 2009 and March 2014. Patients were excluded who had <2-year follow-up, underwent bilateral surgery, or had a history of surgery, osteoarthritis (Tönnis grade 2 or 3), and other diagnoses, including lateral center-edge angle <25° diagnosed as developmental hip dysplasia. Patients were divided into 2 groups according to their labral condition: reconstruction and refixation. Unsalvageable labral tear was defined as any irreparable labral tear, including severe degenerative tear, frayed labrum, labral ossification, flattened labrum, and failed prior repair during surgery. Univariate and multivariate analyses identified risk factors for segmental labral reconstruction. Patient-reported outcome scores and postoperative revision rates were also assessed. RESULTS Twenty-five hips (18 male, 7 female) and 126 hips (65 male, 61 female) were included in the reconstruction and refixation groups, respectively. The mean ± SD ages were 52.6 ± 15.0 and 36.5 ± 16.1 years in the reconstruction and refixation groups, respectively. In the reconstruction group, the mean modified Harris Hip Score significantly improved from 67.3 ± 14.9 preoperatively to 95.0 ± 8.1 at final follow-up (P < .001), and the mean Nonarthritic Hip Score improved from 63.0 ± 18.3 preoperatively to 89.5 ± 10.1 at final follow-up (P < .001). In the refixation group, the mean modified Harris Hip Score significantly improved from 69.2 ± 18.6 preoperatively to 93.0 ± 11.2 at final follow-up (P < .001), and the mean Nonarthritic Hip Score improved from 60.7 ± 18.8 preoperatively to 88.6 ± 15.0 at final follow-up (P < .001). No significant difference was noted in patient-reported outcome scores and revision hip arthroscopy rates. The rate of conversion of total hip arthroplasty was higher in the reconstruction group than in the refixation group. Risk factors for unsalvageable labral tear were age ≥45 years (odds ratio [OR], 8.83; P < .007), body mass index ≥23.1 kg/m2 (OR, 13.05; P < .001), and vertical center anterior angle ≥36° (OR, 19.03; P < .001). Furthermore, in this study, unsalvageable labral tears were present in cases with at least 2 of the 3 risk factors. CONCLUSION Age ≥45 years, body mass index ≥23.1 kg/m2, and vertical center anterior angle ≥36° are risk factors for unsalvageable labral tear at initial hip arthroscopic surgery for patients with FAI.
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Affiliation(s)
- Hirotaka Nakashima
- Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Manabu Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu, Japan
| | - Yasuo Ohnishi
- Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hajime Utsunomiya
- Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shiho Kanezaki
- Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Yahatanishi-ku, Kitakyushu, Japan
| | - Soshi Uchida
- Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
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45
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Abstract
BACKGROUND A common claim in the orthopaedic literature is that acetabular dysplasia (AD) exists when the center-edge angle of Wiberg (CE angle) is <20 degrees and that AD leads to osteoarthritis (OA). Our purpose is to evaluate the validity of the linkage between AD and OA. METHODS We assess and discuss the theories and the empirical evidence relating AD to OA. Moreover, we test the rule that hips with a CE angle <20 degrees will develop OA by 65 years of age, by looking for exceptions to this rule. RESULTS Wiberg and Cooperman and colleagues present 30 ideal patients for assessing the relationship between AD and OA. Each was arthritis free, with stable AD, CE angle <20 degrees, without signs of subluxation. They were all followed and all developed OA. In the studies by Stulberg and colleagues, and Jacobsen and colleagues, every patient presented with OA, making it difficult to be certain about the appearance of the hip before the onset of OA. In the study by Murphy and colleagues, we have the same problem, as an unknown number of patients already had OA at first assessment. All of these studies used different schemes for diagnosing OA, making the studies difficult to compare. Most of the patients in the studies were of Northern European ancestry, making the results difficult to generalize to other populations. Four patients had CE angles <20 degrees and did not develop severe arthritis by 65 years of age. CONCLUSIONS Our conclusions apply directly to patients of Northern European ancestry. A few patients with stable, mild AD (CE angle 15 to 19 degrees) will be arthritis free at 65 years of age. Almost all patients with stable AD develop OA by 65 years of age. Unstable AD (CE angle <20 degrees, with subluxation) always leads to OA by 65 years of age. It is probably reasonable to extend these conclusions to other populations, but the reader must be prepared to re-evaluate them, as more data accumulates.
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Renouf J, Pergaminelis N, Tran P, Fary C, Tirosh O. The outcome of arthroscopic repair of acetabular labral tears using the iHOT-33. BMC Musculoskelet Disord 2019; 20:210. [PMID: 31084619 PMCID: PMC6515603 DOI: 10.1186/s12891-019-2611-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to determine patient reported outcome measures (PROMS) after arthroscopic repair of an isolated labral tear using the validated International Hip Outcome Tool (iHOT-33). The iHOT-33 specifically measures (1) symptoms and functional limitations, (2) sport and recreation limitations, (3) job related concerns and social and (4) emotional and lifestyle concerns. Methods A retrospective review was performed on 45 procedures in 43 patients between September 2012 and September 2015. Two patients had bilateral isolated labral tears. Patients were excluded if they were younger than 18 years, had prior ipsilateral hip surgery and had radiological or arthroscopic evidence of femoroacetabular impingement (FAI), hip dysplasia or other bony dysmorphism. Results Of the 43 patients undergoing arthroscopy there were 29 right and 16 left hips repaired. There were 34 females and 9 males. The mean age at surgery was 37.4 years (range 19–63 years) with a mean follow up of 1.7 years (range 1.0–2.6 years). At follow up the mean total iHOT-33 score improved from 34.1 to 67.3 (p < 0.02). The mean improvement was 33.2 (p = < 0.02). Significant improvements were described in all 4 iHOT-33 sub sections. Conclusion The study showed statistically significant favourable outcomes in selected patients with short follow-up for patients that underwent hip arthroscopy for an isolated labral tear using the validated iHOT-33. Level of Evidence IV, retrospective non-randomised study.
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Affiliation(s)
- Jesse Renouf
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia. .,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia. .,The University of Melbourne and Western Health, Parkville, Melbourne, VIC, Australia.
| | - Nicholas Pergaminelis
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia.,The University of Melbourne and Western Health, Parkville, Melbourne, VIC, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia
| | - Oren Tirosh
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, 3011, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Melbourne, VIC, Australia
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Webb MSL, Devitt BM, O'Donnell JM. Preserving the chondrolabral junction reduces the rate of capsular adhesions. J Hip Preserv Surg 2019; 6:50-54. [PMID: 31069095 PMCID: PMC6501442 DOI: 10.1093/jhps/hnz005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/07/2019] [Accepted: 02/03/2019] [Indexed: 12/19/2022] Open
Abstract
The operative treatment of pincer-type femoroacetabular impingement (FAI) has become an increasingly more common procedure. Classically, the labrum is incised at the chondrolabral junction (CLJ), or a concurrent tear is extended to allow access to the acetabular rim facilitating acetabuloplasty. The labrum is subsequently repaired using suture anchors. More recently, acetabuloplasty has been performed without incising the labrum and negating the need to use suture anchors. The aim of this study is to determine whether preserving the CLJ reduces the incidence of revision hip arthroscopy for the treatment of capsulolabral adhesions. This retrospective study compared two cohorts of patients undergoing hip arthroscopy for pincer-type FAI from August 2002 to April 2015. The groups analysed were patients undergoing acetabuloplasty with labral repair (LR) and those with no labral repair (NLR). The revision rates and causes for revision were compared using the χ2 analysis. There were 1010 cases in total. Acetabuloplasty with LR was performed in 546 hips (519 patients), while acetabuloplasty with NLR was performed in 464 hips (431 patients). In the LR group, there were 54 (9.9%) revisions, 25 (46%) of which were due to capsulolabral adhesions. The NLR group had 36 (7.8%) revisions with six (17%) due to capsulolabral adhesions. Preserving the CLJ, thereby avoiding the need for drilling and the insertion of suture anchors, when performing an acetabuloplasty for pincer-type FAI, significantly reduces the rate of symptomatic adhesions requiring revision arthroscopy.
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Affiliation(s)
- Mark S L Webb
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, Victoria, Australia.,Trauma & Orthopaedic Department, St. George's Hospital, Blackshaw Road, London, UK
| | - Brian M Devitt
- OrthoSport Victoria, Level 5, 89 Bridge Road, Richmond, Victoria, Australia
| | - John M O'Donnell
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, Victoria, Australia
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Rizkallah M, Haddad M, Haykal G. Femoral head fracture in an adult patient with isolated posterior labrum avulsion recognized through the 'fleck' sign: technical tips. J Hip Preserv Surg 2019; 6:86-90. [PMID: 31069100 PMCID: PMC6501445 DOI: 10.1093/jhps/hnz006] [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: 08/21/2018] [Accepted: 02/03/2019] [Indexed: 11/24/2022] Open
Abstract
Femoral head fractures in adults are known to be frequently associated with femoral neck fractures, acetabular fractures and sciatic nerve neurapraxia. Here, we report for the first time in the English medical literature the case of a 30-year-old patient having a Pipkin Type II comminuted femoral head fracture associated to an isolated acetabular labral osteochondral avulsion. This entity was diagnosed preoperatively through the presence of the acetabular ‘fleck’ sign recently described in adolescents with hip dislocation. This was of paramount importance knowing the key role of the acetabular labrum in physiological hip functioning. Therefore, a high index of suspicion of complete posterior acetabular labrum avulsion should be raised in front of a hip computed tomography scan showing the acetabular fleck sign even in an adult patient. This finding is important in posing the surgical indication and in completing the preoperative surgical planning in cases of femoral head fractures and dislocations.
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Affiliation(s)
- Maroun Rizkallah
- Orthopedic Surgery Department, Mount Lebanon Hospital, Faculty of Medicine, Saint Joseph University, Blvd. Camille Chamoun, Beirut, Lebanon
| | - Marwan Haddad
- Radiology Department, Mount Lebanon Hospital, Faculty of Medicine, Lebanese University, Blvd. Camille Chamoun, Beirut, Lebanon
| | - Gaby Haykal
- Orthopedic Surgery Department, Mount Lebanon Hospital, Faculty of Medicine, Saint Joseph University, Blvd. Camille Chamoun, Beirut, Lebanon
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Aliprandi A, Brioschi M, Magnani S, Sdao S, Albano D, Sconfienza LM, Randelli F. The Extension-Thickness-Damage (ETD) score: a pre-operative hip MR arthrography-based classification to predict type of labrum surgery. Arch Orthop Trauma Surg 2019; 139:675-683. [PMID: 30631914 DOI: 10.1007/s00402-019-03112-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hip magnetic resonance arthrography (MRA) is the pre-operative imaging modality of choice in patients with labral damage, with several classifications of labral tears having been reported based on MRA findings. Nevertheless, none of the available classification systems allows the surgeon to predict before surgery how a labral tear could be treated. Our purpose was to develop a new MRA-based scoring system of labral tears to predict before surgery the treatment option more suitable for labral tears. MATERIALS AND METHODS Forty-seven patients (29 males and 18 females; mean age: 35.9 ± 12.4) performed hip MRA for suspicious of femoroacetabular impingement and were afterwards subjected to arthroscopic treatment. Two musculoskeletal radiologists reviewed all pre-operative examinations and provided the Extension-Thickness-Damage score for each patient, based on Extension of tear, Thickness of labrum, and type of Damage. Chondral lesions grading was based on the arthroscopic findings according to Konan classification. For statistical purposes, patients were divided into two groups, depending on the type of treatment: labral repair or debridement. Mann-Whitney U, Chi-square, receiver operator curves, and Cohen kappa statistics were used. RESULTS 35/47 underwent repair, while 12/47 were debrided. In both groups, the median chondral damage was grade III, with no significant differences (p = 0.439). The median Extension-Thickness-Damage score in the repair group (6) was significantly lower (p < 0.001) than that in the debridement group (8). The highest diagnostic performance (area under the curve) of Extension-Thickness-Damage was 0.819. The inter-observer agreement was substantial in the evaluation of Extension (k = 0.626) and Thickness (k = 0.771), and almost perfect for Damage (k = 0.827). Higher scores of Extension and Thickness were more frequently associated with debridement (p < 0.001; p = 0.0016, respectively), with no significant differences on the basis of Damage parameter (p = 0.284). CONCLUSIONS The MRA-based Extension-Thickness-Damage score could represent a helpful pre-operative tool, expressing the extent of the damage and its reparability before arthroscopy.
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Affiliation(s)
- Alberto Aliprandi
- Radiology Unit, Istituti Clinici Zucchi, Via Bartolomeo Zucchi, 24, 20052, Monza, Italy
| | - Marco Brioschi
- Postgraduate School in Orthopedic Surgery, Università degli Studi di Milano, Via Pascal 36, 20135, Milan, Italy
| | - Sandro Magnani
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Silvana Sdao
- Department of Radiology, Ospedale Alessandro Manzoni, Via dell'Eremo 9, 23900, Lecco, Italy
| | - Domenico Albano
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Pascal 36, 20135, Milan, Italy
| | - Filippo Randelli
- Hip Department, Orthopedics and Trauma, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Italy
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Chahla J, Nwachukwu BU, Beck EC, Neal WH, Cancienne J, Okoroha KR, Ahn J, Nho SJ. Influence of Acetabular Labral Tear Length on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome With Capsular Plication. Am J Sports Med 2019; 47:1145-1150. [PMID: 30943086 DOI: 10.1177/0363546519831291] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The literature on the effects of labral tear on patient-reported outcomes, midterm pain, and overall patient satisfaction is limited. PURPOSE To determine the effect of labral tear length on postoperative outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Consecutive patients undergoing primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified in a prospectively collected database. All patients completed the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale for pain and satisfaction. Patients were stratified by labral tear length into small (<2.5 cm) or large (≥2.5 cm) based on the receiver operating characteristic curve analysis. Patient characteristics and outcomes were analyzed with multivariate linear regression analyses to identify predictors of labral tear length. Binary logistic regression analysis was performed to determine whether labral tear length predicted the likelihood of achieving the minimal clinically important difference. RESULTS Of the 747 eligible patients, 600 (80.3%) had 2-year reported outcomes and were included in the final analysis. Mean age, body mass index, and tear length were 33.5 ± 12.3 years, 25.4 ± 9.2 kg/m2, and 2.7 ± 0.7 cm, respectively. Men had higher frequency of large tears when compared with women (77% vs 43.7%, P < .001). Independent t test demonstrated significant differences in 2-year outcomes between patients with tears <2.5 and ≥2.5 cm, respectively: HOS-ADL (87.3 ± 16.3 vs 84.3 ± 18.1, P = .033), HOS-SS (76.6 ± 23.5 vs 70.5 ± 27.7, P = .005), mHHS (82.5 ± 18.0 vs 78.5 ± 18.2, P = .009), and satisfaction (83.5 ± 23.4 vs 77.8 ± 34.9, P = .026). Binary logistic regression analysis demonstrated that labral tear length is an independent predictor of visual analog scale for satisfaction, HOS-ADL, HOS-SS, and mHHS. Binary logistic regression analysis demonstrated that patients with small labral tears had a higher likelihood of achieving the minimal clinically important difference for the HOS-SS (odds ratio, 1.61; 95% CI, 1.39-1.92; P < .02) and the patient acceptable symptomatic state for the mHHS (odds ratio, 1.56; 95% CI, 1.11-2.2; P = .038) than those with larger tears. CONCLUSION Labral tear length is independently predictive of patient-reported outcomes after hip arthroscopy for FAIS. Furthermore, patients with smaller tears (<2.5 cm) had better outcomes and a higher likelihood of achieving a minimal clinically important difference at 2-year follow-up. However, the mean differences between changes in pre- and postoperative outcomes were relatively small and may not be clinically meaningful.
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Affiliation(s)
- Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - William H Neal
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jourdan Cancienne
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kelechi R Okoroha
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Junyoung Ahn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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