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Park JW, Hwang JM, Yoo JJ. Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: An Updated Review. Clin Orthop Surg 2024; 16:517-525. [PMID: 39092294 PMCID: PMC11262938 DOI: 10.4055/cios23307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 08/04/2024] Open
Abstract
Treatment strategies for femoroacetabular impingement (FAI) syndrome have evolved in tandem with increased comprehension of FAI's impact on hip joint health. Early intervention, including arthroscopic surgery, has gained popularity due to its potential to delay the progression of osteoarthritis. Arthroscopic surgery has demonstrated significant efficacy in treating FAI syndrome, with robust evidence from randomized controlled trials and systematic reviews supporting its use. Despite arthroscopic surgery's success, complications and reoperations are not uncommon. The incidence ranges from 1% to 31% and 4% to 13%, respectively. Adjunctive biologic treatments, such as bone marrow aspirate concentrates and platelet-rich plasma, have shown promise in chondral lesion management. However, robust evidence supporting their routine use in FAI syndrome is currently lacking. Among conservative treatment methods, intra-articular injections offer diagnostic and therapeutic benefits for FAI patients. While they may provide pain relief and aid in prognosis, their long-term efficacy remains a subject of debate. Comparative studies between conservative and arthroscopic treatments highlight the importance of personalized approaches in managing FAI syndrome. In conclusion, recent advancements in FAI syndrome management have illuminated various treatment modalities. Arthroscopic surgery stands as a pivotal intervention, offering substantial benefits in pain relief, function, and quality of life. However, careful patient selection and postoperative monitoring are crucial for optimizing outcomes. Adjunctive biologics and intra-articular injections show promise but require further investigation. Tailoring treatment to individual patient characteristics remains paramount in optimizing FAI syndrome management.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Mo Hwang
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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Loewen AM, Morris WZ, Ulman S, Tulchin-Francis K, Sucato DJ, Podeszwa DA, Ellis HB. Pre-operative gait kinematics and kinetics do not change following surgery in adolescent patients with femoroacetabular impingement. Gait Posture 2024; 109:213-219. [PMID: 38359697 DOI: 10.1016/j.gaitpost.2024.02.006] [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] [Received: 03/01/2023] [Revised: 12/21/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a condition where the femoral head-neck junction collides with the acetabulum. Open or arthroscopic treatment of FAI aims to increase hip motion while reducing impingement during passive or dynamic movements. RESEARCH QUESTION What are the biomechanical characteristics of the hip and pelvis in adolescents and young adults diagnosed with FAI syndrome 1) pre-operatively compared to controls and 2) pre- to post-operatively? METHODS 43 patients with FAI and 43 controls were included in the study. All patients with FAI had cam deformities and underwent unilateral hip preservation surgery (either open or arthroscopic). Pre- and post-operative imaging, patient-reported outcomes, and gait analysis were performed. Joint angles and internal joint moments were evaluated with an emphasis on the pelvis and hip. A comparative analysis was conducted to evaluate the gait patterns before and after surgical treatment, as well as to compare pre-operative gait patterns to a control group. RESULTS 43 patients with FAI (28 female, 16.5 ± 1.5 yrs) and 43 controls (28 female, 16.0 ± 1.5 yrs) were included. Pre-operative patients with FAI had decreased stride length and walking speed compared to controls, with no significant change following surgery. There were no differences in sagittal and coronal plane hip and pelvis kinematics comparing pre- to post-operative and pre-operative to controls. Pre-operatively, differences in internal hip rotation angle (pre: 3.3˚, post: 3.9˚, controls: 7.7˚) and hip extensor moment (pre: 0.121, post: 0.090, controls: 0.334 Nm/kg) were observed compared to controls with no significant changes observed following surgery. SIGNIFICANCE Compensatory movement strategies in pelvic and hip motion are evident during gait in patients with FAI, particularly in the sagittal and transverse planes. These strategies remained consistent two years post-surgery. While surgery improved radiographic measures and patient-reported outcomes, gait did not elicit biomechanical changes following surgical treatment.
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Affiliation(s)
| | - William Z Morris
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sophia Ulman
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Dan J Sucato
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David A Podeszwa
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Henry B Ellis
- Scottish Rite for Children, Dallas, TX, USA; University of Texas Southwestern Medical Center, Dallas, TX, USA
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Arakawa H, Kobayashi N, Kamono E, Yukizawa Y, Takagawa S, Honda H, Inaba Y. Prior hip arthroscopy increases the risk of dislocation, reoperation, and revision after hip arthroplasty: An updated meta-analysis and systematic review. J Orthop Sci 2024; 29:157-164. [PMID: 36669953 DOI: 10.1016/j.jos.2022.12.016] [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] [Received: 10/30/2022] [Revised: 12/13/2022] [Accepted: 12/22/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The indications for hip arthroscopy have been increasing, as have been the number of patients undergoing total hip arthroplasty (THA) after hip arthroscopy. Several matched cohort studies have assessed the impact of prior hip arthroscopy on THA, but conflicting results have been observed. The purpose of this study was to evaluate the influence of prior arthroscopy on subsequent THA. METHODS This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 checklist. PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library were searched to identify relevant studies. Dichotomous variables were summarized qualitatively as a meta-analysis of pooled odds ratios (ORs) and 95% confidence intervals (CIs), and continuous variables were summarized as standardized mean differences and 95% CIs. P-values <0.05 were considered statistically significant. The risk of bias was evaluated for each study, as was publication bias. RESULTS In patients who underwent hip arthroscopy prior to THA, the ORs for dislocation, reoperation, and revision were 2.02 (P = 0.01), 1.66 (P = 0.01), and 2.15 (P = 0.001), respectively. There were no significant between-group differences in the Harris Hip Score (HHS; P = 0.40), WOMAC (P = 0.069), FJS-12 (P = 0.77), estimated blood loss (P = 0.48), and surgical time (P = 0.16). CONCLUSIONS Prior hip arthroscopy is a risk for postoperative dislocation, reoperation, or revision after conversion THA. However, prior hip arthroscopy has no effect on patient-reported outcomes, or operative factors such as surgical time and blood loss.
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Affiliation(s)
- Hirokazu Arakawa
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Naomi Kobayashi
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan.
| | - Emi Kamono
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Yohei Yukizawa
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Shu Takagawa
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Hideki Honda
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
| | - Yutaka Inaba
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, 4-57 Urafune-cho, Minami-ku, Yokohama, Japan
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Ruzbarsky JJ, Comfort SM, Fukase N, Briggs KK, Vidal LB, Philippon MJ. Timing From Symptom Onset to Hip Arthroscopy Does Not Affect Patient-Reported Outcome Measures for the Treatment of Femoroacetabular Impingement in Adolescent Patients. Arthroscopy 2023; 39:2466-2473. [PMID: 37100216 DOI: 10.1016/j.arthro.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To evaluate symptom duration and its relationship to patient-reported outcomes (PROs) and survivorship after hip arthroscopy in adolescents. METHODS Patients ≤18 at time of primary hip arthroscopy for femoroacetabular impingement (FAI) between January 2011 and September 2018 were included. Exclusion criteria consisted of history of previous ipsilateral hip surgery, presence of osteoarthritis or dysplasia on preoperative radiographs, previous hip fracture, or history of slipped capital femoral epiphysis or Legg-Calve-Perthes disease. Minimum 2-year PROs (modified Harris Hip Score, Hip Outcome Score [HOS]-Activities of Daily Living, HOS-Sport Scale, Short Forms 12 [SF-12]), minimum clinically significant difference (MCID) and patient-acceptable symptom state (PASS) rates, and revision surgery rates were compared based on symptom duration. RESULTS Two-year minimal follow-up was obtained for 111 patients (134 hips) (80%), including 74 females and 37 males with a mean age of 16.4 ± 1.1 (range 13.0-18.0). The mean symptom duration was 17.2 ± 15.2 months (range 43 days to 6.0 years). Ten patients (11 hips), 6 females (7 hips) and 4 males, required revision surgery at an average of 2.3 ± 1.0 years (range 0.9-4.3 years). At a mean follow-up of 4.8 ± 2.2 years (range 2-10 years), there were statistically significant improvements in all PROs (P < .05 for all). Symptom duration showed no significant correlation to post-operative scores (correlation coefficient range -0.162 to -0.078, P > .05 for all). Symptom duration ≤12 months versus >12 months or as a continuous variable was not a predictor for requiring revision surgery or achieving MCID/PASS (95% confidence interval crosses 1 for all). CONCLUSIONS In an adolescent cohort of symptomatic FAI patients who underwent hip arthroscopy, there is no difference in PRO measures when analyzing symptom duration by arbitrary time intervals or as a continuous variable. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Joseph J Ruzbarsky
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A
| | | | - Naomasa Fukase
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Karen K Briggs
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Leslie B Vidal
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A
| | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A; Steadman Clinic and United States Coalition for the Prevention of Illness and Injury in Sport, Vail, Colorado, U.S.A.
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Pasculli RM, Callahan EA, Wu J, Edralin N, Berrigan WA. Non-operative Management and Outcomes of Femoroacetabular Impingement Syndrome. Curr Rev Musculoskelet Med 2023; 16:501-513. [PMID: 37650998 PMCID: PMC10587039 DOI: 10.1007/s12178-023-09863-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To serve as a guide for non-operative physicians in the management of femoroacetabular impingement syndrome and provide an algorithm as to when to refer patients for potential surgical management. RECENT FINDINGS Supervised physical therapy programs that focus on active strengthening and core strengthening are more effective than unsupervised, passive, and non-core-focused programs. There is promising evidence for the use of intra-articular hyaluronic acid and PRP as adjunct treatment options. Recent systematic reviews and meta-analyses have found that in young active patients, hip arthroscopy demonstrates improved short-term outcomes over physical therapy. The decision for the management of FAIS is complex and should be specific to each patient. Consideration of the patient's age, timing to return to sport, longevity of treatment, hip morphology, and degree of cartilage degeneration is required to make an informed decision in the treatment of these patients.
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Affiliation(s)
- Rosa M. Pasculli
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA USA
| | - Elizabeth A. Callahan
- Department of Physical Medicine and Rehabilitation, New York University, New York, NY USA
| | - James Wu
- University of California Berkeley, Berkeley, CA USA
| | - Niam Edralin
- University of California Berkeley, Berkeley, CA USA
| | - William A. Berrigan
- Department of Orthopaedics, University of California San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
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Noebauer-Huhmann IM, Koenig FRM, Chiari C, Schmaranzer F. [Femoroacetabular impingement in adolescents]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:749-757. [PMID: 37698653 PMCID: PMC10522737 DOI: 10.1007/s00117-023-01197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
Femoroacetabular impingement syndrome (FAIS) is caused by a repetitive mechanical conflict between the acetabulum and the proximal femur, occurring in flexion and internal rotation. In cam impingement, bony prominences of the femoral head-neck junction induce chondrolabral damage. The acetabular type of FAIS, termed pincer FAIS, may be either due to focal or global retroversion and/or acetabular overcoverage. Combinations of cam and pincer morphology are common. Pathological femoral torsion may aggravate or decrease the mechanical conflict in FAI but can also occur in isolation. Of note, a high percentage of adolescents with FAI-like shape changes remain asymptomatic. The diagnosis of FAIS is therefore made clinically, whereas imaging reveals the underlying morphology. X‑rays in two planes remain the primary imaging modality, the exact evaluation of the osseous deformities of the femur and chondrolabral damage is assessed by magnetic resonance imaging (MRI). Acetabular coverage and version are primarily assessed on radiographs. Evaluation of the entire circumference of the proximal femur warrants MRI which is further used in the assessment of chondrolabral lesions, and also bone marrow and adjacent soft tissue abnormalities. The MRI protocol should routinely include measurements of femoral torsion. Fluid-sensitive sequences should be acquired to rule out degenerative or inflammatory extra-articular changes.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich.
| | - Felix R M Koenig
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich
| | - Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Wien, Österreich
- Abteilung für Kinderorthopädie und Fußchirurgie, Orthopädisches Spital Speising, Wien, Österreich
| | - Florian Schmaranzer
- Universitätsklinik für Diagnostische‑, Interventionelle- und Pädiatrische Radiologie, Inselspital Bern, Universität Bern, Bern, Schweiz
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Hassan MM. Editorial Commentary: Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Adolescents Improves Outcomes: Don't Forget the Young Guns. Arthroscopy 2023; 39:1220-1221. [PMID: 37019534 DOI: 10.1016/j.arthro.2023.01.010] [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: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 04/07/2023]
Abstract
It has been said that youth is wasted on the young. This notion does not apply to the value that hip arthroscopy provides in managing hip pathology in adolescents. Multiple studies have shown the efficacy of hip arthroscopy as a treatment modality in the adult population for a multitude of hip pathologies, particularly femoroacetabular impingement syndrome. The implementation of hip arthroscopy in the management of femoroacetabular impingement syndrome in the adolescent population is on the rise. More studies illustrating favorable outcomes following hip arthroscopy in adolescents will serve to reinforce its utility as a treatment option for this population. Early intervention and preservation of hip function are of critical importance in a youthful and active patient population. As a word of caution, acetabular retroversion predisposes these patients to an increased risk of revision surgery.
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Albertoni DB, Gianola S, Bargeri S, Hoxhaj I, Munari A, Maffulli N, Castellini G. Does femoroacetabular impingement syndrome affect range of motion? A systematic review with meta-analysis. Br Med Bull 2023; 145:45-59. [PMID: 36368014 DOI: 10.1093/bmb/ldac027] [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] [Accepted: 10/03/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND It is unclear whether femoroacetabular impingement syndrome (FAIS) affect hip range of motion (ROM). SOURCES OF DATA We performed a systematic review with meta-analysis searching six electronic databases from inception to March 21, 2022. We included studies assessing hip ROM in FAIS, FAI morphology without symptoms (FAIm), and healthy controls. Mean differences between groups were measured in ROM degrees with 95% confidence interval (CI). AREAS OF AGREEMENT A total of 17 studies (1702 hips) were included. Comparison of FAIS patients versus healthy controls showed that hip ROM was clinically and statistically reduced in FAIS for internal rotation (90° hip flexion, -8.01°, 95% CI: -11.21, -4.90; 0° hip flexion -6.38°, 95% CI: -9.79, -2.97); adduction (90° hip flexion, -4.74°, 95% CI: -8.13, -1.34); flexion (-5.41°, 95% CI: -7.05, -3.49), abduction (0° hip flexion, -5.76°, 95% CI: -8.38, -3.23), and external rotation (90° hip flexion, -3.5°, 95% CI: -5.32, -1.67) ranging from low to high certainty of evidence. Comparison of FAIm versus healthy controls showed no statistically significant differences in any direction of movement, albeit with uncertainty of evidence. AREAS OF CONTROVERSY The certainty of evidence was unclear, particularly for asymptomatic FAIm. GROWING POINTS Hip ROM may be reduced in all directions except extension in FAIS compared to controls. Hip ROM may not be restricted in asymptomatic FAIm. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies are needed to resolve the uncertainty of evidence about ROM restrictions in asymptomatic FAIm compared to healthy controls.
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Affiliation(s)
- Davide Bruno Albertoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Ilda Hoxhaj
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome, Italy
| | - Alice Munari
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Nicola Maffulli
- Department of Orthopaedics, School of Medicine, Surgery and Dentistry, Salerno, Italy
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
- Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
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Mullins K, Filan D, Carton P. High survivorship and excellent 5-year outcomes in patients older than 40 years undergoing arthroscopy for femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 2023; 31:2123-2130. [PMID: 36912924 DOI: 10.1007/s00167-023-07369-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/24/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE To assess 5-year clinical outcome, in adults > 40 years of age, following hip arthroscopy for femoroacetabular impingement compared to a younger, matched, control group. METHODS All primary arthroscopies for FAI between 2009 and 2016 were considered (n = 1762). Hips presenting with Tönnis > 1, lateral centre edge angle < 25°, or prior hip surgery were excluded. Younger (< 40 years) and older hips (> 40 years) were matched for gender, Tönnis grade, capsular repair and radiological parameters. Survival (avoidance of total hip replacement {THR}) was compared between the groups. Patient reported outcome measures (PROMs) were also completed at baseline and 5 years to assess changes in functional capacity. Additionally, hip range of motion (ROM) was assessed at baseline and review. The minimal clinically important difference (MCID) was determined and compared between groups. RESULTS Ninety-seven older hips were matched to 97 younger controls (78% male in both groups). The average age of the older group at the time of surgery was 48.0 ± 5.7 years, compared to 26.7 ± 6.0. Six (6.2%) of the older hips and 1 (1%) of younger hips converted to THR (p = 0.043, effect size = 0.74, large). There were statistically significant improvements in all PROMs. At follow-up, there were no differences in PROMs between groups; significant improvements in hip ROM were also observed with no difference in ROM between groups at either time point. Similar achievement of MCIDs was observed in both groups. CONCLUSIONS Older patients experience a high survivorship rate at 5 years, although this may be lower than younger patients. Where THR is avoided, large clinically significant improvements in pain and function are observed. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Karen Mullins
- UPMC Sports Medicine Clinic, WIT Arena, Cork Road, Waterford, Ireland.
| | - David Filan
- UPMC Sports Medicine Clinic, WIT Arena, Cork Road, Waterford, Ireland
| | - Patrick Carton
- UPMC Sports Medicine Clinic, WIT Arena, Cork Road, Waterford, Ireland.,The Hip and Groin Clinic, UPMC Whitfield, Butlerstown North, Cork Road, Waterford, Ireland
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Migliorini F, Maffulli N, Bell A, Cuozzo F, Hildebrand F, Weber CD. Midterm results after arthroscopic femoral neck osteoplasty combined with labral debridement for cam type femoroacetabular impingement in active adults. J Orthop Surg Res 2023; 18:67. [PMID: 36707868 PMCID: PMC9880366 DOI: 10.1186/s13018-023-03543-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/14/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Arthroscopic labral procedures are frequently undertaken in patients with femoroacetabular impingement (FAI). The role of arthroscopic femoral neck osteoplasty is well established, but less is known about labral procedures. This study evaluates the midterm efficacy and feasibility of arthroscopic osteoplasty with concomitant labral debridement for cam impingement in active adults. METHODS The present study was conducted according to the STROBE Statement. All 108 patients who underwent primary hip arthroscopy for cam type FAI combined with labral debridement were considered. Axial and anteroposterior plain radiographs of the pelvis were obtained preoperatively to identify the cam deformity and assess the presence of osteoarthritis, the lateral centre-edge angle, and the alpha angle. The ROM (flexion, extension, abduction, adduction, and intra/extra rotation) was evaluated. The following PROMs were administered: visual analogic scale (VAS), Tegner Activity Scale, non-arthritic hip score (NAHS), the international Hip Outcome Tool (iHOT-33) overall score, and related subscales: symptoms and functional limitations, sports and recreational activities, job-related concerns, and social, emotional, and lifestyle concerns. RESULTS At a mean of 2.0 ± 1.1 months, all 108 patients returned to their daily activities with no limitation. At a mean of 2.6 ± 1.4 months, all 108 patients were able to return to sport with no limitation. At 11.9 ± 2.1-month follow-up, no differences were reported in the range of motion compared to baseline: flexion (P = 0.3), extension (P = 0.09), abduction (P = 0.1), adduction (P = 0.3), internal rotation (P = 0.4), and external rotation (P = 0.6). At 72.8 ± 21.7-month follow-up, the mean VAS score was 1.7 ± 3.0, Tegner Activity Scale 3.5 ± 1.4, NAHS 92.1 ± 21.5, iHOT33 83.3 ± 27.2. At a mean of 21.7 ± 15.5 months following the index procedure, 14 of 108 patients had undergone total hip arthroplasty. No further revisions or complications were reported. CONCLUSION Arthroscopic femoral neck osteoplasty with concomitant labral debridement for cam type of FAI in active adults yields the reliable results, with a rate of progression to total hip arthroplasty of 13% (14 of 108) at 3-year follow-up. All patients returned to their daily activities with no limitation 2 months postoperatively. Within 3 months, all patients returned to sport with no limitations. No complication related to the index procedure was reported, and no further arthroscopic procedures were necessary.
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Affiliation(s)
- Filippo Migliorini
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany ,Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy ,grid.9757.c0000 0004 0415 6205Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, ST4 7QB England ,grid.4868.20000 0001 2171 1133Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, E1 4DG England
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152 Simmerath, Germany
| | - Francesco Cuozzo
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, SA Italy
| | - Frank Hildebrand
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Christian David Weber
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
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Maldonado DR, Kufta AY, Krych AJ, Levy BA, Okoroha KR, Gonzalez-Carta K, Domb BG. Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Adolescents Improves Outcomes and Clinical Benefit Achievement Rates at Short-Term Follow-Up. A Multicenter Analysis. Arthroscopy 2022; 39:1211-1219. [PMID: 36572612 DOI: 10.1016/j.arthro.2022.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/01/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To report minimum 2-year follow-up patient-reported outcome scores (PROs) and rates of achieving the minimal clinically important difference (MCID), the patient-acceptable symptomatic state (PASS), and the maximal outcome improvement (MOI) on adolescents following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Second, to determine risk factors for revision surgery. METHODS Prospectively collected data from two high-volume hip arthroscopy centers were retrospectively reviewed on adolescents (≤19 years old) who underwent primary hip arthroscopy between November 2008 and February 2019. Adolescents with a minimum 2-year follow-up for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) for pain were included regardless of their growth plate status. Exclusion criteria were Tönnis grade >1, lateral center edge-angle <18°, and previous ipsilateral hip surgery or conditions. Preoperative and postoperative radiographic data, MCID, PASS, MOI, secondary surgeries, and complications were reported. A multivariable survival analysis for risk factors for secondary surgery was conducted. RESULTS A total of 287 hips (249 patients) were included (74.9% females). The mean values for age, body mass index, and follow-up were 16.3 ± 1.3 years, 22.3 ± 3.5, and 26.6 ± 9.4 months, respectively. Further, 88.9% underwent labral repair, 81.5% femoroplasty, and 85.4% capsular closure. Improvement for all PROs was reported (P < .001) with high patient satisfaction (8.8 ± 1.5). Achievement for the MCID was 71.7%, 83.0%, 68.1%, and 79.5% for the mHHS, NAHS, HOS-SSS, and iHOT-12, respectively. Achievement for the PASS was 68.3% for the mHHS and 73.2% for the NAHS. The MOI for mHHS, NAHS, and VAS was 58.3%, 77.0%, and 59.6%, respectively. Rates of revision hip arthroscopy, cam recurrence, and heterotopic ossification were 5.8%, 1.7%, and 5.5%, respectively. Acetabular retroversion was found to be a risk factor for revision surgery (P = .03). CONCLUSION The results of this multi-center study demonstrated that adolescents who underwent primary hip arthroscopy for FAIS reported significant improvement in all PROs, with satisfactory achievement rates for the MCID, PASS, MOI, and high patient satisfaction at a minimum 2-year follow-up. LEVEL OF EVIDENCE IV, retrospective multicenter study.
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Affiliation(s)
- David R Maldonado
- American Hip Institute Research Foundation, Chicago, Illinois, USA; Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Allison Y Kufta
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Karina Gonzalez-Carta
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA; American Hip Institute, Chicago, Illinois, USA.
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Autologous chondrocyte implantation in the knee is effective in skeletally immature patients: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 31:2518-2525. [PMID: 36329188 PMCID: PMC10183428 DOI: 10.1007/s00167-022-07212-y] [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] [Received: 08/25/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This systematic review evaluated the efficacy and safety of autologous chondrocyte implantation (ACI) for chondral defects of the knee in skeletally immature patients. Current available data from patients reported outcome measures (PROMs) and complications were collected, analyzed, and discussed. METHODS This systematic review was conducted according to the PRISMA guidelines. The following databases were accessed in May 2022: PubMed, Google scholar, Embase, and Scopus. All the clinical studies investigating the efficacy of ACI to manage chondral defects of the knee in skeletally immature patients were accessed. Articles treating patients with surgical procedures other than ACI were not eligible, nor were studies with a follow-up shorter than 12 months. RESULTS Data from 9 studies (251 procedures) were collected. 32% (80 of 251) of patients were females. The mean length of follow-up was 44.2 ± 29.4 (range, 12-115) months. The mean age of the patients was 16.4 ± 0.7 (range, 15-17) years. The Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Document Committee (IKDC) increased of + 41.9/100 (P = 0.003) and + 33.2/100 (P = < 0.0001) points, respectively. The Lysholm Knee Score improved of + 20.6/100 (P = 0.02) points. The Visual Analogue Scale (VAS) for pain reduced of - 3.6/10 (P = 0.004) points. The Tegner scale did not show any statistically significant improvement from baseline to follow-up (P = n.s.). The rate of graft hypertrophy was 12.5% (5 of 40 patients), and the rate of failure 5.6% (8 of 142 patients). CONCLUSION ACI for chondral defects of the knee is effective to improve PROMs in skeletally immature patients. The safety profile of ACI still remains controversial. LEVEL OF EVIDENCE III.
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Osteoarthritis Risks and Sports: An Evidence-based Systematic Review. Sports Med Arthrosc Rev 2022; 30:118-140. [PMID: 35921595 DOI: 10.1097/jsa.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Regular sports activities are associated with multiple physical and psychological health benefits. However, sports also may lead to injuries and the development of osteoarthritis (OA). This systematic review investigated the association between sports activity, sports type, and the risk of developing OA. METHODS A systematic review was performed by assessing studies that have investigated the risk of OA development in sports. Data extracted included general information, study design, number of participants, related body mass index, sports type, and assessment of OA. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 63 studies were included in this systematic review. The overall Newcastle-Ottawa Scale score was 6.46±1.44 demonstrating a good methodological quality of the articles included in the present study. A total of 628,036 participants were included, with a mean follow-up of 8.0±8.4 years. The mean age of the included athletes was 45.6±15.8, with a mean body mass index of 24.9±2.3 kg/m 2 . CONCLUSION Football and soccer players seem to be at higher risk for the development of OA, although the injury status of the joint should be considered when assessing the risk of OA. High equipment weight and increased injury risk also put military personnel at a higher risk of OA, although elite dancing leads to more hip labral tears. Femoroacetabular impingement was also often diagnosed in ice-hockey players and ballet dancers.
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Outcome-Affecting Parameters of Hip Arthroscopy for Femoroacetabular Impingement with Concomitant Cartilage Damage-Data Analysis from the German Cartilage Registry. J Clin Med 2022; 11:jcm11061532. [PMID: 35329858 PMCID: PMC8949441 DOI: 10.3390/jcm11061532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
This study aims to report on a prospectively collected, multicenter database of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAI) and concomitant cartilage damage (according to the International Cartilage Repair Society) and to assess the outcome-affecting parameters. In the study, 353 hips with up to 24 months’ follow-up were assessed by iHOT-33 scoring and achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) levels. Multiple and binary regression analyses were performed to identify factors related to (un-) favorable outcomes and to assess their clinical relevance with regard to achieving the MCID and PASS. Multiple regression yielded the parameters of male sex (p = 0.022) and lower body mass index (BMI) (p = 0.019) at 6 months, lower BMI (p = 0.022) and younger age (p = 0.022) at 12 months, and younger age at 24 months (p = 0.039) to be significantly associated with higher iHOT scoring. Male sex (p = 0.019) and lower BMI (p = 0.018) were significantly correlated with achievement of the PASS in binary regression at 6 months, whereas at 12 (p = 0.010) and at 24 (p = 0.003) only younger age was shown to be significantly correlated. None of the parameters was statistically associated with achievement of the MCID. As the parameters of younger age, male sex, and lower BMI were identified as temporarily correlated with a preferable outcome in general and with achievement of the PASS in particular, these findings help to preoperatively identify factors associated with (un-) favorable therapy results.
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Jimenez AE, Glein RM, Owens JS, Lee MS, Maldonado DR, Saks BR, Lall AC, Domb BG. Predictors of Achieving the Patient Acceptable Symptomatic State at Minimum 5-Year Follow-up Following Primary Hip Arthroscopy in the Adolescent Athlete. J Pediatr Orthop 2022; 42:e277-e284. [PMID: 34857723 DOI: 10.1097/bpo.0000000000002022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Predictors of outcomes in adolescent athletes undergoing hip arthroscopy have not been established. The purpose of this study was to identify factors correlated with achieving the Patient Acceptable Symptomatic State (PASS) for the Hip Outcome Score-Sports Specific Subscale (HOS-SSS) at a minimum 5-year follow-up in adolescent athletes undergoing primary hip arthroscopy. METHODS Data were reviewed on adolescent (below 18 y old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between March 2008 and October 2015. Patients were included if they participated in sport within 1 year before surgery and had preoperative, 2-year, and minimum 5-year postoperative patient-reported outcome (PRO) scores for the modified Harris Hip Score, HOS-SSS, Visual Analog Scale for pain (VAS), and Non-Arthritic Hip Score (NAHS). Patients were divided into 2 groups based on whether they achieved PASS for HOS-SSS. Demographics, intraoperative findings, radiographic variables, surgical treatments, and PRO were compared. Multivariate logistic regression with corresponding odds ratios (ORs) quantified the correlation between variables and achievement of the PASS. RESULTS A total of 123 athletes with a mean age of 16.2±1.1 years were included. These athletes demonstrated significant imrpovement from preoperative to minimum 5-year follow-up for all recorded PROs (P<0.001). The multivariate logistic regression model identified preoperative NAHS (P=0.019, OR: 1.033), 2-year postoperative HOS-SSS (P=0.014, OR: 1.037), and 2-year postoperative VAS (P=0.003, OR: 0.590) as statistically significantly correlated with achieving the PASS. Athletes with a 2-year postoperative VAS pain score ≤2 achieved PASS at a rate of 81.9%, while those with a score >2 achieved PASS at a rate of 24.1% (P<0.001, OR: 14.2, 95% confidence interval: 5.23-38.7). CONCLUSIONS Favorable outcome were achieved at mid-term follow-up in adolescent athletes undergoing primary hip arthroscopy. Preoperative NAHS, 2-year postoperative HOS-SSS, and 2-year postoperative VAS pain scores were correlated with achieving the PASS for HOS-SSS at a minimum 5-year follow-up. Patients with 2-year postoperative VAS ≤2 were significantly more likely to achieve the PASS at 5-year follow-up than those with scores >2. LEVEL OF EVIDENCE Level III-case-control study.
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Affiliation(s)
| | | | | | | | | | - Benjamin R Saks
- American Hip Institute Research Foundation
- AMITA Health St. Alexius Medical Center, Hoffman Estates, IL
| | - Ajay C Lall
- American Hip Institute Research Foundation
- American Hip Institute, Chicago
- AMITA Health St. Alexius Medical Center, Hoffman Estates, IL
| | - Benjamin G Domb
- American Hip Institute Research Foundation
- American Hip Institute, Chicago
- AMITA Health St. Alexius Medical Center, Hoffman Estates, IL
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Chiari C, Lutschounig MC, Nöbauer-Huhmann I, Windhager R. [Femoroacetabular impingement syndrome in adolescents-How to adivse? How to treat?]. DER ORTHOPADE 2022; 51:211-218. [PMID: 35166900 PMCID: PMC8894180 DOI: 10.1007/s00132-022-04214-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/01/2022]
Abstract
Hintergrund Das Femoroazetabuläre Impingement-Syndrom (FAIS) ist eine relevante Ursache für Leistenschmerzen beim Jugendlichen. Insbesondere sind Sportler betroffen. Ziel der Arbeit Die Arbeit soll einen evidenzbasierten Hintergrund für Beratung und Therapie des FAIS beim Adoleszenten bieten. Material und Methoden Anhand der aktuellen Literatur wurde eine Übersicht zu Prävalenz und Pathogenese, Abklärung und Diagnostik sowie therapeutischen Empfehlung des FAIS beim Adoleszenten erarbeitet. Ergebnisse und Diskussion Das FAIS beim Jugendlichen betrifft vor allem sportlich aktive Patienten. Bestimmte Sportarten begünstigen die Entstehung eines FAIS. Cam-Impingement, Pincer-Impingement und kombiniertes FAIS sind die häufigsten Entitäten in dieser Altersgruppe. Die Cam-Morphologie entsteht kurz vor Schluss der proximalen Femurwachstumsfuge. Beim Cam-Impingement muss die Epiphyseolysis capitis femoris (ECF) von der primären Cam-Morphologie unterschieden werden. Die ECF verlangt eine rasche operative Versorgung mit Stabilisierung der Epiphyse, während das primäre Cam-Impingement elektiv abgeklärt werden kann und ein konservativer Behandlungsversuch sinnvoll ist. Schäden an Labrum und Knorpel werden regelhaft beobachtet. Eine systematische radiologische Abklärung mittels Projektionsröntgen und MRT ist obligat, um einen adäquaten Therapieplan zu entwickeln. Bei jugendlichen Patienten mit FAIS sollte immer ein konservativer Therapieversuch erfolgen. Ist dieser nicht erfolgreich, ist die operative Sanierung mit Hüftarthroskopie indiziert. Die postoperativen Ergebnisse zeigen bei Jugendlichen sehr gute Erfolge mit rascher Besserung der Beschwerden, geringen Komplikationen und einer hohen „Return-to-sport“-Rate.
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Affiliation(s)
- Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Marie-Christine Lutschounig
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Iris Nöbauer-Huhmann
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie/Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich
| | - Reinhard Windhager
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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Minimum 2-Year Outcomes Following Arthroscopic Hip Labral Reconstruction in Adolescents and Young Adults. J Pediatr Orthop 2022; 42:83-89. [PMID: 34657092 DOI: 10.1097/bpo.0000000000001984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Labral repair is generally preferred when facing labral tears. When an irreparable labral tear in the context of femoroacetabular impingement syndrome is present, arthroscopic labral reconstruction has been proven to be a valid option for labral restoration. However, data on this procedure for the adolescent population is scarce. The purpose of the present study was to report minimum 2-year follow-up patient-reported outcome measures (PROMs) on adolescents and young adults following arthroscopic acetabular labral reconstruction. METHODS Data were prospectively collected and retrospectively reviewed on adolescents and young adults who underwent hip arthroscopy between March 2009 and June 2018. Inclusion criteria were labral reconstruction, baseline and minimum 2-year follow-up PROMs. Patients were excluded if they were unwilling to participate in the study, had Tönnis grade >1, or dysplasia. RESULTS Twenty-three hips (22 patients) that underwent labral reconstruction were included. Ten hips (10 patients) underwent primary labral reconstruction, and 13 hips (12 patients) underwent revision reconstruction. The mean age was 19.3 years and 56.5% of patients were males. All patients improved significantly at minimum 2 years for all PROMs (P<0.001) with high satisfaction. Patients in both groups demonstrated improvement for all PROMs, patient satisfaction, and a rate of achieving the minimal clinically important difference. CONCLUSION Arthroscopic labral reconstruction in adolescents and young adults demonstrated significant improvement and high patient satisfaction at minimum 2-year follow-up in the setting of irreparable labral tear. Favorable outcomes, high patient satisfaction, and high achievement rate for the minimal clinically important difference were obtained following labral reconstruction in this population the primary and revision scenarios. LEVEL OF EVIDENCE Level IV, case-series.
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Gao G, Fu Q, Wu R, Liu R, Ao Y, Xu Y. The correlation between the labrum size and the labral tear in asymptomatic volunteers and symptomatic patients. J Orthop Surg Res 2021; 16:567. [PMID: 34544472 PMCID: PMC8454115 DOI: 10.1186/s13018-021-02719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some studies have proved that labrum size is associated with symptoms in patients with hip labral tear. The correlation between the labrum size and the labral tear in asymptomatic volunteers and symptomatic patients is still uncertain. METHODS The volunteers with no history of pain, injury, or surgery were recruited from the community. Patients who were diagnosed with labral tear and underwent hip arthroscopic surgery in this period in our hospital were also included. The length and height of the acetabular hip labrum were measured at three separate anatomic sites through magnetic resonance imaging (MRI) along the acetabular rim: lateral, anterior, and anteroinferior. RESULTS A total of 70 volunteers (125 hips) and 70 patients (70 hips) were included in this study. Sixty-six (52.8%) hips had labral tears in all 125 hips of volunteers. The lateral labral length of volunteers with labral tears was significantly larger than those without labral tears (P < .05). In 14 volunteers with unilateral labral tears, length of lateral, anterior, and anteroinferior labrum in the side with tear were significantly larger than normal on the other side. The anterior labral height of volunteers was significantly larger than that of patients (P < .05). CONCLUSIONS In conclusion, asymptomatic volunteers with larger length of lateral, anterior, and anteroinferior labrum are more prone to present with labral tears. Symptomatic patients with labral tears exhibited thinner anterior labrum. Further studies are warranted to explore the mechanisms of labral tears in asymptomatic people and validate the use of labral size as a guide to differential diagnosis and treatment.
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Affiliation(s)
- Guanying Gao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Qiang Fu
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Ruiqi Wu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Rongge Liu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yingfang Ao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yan Xu
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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