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Outcomes and rate of return to play in elite athletes following arthroscopic surgery of the hip. INTERNATIONAL ORTHOPAEDICS 2021; 45:2507-2517. [PMID: 34148120 PMCID: PMC8514359 DOI: 10.1007/s00264-021-05077-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Background The tremendous physical demands of elite performance increase the risk of elite athletes sustaining various orthopaedic injuries. Hip pain is common in high-level athletes representing up to 6% of all athletic injuries. Expedient diagnosis and effective treatment are paramount for their future sporting careers and to prevent subsequent joint degeneration. Purpose This systematic review aimed to evaluate the outcome and the rate of return to play (RTP) following arthroscopic procedures in the hip (osteoplasty, chondroplasty, labral repair and/or debridement, capsulotomy, capsulorrhaphy or any soft tissue procedure) in elite athletes. Elite athletes were defined as those who represented their country in international contests or were competing professionally for the purpose of this study. Methods A computer-based systematic search, following the PRISMA Guidelines, was performed on CENTRAL, PUBMED, EMBASE, SCOPUS, EBSCO, Google Scholar and Web of Science from inception until January 1, 2020, identifying studies that looked at return to sports post-hip arthroscopy in elite athletes. Weighted means were calculated for the RTP rate and duration and for patient-reported outcome measures (PROMs). Results After eligibility screening, 22 articles were included with a total of 999 male and seven female patients, 1146 hips and a mean age of 28.4 ± 3.2 years. The mean follow-up period was 35.8 ± 13.4 months and 15.9 ± 9.6% of athletes had undergone bilateral procedures. Overall, 93.9% (95% CI: 90.5, 96.6, P < 0.0001) of patients demonstrated RTP after 6.8 ± 2.1 months post-surgery and all PROMs improved post-operatively. During follow-up, 9.6% (95% CI: 5.2, 15.2, P = 0.025) patients needed further intervention. Conclusion A high percentage of elite athletes return to the same level of competition after hip arthroscopy, with a low rate of further interventions. Hip arthroscopy appears to be an efficacious treatment for hip and/or groin pain, caused by pathologies such as FAI or labral tears, in elite athletes in the shorter term. Long term outcomes need further evaluation.
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Stone AV, Mehta N, Beck EC, Waterman BR, Chahla J, Ukwuani G, Nho SJ. Comparable patient-reported outcomes in females with or without joint hypermobility after hip arthroscopy and capsular plication for femoroacetabular impingement syndrome. J Hip Preserv Surg 2019; 6:33-40. [PMID: 31069093 PMCID: PMC6501436 DOI: 10.1093/jhps/hnz004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/13/2018] [Accepted: 02/03/2019] [Indexed: 12/16/2022] Open
Abstract
Hip arthroscopy is widely utilized to treat femoroacetabular impingement syndrome (FAIS). In order to evaluate the postoperative clinical and functional outcomes at 2-year follow up in patients with and without benign joint hypermobility syndrome following hip arthroscopy with capsular plication for FAIS, consecutive female patients with generalized ligamentous laxity undergoing primary hip arthroscopy with complete T-capsulotomy closure via plication for FAIS were prospectively identified. Patients were matched in a 4:1 ratio based on Beighton-Horan joint mobility index (BHJMI) then classified into no generalized joint laxity (NGJL, Score<4) or generalized joint laxity cohort (GJL, Score=4). Patient and surgical-related factors were analyzed using univariate and paired analysis with statistical significance set at a = 0.05. A total of 125 female patients were included in the study: 25 generalized joint laxity (GJL) patients and 100 matched to age, sex and BMI (NGJL cohort). The results demonstrated that there were no significant differences between demographics, preoperative range of motion, or radiographic analysis on univariate analysis. There was no statistical difference in postoperative range of motion between groups, though both groups demonstrated significant increases in postoperative flexion and postoperative internal rotation following hip arthroscopy. Paired analysis demonstrated no significant difference in HOS-SS, HOS-ADL, mHHS or VAS-pain, while GJL patients reported significantly greater patient satisfaction score at 2-years follow-up (p=0.007). In summary, hip arthroscopy with capsular plication is a highly effective treatment for FAIS in patients with and without generalized joint laxity. In our analysis, patients with and without generalized joint laxity demonstrated statistically similar and significant improvement in outcomes.
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Affiliation(s)
- Austin V Stone
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nabil Mehta
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Edward C Beck
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gift Ukwuani
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Ross JR, Khan M, Noonan BC, Larson CM, Kelly BT, Bedi A. Characterization and Correction of Symptomatic Hip Impingement in American Football Linemen. HSS J 2018; 14:128-133. [PMID: 29983653 PMCID: PMC6031539 DOI: 10.1007/s11420-018-9605-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) morphology can lead to range-of-motion deficits in football players. It is therefore important for physicians treating these players to be aware of the location and implications of FAI morphology. PURPOSE/QUESTIONS We sought to characterize the radiographic deformity and dynamic impingement observed in a consecutive series of American football linemen with symptomatic, mechanical hip pain who underwent surgical treatment for FAI and to use software analysis to identify the location of impingement and terminal range of motion and the effects of simulated correction. METHODS A retrospective analysis was conducted of 17 hips in 13 football linemen who underwent arthroscopic correction for symptomatic FAI. Computed tomography (CT) scans were used to generate preoperative three-dimensional models of the hips. Femoral and acetabular measurements, maximum hip flexion, abduction, internal rotation at 90° flexion (IR90), and flexion/adduction/internal rotation (FADIR) were determined, and areas of bony collision were defined. Simulated femoral correction was performed and motion analysis was repeated. RESULTS Mean femoral version was 13.1° (range, 0 to 26°), while mean femoral neck-shaft angle was 132.1° (range, 123 to 145°). Mean maximum alpha angle on the radial reformatted CT was 69.2° (range, 48 to 95°) and was located at the 12:45 clock-face position (range, 11:30 to 2:15). Mean acetabular version values at 1:30 and 3:00 were 1.1° (range, - 11 to 11°) and 12.7° (range, 2 to 20°), respectively. Fifty-three percent of hips showed a "crossover" sign. Mean lateral center-edge angle was 31.7° (range, 25 to 44°). CT-derived motion analysis demonstrated a mean preoperative flexion of 108.2° (range, 73 to 127°), IR90 of 20.5° (range, 0 to 52°), and FADIR of 12.3° (range, 0 to 39°). Simulated correction resulted in significant improvements in flexion (6.6°), IR90 (11.3°), and FADIR (10.6°). CONCLUSIONS While cephalad retroversion was observed in approximately half of the hips, a significant cam deformity was seen maximally at 12:45, a more posterior cam location than that of the general population. Managing this pathology required obtaining preoperative and intraoperative images to characterize lesions and allow for their complete correction. With complete correction of the deformity, simulated range of motion demonstrated significant improvement in flexion, IR90, and FADIR maneuvers.
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Affiliation(s)
- James R. Ross
- 0000000086837370grid.214458.eSports Medicine and Shoulder Service, MedSport, University of Michigan, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA
| | - Moin Khan
- 0000000086837370grid.214458.eSports Medicine and Shoulder Service, MedSport, University of Michigan, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA
| | | | - Christopher M. Larson
- grid.477554.0Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, MN USA
| | - Bryan T. Kelly
- 0000 0001 2285 8823grid.239915.5Sports Medicine Service, Hospital for Special Surgery, New York, NY USA
| | - Asheesh Bedi
- 0000000086837370grid.214458.eSports Medicine and Shoulder Service, MedSport, University of Michigan, 24 Frank Lloyd Wright Dr., Lobby A, Ann Arbor, MI 48106 USA ,0000 0001 2285 8823grid.239915.5Sports Medicine Service, Hospital for Special Surgery, New York, NY USA
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Knapik DM, Sheehan J, Nho SJ, Voos JE, Salata MJ. Prevalence and Impact of Hip Arthroscopic Surgery on Future Participation in Elite American Football Athletes. Orthop J Sports Med 2018; 6:2325967117752307. [PMID: 29435469 PMCID: PMC5802644 DOI: 10.1177/2325967117752307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Intra-articular injuries to the hip in elite athletes represent a source of significant pain and disability. Hip arthroscopic surgery has become the gold standard for the treatment of disorders involving the hip joint. Purpose: To examine the incidence of and abnormalities treated with hip arthroscopic surgery as well as the impact on future participation in American football athletes invited to the National Football League (NFL) Scouting Combine with a history of hip arthroscopic surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Athletes invited to the NFL Combine from 2012 to 2015 were evaluated for a history of hip arthroscopic surgery. Athlete demographics, imaging findings, and physical examination results were gathered using the NFL Combine database. Information on prospective participation in the NFL with regard to draft status, games played, games started, and current status was gathered using publicly available databases and compared against all other athletes participating in the combine. Results: Fourteen athletes (15 hips) had a history of arthroscopic hip surgery. Acetabular labral tears were treated in 93% (14 hips), with femoroacetabular impingement decompression performed in 33% (5 hips). Compared with athletes who had no history of hip arthroscopic surgery, those undergoing arthroscopic surgery did not possess a lower likelihood of being drafted (66% vs 71%, respectively; P = .78) or of being on an active roster (52% vs 43%, respectively; P = .44) after their first season in the NFL. Moreover, there was no significant difference in the number of regular-season games played (10.9 ± 4.8 with arthroscopic surgery vs 11.0 ± 5.1 without; P = .96) or started (7.0 ± 3.6 with arthroscopic surgery vs 7.1 ± 5.3 without; P = .98). Conclusion: American football athletes invited to the NFL Combine with a history of hip arthroscopic surgery were not at risk for diminished participation when compared with all other athletes during their first season in the NFL.
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Affiliation(s)
- Derrick M Knapik
- Sports Medicine Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | | | - Shane J Nho
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
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Pascual-Garrido C, Schrock JB, Mitchell JJ, Camino Willhuber G, Mei-Dan O, Chahla J. Arthroscopic Fixation of Os Acetabuli Technique: When to Resect and When to Fix. Arthrosc Tech 2016; 5:e1155-e1160. [PMID: 28224071 PMCID: PMC5310184 DOI: 10.1016/j.eats.2016.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/05/2016] [Indexed: 02/03/2023] Open
Abstract
Acetabular rim fractures, or os acetabuli, are hypothesized to occur as a result of an unfused ossification center or a stress fracture from repetitive impingement of an abnormally shaped femoral neck against the acetabular rim. When treated surgically, these fragments are typically excised as part of the correction for femoroacetabular impingement. However, in some patients, removal of these fragments can create symptoms of gross instability or microinstability of the hip. In these cases, internal fixation of the fragment is necessary. The purpose of this technical note is to describe indications, the arthroscopic technique, and postoperative care for fixation of acetabular rim fractures.
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Affiliation(s)
- Cecilia Pascual-Garrido
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.,Address correspondence to Cecilia Pascual-Garrido, M.D., Division of Hip Preservation, Department of Sports Medicine, University of Colorado Hospital, CU Sports Medicine and Performance, 2150 Stadium Drive, Boulder, CO 80309, U.S.A.Division of Hip PreservationDepartment of Sports MedicineUniversity of Colorado HospitalCU Sports Medicine and Performance2150 Stadium DriveBoulderCO80309U.S.A.
| | - John B. Schrock
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | | | - Gaston Camino Willhuber
- Department of Orthopaedic Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Reliability of hip internal rotation range of motion measurement using a digital inclinometer. Knee Surg Sports Traumatol Arthrosc 2015; 23:2562-7. [PMID: 24912575 DOI: 10.1007/s00167-014-3096-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Assessment of hip internal rotation (IR) is a critical element in the evaluation of a painful hip, yet there currently exists no consistent method of determining this measurement. The purpose of this study is to report the intra-rater and inter-rater reliability of active and passive hip IR measurement using a digital inclinometer. METHODS Twenty-five subjects (8 men, 17 women) with asymptomatic hip joints, and no known pathology between the ages of 22 and 42 participated. Two examiners measured hip IR for each subject using a digital inclinometer while visually monitoring pelvic motion. Measurements included passive IR, active IR, and active IR while internally rotating both legs simultaneously. Statistical analysis was performed including intra-rater and inter-rater reliability. RESULTS There was no significant difference in measured IR values. Mean range of motion values for all techniques and both examiners ranged from 30.7° to 32.8°. Intra-rater reliability for examiner 1 ranged from 0.84 to 0.92. Inter-rater reliability ranged from 0.89 to 0.93. Of the methods utilized, active IR of a single leg was the most responsive technique with a minimal detectable change value of 5.4°. CONCLUSIONS Clinical assessment of hip IR range of motion can be performed efficiently and reliably with a digital inclinometer along with visual monitoring of the pelvis for unwanted motion. Findings from this study support unilateral active hip IR in a seated position as a reliable and responsive technique for obtaining hip IR measurements.
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Hammoud S, Bedi A, Voos JE, Mauro CS, Kelly BT. The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain. Sports Health 2014; 6:108-18. [PMID: 24587859 PMCID: PMC3931342 DOI: 10.1177/1941738114522201] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Context: In active individuals with femoroacetabular impingement (FAI), the resultant reduction in functional range of motion leads to high impaction loads at terminal ranges. These increased forces result in compensatory effects on bony and soft tissue structures within the hip joint and hemipelvis. An algorithm is useful in evaluating athletes with pre-arthritic, mechanical hip pain and associated compensatory disorders. Evidence Acquisition: A literature search was performed by a review of PubMed articles published from 1976 to 2013. Level of Evidence: Level 4. Results: Increased stresses across the bony hemipelvis result when athletes with FAI attempt to achieve supraphysiologic, terminal ranges of motion (ROM) through the hip joint required for athletic competition. This can manifest as pain within the pubic joint (osteitis pubis), sacroiliac joint, and lumbosacral spine. Subclinical posterior hip instability may result when attempts to increase hip flexion and internal rotation are not compensated for by increased motion through the hemipelvis. Prominence of the anterior inferior iliac spine (AIIS) at the level of the acetabular rim can result in impingement of the anterior hip joint capsule or iliocapsularis muscle origin against the femoral head-neck junction, resulting in a distinct form of mechanical hip impingement (AIIS subspine impingement). Iliopsoas impingement (IPI) has also been described as an etiology for anterior hip pain. IPI results in a typical 3-o’clock labral tear as well as an inflamed capsule in close proximity to the overlying iliopsoas tendon. Injury in athletic pubalgia occurs during high-energy twisting activities in which abnormal hip ROM and resultant pelvic motion lead to shearing across the pubic symphysis. Conclusion: Failure to recognize and address concomitant compensatory injury patterns associated with intra-articular hip pathology can result in significant disability and persistent symptoms in athletes with pre-arthritic, mechanical hip pain. Strength-of-Recommendation Taxonomy (SORT): B
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Affiliation(s)
- Sommer Hammoud
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asheesh Bedi
- MedSport, Division of Sports Medicine and Shoulder Surgery, University of Michigan, Ann Arbor, Michigan
| | - James E Voos
- Orthopaedic and Sports Medicine Clinic of Kansas City, Kansas City, Missouri
| | - Craig S Mauro
- Select Specialty Hospital-Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan T Kelly
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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McCormick F, Alpaugh K, Nwachukwu BU, Yanke AB, Martin SD. Endoscopic repair of full-thickness abductor tendon tears: surgical technique and outcome at minimum of 1-year follow-up. Arthroscopy 2013; 29:1941-7. [PMID: 24140139 DOI: 10.1016/j.arthro.2013.08.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to assess the surgical outcomes of endoscopically repaired full-thickness abductor tendon tears using validated outcome measures. METHODS After institutional review board approval was obtained, clinical outcome data were retrospectively collected from patients who underwent endoscopic gluteus medius and/or minimus repair by a single surgeon between August 2009 and September 2011. With a minimum follow-up of 1 year, patients were evaluated using the modified Harris Hip Score and the validated Hip Outcome Score (HOS). The HOS questionnaire included 2 subsections: HOS-Activities of Daily Living and HOS-Sports. Physical examination data were gathered during routine clinic visits, 1 year postoperatively. Statistical analysis was descriptive. The change in strength testing postoperatively was assessed with the Wilcoxon signed rank test, with significance set at P ≤ .05. RESULTS Twelve patients were identified, 1 of whom was excluded; 10 of 11 patients (91%) completed the study requirements. The mean patient age was 65.9 years (range, 60 to 74 years), 70% were women, and the mean follow-up period was 23 months (range, 13 to 38 months). The mean postoperative scores were 84.7 (SD, 14.5) for the modified Harris Hip Score and 89.1 (SD, 11.3) for the HOS-Activities of Daily Living, with 90% patient satisfaction. All patients had clinically and statistically improved abductor tendon strength (P = .004). Patients with good to excellent outcomes were younger (P < .001). There were no complications identified. CONCLUSIONS In our small series, endoscopic abductor tendon repair was an effective surgical intervention after failed conservative management at short-term follow-up. Patients had reliably good to excellent outcomes with improved strength during hip abduction, were at low risk of complications, and were satisfied with the outcome. In addition, younger patients achieved better outcomes. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Frank McCormick
- Rush Sports Medicine Fellowship Program, Midwest Orthopedics at Rush, Chicago, Illinois, U.S.A..
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Choong P, Brooks P. Achievements during the Bone and Joint Decade 2000-2010. Best Pract Res Clin Rheumatol 2013; 26:173-81. [PMID: 22794093 DOI: 10.1016/j.berh.2012.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 03/08/2012] [Indexed: 11/27/2022]
Abstract
Musculoskeletal diseases continue to produce major disability around the world. Advances in therapy - particularly for the inflammatory diseases - have the potential to eradicate the inflammation and thus prevent joint destruction. Surgical advances include minimally invasive and computer-assisted robotic surgery, and advances in arthroscopic surgery. The development of new musculoskeletal tissues - tendons, cartilage and bone using nanotechnology and stem cells - has the potential to revolutionise the way we approach these chronic destructive diseases as well as major trauma. With the rapid increase in these conditions with an ageing population, new models of care will need to be developed to ensure that the right care is delivered at the right time by the most appropriately trained health professional and at a reasonable cost. The Bone and Joint Decade has played a significant role in focussing researchers, clinicians and health educators on these diseases and also in drawing them to the attention of Governments around the globe. While there is still much to be done, the journey has commenced and will continue into the future with education, research and service delivery into these important conditions being further enhanced.
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Affiliation(s)
- Peter Choong
- Department of Surgery, University of Melbourne, St. Vincent's Hospital Melbourne, Vic, Australia
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Krych AJ, Thompson M, Larson CM, Byrd JWT, Kelly BT. Is posterior hip instability associated with cam and pincer deformity? Clin Orthop Relat Res 2012; 470:3390-7. [PMID: 22879091 PMCID: PMC3492598 DOI: 10.1007/s11999-012-2468-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior hip instability is an increasingly recognized injury in athletes; however, the function of patients after these injuries and an understanding of the pathoanatomy and underlying mechanism are currently unclear. QUESTIONS/PURPOSES We determined (1) the function of patients after these hip injuries using validated, self-reported outcome instruments and (2) the specific pathoanatomy sustained in these events to better understand the mechanism of posterior hip instability. METHODS We reviewed the records of all 22 athletes presenting to our clinics with a posterior acetabular rim fracture confirming a posterior hip instability episode. Radiograph, CT, and MRI findings were documented in all patients. Intraoperative findings were recorded in patients undergoing surgery. There were 19 males and three females with an average age of 22 years (range, 13-31 years). Minimum followup was 2 years (average, 4 years; range, 2-16 years). RESULTS The mean modified Harris hip score was 94, Hip Outcome Scores for Activities of Daily Living and Sport were 99 and 87, respectively, and 20 of 22 athletes returned to sport. The most common constellation of pathoanatomy was a posterior labral tear with rim fracture, anterior labral tear, capsular tear, ligamentum teres avulsion, and chondral injury of the femoral head with loose bodies. Sixteen of the 18 patients with femoroacetabular impingement (FAI) had a twisting or noncontact mechanism of injury. CONCLUSIONS When posterior hip subluxation is recognized and avascular necrosis avoided, these athletes generally have high functional outcome scores and high rates of return to sport. There is an apparent association between the occurrence of posterior hip instability and the presence of structural abnormalities often associated with FAI, which may contribute to a mechanism of FAI-induced posterior subluxation. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Matt Thompson
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | | | | | - Bryan T. Kelly
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Barnthouse NC, Wente TM, Voos JE. Greater Trochanteric Pain Syndrome: Endoscopic Treatment Options. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Poultsides LA, Bedi A, Kelly BT. An algorithmic approach to mechanical hip pain. HSS J 2012; 8:213-24. [PMID: 24082863 PMCID: PMC3470663 DOI: 10.1007/s11420-012-9304-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND As our understanding of hip pathology evolves, the focus is shifting toward earlier identification of hip pathology. Therefore, it is vitally important to elucidate intra-articular versus extra-articular pathology of hip pain in every step of the patient encounter: history, physical examination, and imaging. QUESTIONS/PURPOSES The objective was to address the following research questions: (1) Can an algorithmic approach to physical examination of a painful non-arthritic hip provide a more accurate diagnosis and improved treatment plan? (2) Does an anatomical layered concept of clinical diagnosis improve diagnostic accuracy? (3) What are the diagnostic tools necessary for the accurate application of a four-layer (osteochondral, inert, contractile, and neuromechanical) diagnosis? METHODS An unrestricted computerized search of MEDLINE was conducted. Different terms were used in various combinations. RESULTS An algorithmic approach to physical examination of a painful nonarthritic hip, including history, physical examination (specific tests), and advanced imaging allow for better interpretation of debilitating intra- and extra-articular disorders and their effect on core performance. Additionally, it improves our understanding as to how underlying abnormal joint mechanics may predispose the hip joint and the associated hemipelvis to asymmetric loads. These abnormal joint kinematics (layer I) can lead to cartilage and labral injury (layer II), as well as resultant injury to the musculotendinous (layer III) and neural structures (layer IV) about the hip joint and the hemipelvis. The layer concept is a systematic means of determining which structures about the hip are the source of hip pathology and how to best implement treatment. CONCLUSIONS A clear understanding of the differential diagnosis of hip pain through a detailed and systematic physical examination, diagnostic imaging assessment, and the interpretation of how mechanical factors can result in such a wide range of compensatory injury patterns about the hip can facilitate the diagnosis and treatment recommendations.
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Affiliation(s)
- Lazaros A. Poultsides
- Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
| | - Asheesh Bedi
- Sports Medicine and Shoulder Surgery, MedSport, University of Michigan Health System, Ann Arbor, MI 48109 USA
| | - Bryan T. Kelly
- Department of Orthopaedic Surgery, Center for Hip Pain and Preservation, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 USA
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McCormick F, Nwachukwu BU, Alpaugh K, Martin SD. Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: the influence of age and arthritis. Arthroscopy 2012; 28:1359-64. [PMID: 22906757 DOI: 10.1016/j.arthro.2012.04.059] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 04/01/2012] [Accepted: 04/02/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to perform a retrospective case-control outcome analysis at a minimum 2-year follow-up using a validated hip arthroscopy outcome measure to determine whether arthritis or age is predictive of outcomes after hip arthroscopy for labral pathology. METHODS We identified 176 consecutive patients undergoing hip arthroscopy for labral tears performed between 2001 and 2009 to complete the Modified Harris Hip Score (MHHS) and Hip Outcome Score questionnaires. Patients who underwent additional surgeries or reported an MHHS of less than 80 were compared with the control group of patients who achieved good to excellent surgical results on the MHHS (>80) to calculate odds ratios with 95% confidence intervals by use of the independent variables of patient age of 40 years or older and age below 40 years and the presence of grade 4 Outerbridge changes found at arthroscopy. RESULTS Of 176 patients, 125 (71%) were contacted: 27 patients had undergone additional surgery in the follow-up period, and 98 completed questionnaires. The mean patient age at surgery was 40.9 years (range, 17.3 to 62.8 years) at a mean follow-up of 4.3 years (range, 2 to 10.4 years). Of 98 respondents, 71 (72%) obtained a good to excellent surgical outcome, with 84% reporting satisfaction. The presence of osteoarthritic changes at the time of arthroscopy was predictive of worse outcome scores compared with the nonarthritic cohort (odds ratio, 2.5; 95% confidence interval, 1.2 to 5.3; P = .02). Youth (age <40 years) is predictive of good to excellent results (odds ratio, 7; 95% confidence interval, 2.9 to 16.9; P < .0001). CONCLUSIONS Of the 98 patients who completed the questionnaires in this study, 71 (72%) obtained good to excellent outcome scores. Overall satisfaction among patients undergoing hip arthroscopy was high (84%). Patients aged younger than 40 years did better than older patients, and arthroscopically identified arthritis was predictive of worse surgical outcomes. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Frank McCormick
- Harvard Combined Orthopedic Residency Program, Boston, Massachusetts, USA.
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Nepple JJ, Brophy RH, Matava MJ, Wright RW, Clohisy JC. Radiographic findings of femoroacetabular impingement in National Football League Combine athletes undergoing radiographs for previous hip or groin pain. Arthroscopy 2012; 28:1396-403. [PMID: 22698961 DOI: 10.1016/j.arthro.2012.03.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 03/06/2012] [Accepted: 03/07/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the prevalence of radiographic findings of femoroacetabular impingement (FAI) in elite football players with a history of hip pain or groin injury who underwent radiographs. METHODS We performed a retrospective review of athletes undergoing hip radiography at the National Football League Combine from 2007 to 2009. Radiographs were obtained in athletes with a history of hip pain or injury. Anteroposterior pelvis and frog-lateral radiographs were obtained in 123 hips (107 players) that met our inclusion criteria. Radiographic indicators of cam-type FAI (alpha angle, head-neck offset ratio) and pincer-type FAI (acetabular retroversion, center-edge angle, acetabular inclination) were recorded. Findings were correlated with clinical factors (previous groin/hip pain, position, race, and body mass index). RESULTS The most common previous injuries included groin strain (n = 57) and sports hernia/abdominal strain (n = 21). Markers of cam- and/or pincer-type FAI were present in 94.3% of hips (116 of 123). Radiographic evidence of combined cam- and pincer-type FAI was the most common (61.8%, 76 hips), whereas isolated cam-type FAI (9.8%, 12 hips) and pincer-type FAI (22.8%, 28 hips) were less common. The most common deformities included acetabular retroversion (71.5%) and an abnormal alpha angle (61.8%). A body mass index greater than 35 was associated with the presence of global overcoverage (46.2% v 17.3%, P = .025). CONCLUSIONS Radiographic indicators of FAI are very common among athletes evaluated at the National Football League Scouting Combine subjected to radiographic examination for the clinical suspicion of hip disease. Elite football athletes with significant or recurrent pain about the hip should be evaluated clinically and radiographically for FAI, because pain from FAI may be falsely attributed to or may be present in addition to other disorders. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Jeffrey J Nepple
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
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A biomechanical comparison of repair techniques for complete gluteus medius tears. Arthroscopy 2012; 28:1410-6. [PMID: 22703870 DOI: 10.1016/j.arthro.2012.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare the biomechanical fixation stability conferred by 2 specific arthroscopic repair techniques for complete gluteus medius tendon tears. METHODS Twelve fresh-frozen human cadaveric hemi-pelves were tested. Six received double-row repair with massive cuff stitches (DR-MCS), whereas the remaining 6 underwent double-row repair with knotless lateral anchors (DR-KLA). Constructs were preloaded to 10 N, tested from 10 N to 125 N at 90 N/s for 150 cycles, and then loaded to failure at 1 mm/s. Markers were placed on the tissue for video tracking. RESULTS No significant differences in cyclic outcomes were observed. The DR-KLA construct showed a significantly higher normalized yield load than the DR-MCS construct. Post-yield extension for the DR-MCS construct was significantly higher than that for the DR-KLA construct. At yield load, the optically measured soft-tissue elongation of the DR-KLA construct was significantly higher than that of the DR-MCS construct. CONCLUSIONS This study strongly suggests that the biomechanical stability conferred by DR-MCS and DR-KLA constructs for gluteus medius tendon repair is similar. Because the failure load of the DR-KLA construct is strongly correlated to bone mineral density (BMD), clinical considerations of bone quality may be particularly important for gluteus medius repairs. CLINICAL RELEVANCE Maximum load was strongly correlated to BMD in the DR-KLA group. On the basis of this analysis, BMD should be considered during surgical planning.
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Hammoud S, Bedi A, Magennis E, Meyers WC, Kelly BT. High incidence of athletic pubalgia symptoms in professional athletes with symptomatic femoroacetabular impingement. Arthroscopy 2012; 28:1388-95. [PMID: 22608890 DOI: 10.1016/j.arthro.2012.02.024] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 02/21/2012] [Accepted: 02/22/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to identify the incidence of symptoms consistent with athletic pubalgia (AP) in athletes requiring surgical treatment for femoroacetabular impingement (FAI) and the frequency of surgical treatment of both AP and FAI in this group of patients. METHODS Thirty-eight consecutive professional athletes, with a mean age of 31 years, underwent arthroscopic surgery for symptomatic FAI that limited their ability to play competitively. In all cases a cam and/or focal rim osteoplasty with labral refixation or debridement was performed. In 1 case concomitant intramuscular lengthening of the psoas was performed. Retrospective data regarding prior AP surgery and return to play were collected. RESULTS Thirty-two percent of patients had previously undergone AP surgery, and 1 patient underwent AP surgery concomitantly with surgical treatment of FAI. No patient returned to his previous level of competition after isolated AP surgery. Thirty-nine percent had AP symptoms that resolved with FAI surgery alone. Of the 38 patients, 36 returned to their previous level of play; all 12 patients with combined AP and FAI surgery returned to professional competition. The mean duration before return to play was 5.9 months (range, 3 to 9 months) after arthroscopic surgery. CONCLUSIONS There is a high incidence of symptoms of AP in professional athletes with FAI of the hip. This study draws attention to the overlap of these 2 diagnoses and highlights the importance of exercising caution in diagnosing AP in a patient with FAI. LEVEL OF EVIDENCE Level IV, therapeutic, retrospective case series.
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Heyworth BE, Dolan MM, Nguyen JT, Chen NC, Kelly BT. Preoperative three-dimensional CT predicts intraoperative findings in hip arthroscopy. Clin Orthop Relat Res 2012; 470:1950-7. [PMID: 22528376 PMCID: PMC3369089 DOI: 10.1007/s11999-012-2331-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 03/21/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Currently, plain radiographs and MRI are the standard imaging modalities used for diagnosing femoroacetabular impingement (FAI) and preoperative planning for arthroscopic treatment of FAI. The value of three-dimensional (3D) CT for these purposes is unclear. QUESTIONS/PURPOSES We therefore determined the reliability of CT assessment of FAI and whether CT findings of hip disease predict arthroscopic findings. METHODS We retrospectively assessed the preoperative CT scans of 118 patients who underwent primary hip arthroscopy. Intraoperative findings, including size of the cam lesion, presence of an acetabular labral articular disruption lesion, and one of four types of labral tear were recorded and compared with the retrospectively read CT findings. RESULTS Agreement analysis between CT and intraoperative detection of FAI yielded kappa values of 0.48 for cam lesions and 0.16 for pincer lesions. Increasing values for the CT-based alpha angle correlated with increasing severity of arthroscopically assessed acetabular labral articular disruption grade. Each pattern of FAI predicted a specific labral tear type. CONCLUSIONS Our data suggest CT has moderate value in predicting mechanically based labral tear patterns, although better parameters for assessment of pincer lesions are needed. Diagnostic assessment of patients with suspected FAI may be improved with use of 3D CT.
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Affiliation(s)
- Benton E. Heyworth
- Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Mark M. Dolan
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Joseph T. Nguyen
- Department of Biostatistics, Hospital for Special Surgery, New York, NY USA
| | | | - Bryan T. Kelly
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell School of Medicine, New York, NY USA
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Griffiths EJ, Khanduja V. Hip arthroscopy: evolution, current practice and future developments. INTERNATIONAL ORTHOPAEDICS 2012; 36:1115-21. [PMID: 22371112 DOI: 10.1007/s00264-011-1459-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 11/30/2011] [Indexed: 10/28/2022]
Abstract
Arthroscopic examination and treatment is an ever-increasing part of modern orthopaedic practice in this age of minimally invasive surgery. Arthroscopic procedures have been widespread in surgery of the knee and the shoulder for many years; however, the hip until relatively recently, has been largely neglected. Even now hip arthroscopy is not widely available; this may be due to the complexity of the procedure, the requirement of specialist equipment and a reportedly long learning curve. On the other hand, it has gone through a period of rapid growth over the last decade and is being performed in large numbers routinely in some centres around the world. Hip arthroscopy now provides excellent visualisation of not only the articular surfaces of the hip joint but also of the peritrochanteric or extra-articular space around the hip. Pathology of both the femoral head and the acetabulum along with the soft tissues of the hip, namely the ligamentum teres, the acetabular labrum, the synovial folds and synovium, is readily diagnosed. Modern techniques provide therapeutic options for a myriad of conditions and allow modulation of pathological processes early. Additionally hip arthroscopy is a relatively safe procedure with few complications and contraindications. However, the key to good outcomes is in the careful selection of patients and meticulous surgical technique. The aim of this review is to bring the reader up to date with an overview of the evolution of arthroscopy of the hip, review the current practice and explore possible future developments.
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Affiliation(s)
- Emmet J Griffiths
- Department of Trauma & Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK
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Wall PD, Brown JS, Karthikeyan S, Griffin D. An introduction to hip arthroscopy. Part two: indications, outcomes and complications. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.mporth.2011.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Martin SD, Katz JN. Labral Tears and Femoroacetabular Impingement: Clinical Features and Arthroscopic Management. ACTA ACUST UNITED AC 2012. [DOI: 10.2174/1876539401205010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wall PD, Brown JS, Karthikeyan S, Wyse M, Griffin D. (vi) An introduction to hip arthroscopy part one: surgical anatomy and technique. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.mporth.2011.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Imam S, Khanduja V. Current concepts in the diagnosis and management of femoroacetabular impingement. INTERNATIONAL ORTHOPAEDICS 2011; 35:1427-35. [PMID: 21755334 DOI: 10.1007/s00264-011-1278-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 05/04/2011] [Indexed: 02/06/2023]
Abstract
Femoroacetabular impingement is becoming increasingly recognised as a cause of hip pain in the young adult. It is thought that the condition may lead to acetabular labral tears, chondro-labral separation, chondral delamination and eventually predispose to osteoarthritis of the hip. Efforts have thus been directed to diagnosing and treating the underlying pathology and subsequent sequelae. This article presents the relevant literature with regards to the aetiology of femoroacetabular impingement, its clinical features, investigations and options of management. Finally outcomes relating to both open and arthroscopic approaches to treatment are discussed.
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Affiliation(s)
- Samirul Imam
- Department of Trauma & Orthopaedics, Addenbrooke's, - Cambridge University Hospitals NHS Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK
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Abstract
The primary diagnosis of femoroacetabular impingement is based on clinical symptoms, physical exam findings, and radiographic abnormalities. The study objective was to determine the radiographic findings that correlate with and are predictive of hip pain in femoroacetabular impingement (FAI). One hundred prospective patients with unilateral FAI symptoms based on clinical and radiographic findings were included in this study. All patients filled out a WOMAC pain questionnaire. Two independent-blinded surgeons assessed antero-posterior and lateral radiographs for 33 radiographic parameters of FAI. Correlations between pain scores and radiographic findings were calculated. A matched radiographic analysis was performed comparing symptomatic versus asymptomatic hips. Radiograph findings were also compared between males and females. Weak positive correlations were identified between increasing pain scores with radiographic findings of posterior wall dysplasia, presence of a shallow socket, and a more lateral acetabular fossa relative to the Ilioischial line. A symptomatic hip had a lower neck shaft angle, greater distance from Ilioischial line to acetabular fossa and larger distance from cross-over sign to superolateral point of the acetabulum when compared to the asymptomatic hip in the same patient. Symptomatic hips in males had more joint space narrowing, femoral osteophytes, higher alpha angles and larger, more incongruent femoral heads compared to females. Females had more medial acetabular fossa relative to the Ilioischial line and smaller femoral head extrusion index. Similar to other musculoskeletal conditions, radiographic findings of FAI are poor predictors of hip pain.
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Domb BG, Shindle MK, McArthur B, Voos JE, Magennis EM, Kelly BT. Iliopsoas impingement: a newly identified cause of labral pathology in the hip. HSS J 2011; 7:145-50. [PMID: 22754415 PMCID: PMC3145856 DOI: 10.1007/s11420-011-9198-z] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 02/07/2011] [Indexed: 02/07/2023]
Abstract
Labral tears typically occur anterosuperiorly in association with femoroacetabular impingement or dysplasia. Less commonly, labral pathology may occur in an atypical direct anterior location adjacent to the iliopsoas tendon in the absence of bony abnormalities. We hypothesize that this pattern of injury is related to compression or traction on the anterior capsulo-labral complex by the iliopsoas tendon where it crosses the acetabular rim. In a retrospective review of prospectively collected data, we identified 25 patients that underwent isolated, primary, unilateral iliopsoas release and presented for at least 1 year follow-up (mean 21 months). Pre-operative demographics, clinical presentation, intra-operative findings, and outcome questionnaires were analyzed. The injury was treated with a tenotomy of the iliopsoas tendon at the level of the joint line and either labral debridement or repair. Mean post-operative outcome scores were 87.17, 92.46, and 78.8 for the modified Harris Hip Score, activities of daily living Hip Outcome Score, and sports-related score, respectively. The atypical labral injury identified in this study appears to represent a distinct pathological entity, psoas impingement, with an etiology which has not been previously described.
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Affiliation(s)
- Benjamin G. Domb
- Hinsdale Orthopedics, 1010 Executive Court, Suite 250,, Westmont, IL 60559 USA
| | - Michael K. Shindle
- Summit Medical Group, 1 Diamond Hill Road, Berkely Heights, NJ 07922 USA
| | - Benjamin McArthur
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - James E. Voos
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Erin M. Magennis
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Bryan T. Kelly
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Voos JE, Mauro CS, Kelly BT. Femoroacetabular Impingement in the Athlete: Compensatory Injury Patterns. ACTA ACUST UNITED AC 2010. [DOI: 10.1053/j.oto.2010.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fry R, Domb B. Labral base refixation in the hip: rationale and technique for an anatomic approach to labral repair. Arthroscopy 2010; 26:S81-9. [PMID: 20615651 DOI: 10.1016/j.arthro.2010.01.021] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 01/20/2010] [Accepted: 01/21/2010] [Indexed: 02/02/2023]
Abstract
Recent literature has defined the importance of anatomic repair in shoulder and knee arthroscopy. New advances in hip arthroscopy have created opportunities to apply the principle of anatomic repair to the hip. To address the obstacles in the restoration of labral anatomy, we describe an anatomic approach to labral refixation. We reviewed the literature on biomechanics of the labrum to identify the factors that are essential to the function of the labrum. Existing techniques for arthroscopic labral repair and potential challenges in restoration of labral anatomy were reviewed. A list of criteria for anatomic labral repair was created, and a technique for anatomic labral base refixation was developed. The technique incorporates the understanding of the function and biomechanical role of the labrum and builds on existing techniques to fulfill the criteria for restoration of anatomy. Our purpose was to review the anatomy, biomechanics, and existing repair techniques of the labrum, as well as to describe the rationale and surgical steps for anatomic labral base refixation in the hip.
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Affiliation(s)
- Robert Fry
- Department of Orthopedics, Loyola University Medical Center, Maywood, Illinois 60153, USA.
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Abstract
Intra-articular abnormalities of the hip, such as labral tears, loose bodies, chondral lesions, ligamentum teres tears and femoral acetabular impingement are increasingly being recognized in the pediatric age group. Evaluation for these abnormalities starts with a good history and physical exam. Radiographic imaging with plain films and magnetic resonance imaging help confirm the clinical impression. Arthroscopy of the hip can be utilized to diagnose and treat these abnormalities. Arthroscopy of the hip is a challenging procedure with a learning curve that requires a thorough knowledge of the anatomy of the hip. The hip is a deeply recessed joint that has a large muscular envelope, thick joint capsule and convex and concave surfaces of the femoral head and acetabulum, respectively. The normal anatomy may be distorted due to childhood developmental disorders such as hip dysplasia, Legg-Calve-Perthes Disease and Slipped Capital Femoral Epiphysis that adds additional challenges to the arthroscopist. Isolated intra-articular abnormalities occur rarely and an underlying morphologic abnormality should be identified which also requires management. Complications can be minimized with attention to detail.
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Affiliation(s)
- Dennis R. Roy
- Shriners Hospitals for Children, 3101 SW Sam Jackson Park Road, Portland, OR 97239 USA
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