Hip arthroscopy: Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia

Posted on December 18, 2011 by admin
  • Between December 2003 and September 2009,
  • diagnosed with both symptomatic athletic pubalgia and symptomatic intra-articular hip joint pathology.
  • 37 hips (mean patient age, 25 years)
    • 8 professional athletes,
    • 15 collegiate athletes,
    • 5 elite high school athletes
    • 9 competitive club athletes.
  • Outcomes
    1. return to sports
    2. modified Harris Hip Score,
    3. Short Form 12 score
    4. visual analog scale score.

RESULTS:

  • mean of 29 months (range, 12 to 78 months) after the index surgery.
  • 31 hips underwent 35 athletic pubalgia surgeries.
  • Hip arthroscopy
    • 32 hips (30 cases of femoroacetabular impingement treatment, 1 traumatic labral tear, and 1 borderline dysplasia).
  • Of 16 hips that had athletic pubalgia surgery as the index procedure,
    • 4 (25%) returned to sports without limitations
    • 11 (69%) subsequently had hip arthroscopy at a mean of 20 months after pubalgia surgery.
  •  Of 8 hips managed initially with hip arthroscopy alone,
    • 4 (50%) returned to sports without limitations,
    • 3 (43%) had subsequent pubalgia surgery at a mean of 6 months after hip arthroscopy.
  • Thirteen hips had athletic pubalgia surgery and hip arthroscopy at one setting. Concurrent or eventual surgical treatment of both disorders led to improved postoperative outcomes scores (P < .05) and an unrestricted return to sporting activity in 89% of hips (24 of 27).

CONCLUSIONS:

  • When surgery only addressed either the athletic pubalgia or intra-articular hip pathology in this patient population, outcomes were suboptimal.
  • Surgical management of both disorders concurrently or in a staged manner led to improved postoperative outcomes scoring and an unrestricted return to sporting activity in 89% of hips.

Posted in FAI, Hip Arthroscopy, Pubalgia / Sports hernia | Leave a comment

Hip arthroscopy: Response to diagnostic injection in patients with femoroacetabular impingement, labral tears, chondral lesions, and extra-articular pathology

Posted on December 16, 2011 by admin

The purpose of this study was to compare the percent relief from injection among subjects with arthroscopic findings of femoroacetabular impingement (FAI) and labral and chondral pathologies while controlling for coexisting extra-articular pathology.

METHODS:

  • retrospectively reviewed 72 consecutive subjects (54 female and 18 male subjects), aged 29.9 ± 10.4 years (range, 16 to 55 years)
  • all underwent hip arthroscopy.
  • Three separate analyses of covariance compared the percent relief after injection between groups based on surgically confirmed:
    • type of impingement (none, cam, pincer, or combined),
    • labral pathology (none, mild, or torn)
    • chondral pathology (none, mild acetabular abnormality, acetabular delamination, or femoral lesion)
    • controlling for the presence of extra-articular pathology (iliotibial band, iliopsoas tendinopathy, or bursitis).

RESULTS:

  • no significant main effect for FAI and labral pathology, respectively, on percent relief from injection.
  • significant main effect for chondral pathology of the hip on the percent relief from injection (F?,?? = 3.03, P < .05, partial ?² = .128).
  • those with mild chondral pathology of the acetabulum and those with acetabular delamination had significantly greater percent relief compared with those without chondral pathology.
  • Extra-articular pathology did not influence the percent relief from injection in any of the analyses.

CONCLUSIONS:

  • Subjects with chondral damage had greater relief from injection than those without, regardless of severity.
  • The presence and severity of FAI and labral pathology did not influence the percent relief from injection.

Posted in FAI, Hip Arthroscopy, Injections, Labral Tears | Leave a comment

Hip arthroscopy: An anatomic arthroscopic description of the hip capsular ligaments for the hip arthroscopist

Posted on December 16, 2011 by admin

To examine and describe the normal anatomic intra-articular locations of the hip capsular ligaments in the central and peripheral compartments of the hip joint.

METHODS:

  • 8 paired fresh-frozen human cadaveric hips (mean age, 73.3 years)
  • Arthroscopy was performed on each hip, and the relations of the needles, and thus the ligaments, to the arthroscopic portals and other soft-tissue and osseous landmarks in the hip were recorded by use of a clock-face reference system.

RESULTS:

  • iliofemoral ligament (ILFL) ran from 12:45 to 3 o’clock.
    • ILFL was pierced by the anterolateral and anterior portals just within its lateral and medial borders, respectively.
  • pubofemoral ligament was located from the 3:30 to the 5:30 clock position
    • lateral border was at the psoas-U perimeter
    • medial border was at the junction of the anteroinferior acetabulum and the cotyloid fossa
  • ischiofemoral ligament (ISFL) ran from the 7:45 to the 10:30 clock position.
    • posterolateral portal pierced the ISFL just inside its superior/lateral border
    • inferior/lateral border was located at the posteroinferior acetabulum.
  • the peripheral compartment the lateral ILFL and superior/lateral ISFL borders were in proximity to the lateral synovial fold.
  • The medial ILFL and lateral pubofemoral ligament borders were closely approximated to the medial synovial fold.

 

Posted in Anatomy, Hip Arthroscopy | Leave a comment

Hip arthroscopy: Preoperative and postoperative sagittal plane hip kinematics in patients with femoroacetabular impingement during level walking.

Posted on December 16, 2011 by admin

Femoroacetabular impingement (FAI) has been linked to osteoarthritis.

HYPOTHESIS:

  • The gait of FAI patients 1 year after operative treatment (arthroscopic hip reshaping) will be significantly closer to the normal range and pattern of hip flexion motion, relative to pretreatment.

METHODS:

  • Eleven patients between 18 and 44 years of age
  • diagnosed FAI
  • Kinematics and kinetics collected using motion capture techniques before arthroscopic bone-reshaping surgery and again 1 year after surgery.
  • Pain and perceived activity level (Tegner scale)

RESULTS:

  • Overall hip sagittal plane range of motion increased on the affected side from 27.6° ± 5.0° to 30.7° ± 4.3° (P = .02).
  • The presence of abnormal reversals (second-order change in the slope in the hip flexion/extension curve) that was present in 5 patients preoperatively disappeared or was reduced in prevalence and magnitude in 4 of the patients postoperatively.
  • pain decreased and activity level increased postoperatively.

CONCLUSION:

  • surgical intervention for FAI restores more normal patterns of gait and provides objective support that the surgical procedure is useful.
  • The presence of abnormal reversals in hip flexion has been reported in end-stage hip osteoarthritis, and the presence of these reversals in FAI patients reinforces the idea of FAI being a precursor to hip osteoarthritis.

Posted in FAI, Gait Analysis, Hip Arthroscopy | Leave a comment

Hip arthroscopy: Arthroscopic treatment of labral tears in femoroacetabular impingement: a comparative study of refixation and resection with a minimum two-year follow-up

Posted on December 16, 2011 by admin
  •  reviewed 151 patients (156 hips) with femoroacetabular impingement and labral tears who had been treated arthroscopically.
    • subdivided into
      • labral repair (group 1)
      • resection of the labrum (group 2).
  • patients with advanced degenerative changes were excluded
    • Tönnis grade > 2,
    • lateral sourcil height < 2 mm
    • Outerbridge grade 4 changes in the weight-bearing area of the femoral head)
  • leaving 96 patients (101 hips) in the study.
  • mean follow-up of 2.44 years (2 to 4),
  • modified Harris hip score
    • labral repair group (group 1, 69 hips)
      • 60.2 (24 to 85) pre-operatively to 93.6 (55 to 100),
    • labral resection group (group 2, 32 hips)
      • 62.8 (29 to 96) pre-operatively to 88.8 (35 to 100).
  • labral repair provides a superior result to labral resection.

Posted in Hip Arthroscopy, Labral Tears | Leave a comment

Hip arthroscopy: Safe angle for suture anchor for labral repair

Posted on December 15, 2011 by admin

PURPOSE:

  • ?  safe angle for suture anchor insertion during acetabular labral repair

METHODS:

  • 9 acetabuli were harvested
  • Anatomic measurements were performed at the anterosuperior quadrant.
  • Electronic calipers were used to measure acetabular bone.
  • “Safe angle” measurements were obtained with suture anchor drills and a protractor.

RESULTS:

  • Labral insertion point distances and acetabular bone widths at the labral insertion did not statistically differ.
  • Mean “danger angles” ranged from 17.0 degrees to 23.8 degrees.
  • Safe angle measurements ranged from 20.1 degrees to 27.6 degrees.

CONCLUSIONS:

  • The extracapsular labral insertion, located between 2.3 and 2.6 mm from the rim of the anterosuperior acetabulum, is offered as a starting point for insertion of anchors sized less than 3.0 mm.
  •  A target angle of 10 degrees is recommended.

 

 

Posted in Hip Arthroscopy, Labral Tears | Leave a comment

Hip arthroscopy: Analgesic control after hip arthroscopy: a randomised, double-blinded trial comparing portal with intra-articular infiltration of bupivacaine.

Posted on December 8, 2011 by admin

Abstract

  • Compared the analgesic efficacy of intra-articular infiltration vs portal infiltration of bupivacaine following hip arthroscopy.
  • randomised
    • 10ml of 0.25% bupivacaine either into the joint or around the portal sites following completion of surgery.
  • 73 patients were recruited (40 intra-articular).
  • The portal infiltration group required significantly more rescue analgesia immediately after surgery (2.33mg vs.0.57mg, p=0.036).
  • Visual Analogue Scale pain scores were not significantly different at 1 and 2 hours following surgery, but at 6 hours the portal group had significantly lower VAS scores (p=0.0036).
  • We believe that the initial pain following surgery results from capsular injury and this explains the need for more rescue analgesia in the portal infiltration group. Further work is needed to establish the ideal regimen.
  • A combination of portal and intra-articular infiltration may be the most efficacious.

Posted in Analgesia, Hip Arthroscopy | Leave a comment

Hip arthroscopy: Arthroscopy of the hip in patients following joint replacement.

Posted on December 8, 2011 by admin

Abstract

  • 24 symptomatic patients following total hip replacement, resurfacing arthroplasty of the hip and partial resurfacing (study group),
  • A diagnosis was made or confirmed at arthroscopy in 23
  • relief of symptoms in 10 of these.
  • In a further 7 patients it led to revision hip replacement.
  • arthroscopic approach was more difficult in the arthroplasty group.

Posted in Uncategorized | Leave a comment

Hip arthroscopy: Arthroscopic management of femoroacetabular impingement in athletes.

Posted on December 8, 2011 by admin

Abstract

METHODS:

  • modified Harris hip score
  • preoperatively and postoperatively at 3, 12, 24, 60, and 120 months.
  • 200 patients identified
  • minimum 1-year follow up.

RESULTS:

  • 100% follow-up at an average of 19 months (range, 12-60 months).
  • A total of 116 athletes had achieved 2-year follow-up.
  • average age was 28.6 years (range, 11-60 years)
  • 148 males and 52 females.
  • Pathology
    • 159 cam,
    • 31 combined
    • 10 pincer lesions.
  • Sports level
    • 23 professional,
    • 56 intercollegiate,
    • 24 high school
    • 97 recreational athletes.
  • The male:female ratio was 2.8:1 among cam lesions and 1:1 among pincer lesions.
  • scores
    • preoperative score 72
    • postoperative score of 96
    • median improvement was 20.5 points,
  • return to sport
    • 95% of professional athletes and 85% of intercollegiate athletes were able to return to their previous level of competition.
  • Complications
    • 5 transient neurapraxias (all resolved)
    •  1 minor heterotopic ossification.
    • One athlete (0.5%) underwent conversion to total hip arthroplasty and 4 (2%) underwent repeat arthroscopy.
  • For the group with minimum 2-year follow up, the median improvement was 21 points with a postoperative score of 96.

Posted in Athletes, FAI, Hip Arthroscopy | Leave a comment

Hip arthroscopy: Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes.

Posted on December 8, 2011 by admin

Abstract

BACKGROUND:

  • review the clinical outcome after arthroscopic treatment of femoroacetabular impingement in a mixed population of high-level athletes.

METHODS:

  • High-level athletes who underwent arthroscopic treatment of femoroacetabular impingement (rim trimming, labral refixation or debridement, femoral osteochondroplasty)
  • minimum of 1-year follow-up
  •  (Modified Harris Hip Score [MHHS] and Hip Outcome Score [HOS]) at baseline and most recent follow-up.

RESULTS:

  • 47 patients with an average age of 22.8 ± 6.2 years
  • mean follow-up of 27.0 ± 5.5 months.
  • Thirty-three patients (70.2%) were available for follow-up.
  • The level of competition
    • 27.7% varsity high school,
    • 53.2% college,
    •  19.1% professional athletes.
  • mean MHHS score
    • preoperative, 68.6 ± 12.8
    • postoperative, 88.5 ± 17.7; P = .002
  • HOS score
    • preoperative, 78.8 ± 11.3
    • postoperative, 91.4 ± 14.0; P = .03
  • Return to sport
    • 1 year
      • 79% of patients were able to return to play after hip arthroscopy at a mean of 9.4 ± 4.7 months (range, 4-26 months);
      • of those patients, 92.3% were able to return to the same level of competition.
    • 2-year follow-up,
      • 73% of patients were able to return to play.

Posted in Athletes, FAI, Hip Arthroscopy, Uncategorized | Leave a comment