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Steiner Q, Watson AM, Mosiman SJ, Spiker AM. Association Between Symptoms of Anxiety and Depression, Hip Pathology, and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement. Am J Sports Med 2024; 52:1728-1734. [PMID: 38771945 DOI: 10.1177/03635465241252821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
BACKGROUND In patients with femoroacetabular impingement (FAI), mental health has been implicated in both symptom severity and postoperative outcomes. However, there are limited data regarding the independent influences of baseline mental health and hip pathology on patient-reported outcomes over time after hip arthroscopy. PURPOSE To evaluate the association between mental health and structural hip pathology with pain, hip function, and quality of life (QOL). STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patient records from a single surgeon's hip outcomes registry were retrospectively reviewed. Mental health was evaluated using the Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores. Pain was evaluated with the Single Assessment Numeric Evaluation score for Activities of Daily Living (SANE-ADL), while hip-related QOL was evaluated with the 12-item International Hip Outcome Tool (iHOT-12). Hip function was assessed with the Hip Outcome Score (HOS) Sport-Specific (SS) and ADL subscales. Separate mixed models were used to predict pain, QOL, and hip function, including hip pathology measures (size of labral tear, grade of chondral damage, preoperative alpha angle), anxiety, depression, and time as fixed effects and individuals as a random effect. RESULTS A total of 312 patients were included in this study. The preoperative alpha angle, degree of intraoperative cartilage damage, and size of the labral tear were not associated with pain or QOL (P > .05 for all). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (estimate ± SE) (anxiety: -0.59 ± 0.07, P < .0001; depression: -0.64 ± 0.08, P < .0001), iHOT-12 scores (anxiety: -0.72 ± 0.07, P < .0001; depression: -0.72 ± 0.08, P < .0001), HOS-SS scores (anxiety: -0.68 ± 0.09, P < .0001; depression: -0.57 ± 0.10, P < .0001), and HOS-ADL scores (anxiety: -0.43 ± 0.05, P < .0001; depression: -0.43 ± 0.06, P < .0001). CONCLUSION Patients had similar improvements in pain scores, QOL, and hip function after hip arthroscopy for FAI irrespective of their degree of hip pathology. Additionally, preoperative symptoms of anxiety and depression symptoms were associated with greater pain, decreased QOL, and worse hip function both pre- and postoperatively, independent of the degree of hip pathology. This suggests that efforts to directly address symptoms of anxiety and depression may improve outcomes after hip arthroscopy.
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Affiliation(s)
- Quinn Steiner
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew M Watson
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Samuel J Mosiman
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrea M Spiker
- Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Arora S, Popkin CA, Wong TT. Trends in MR Arthrogram Utilization at a Tertiary Care Academic Center. Curr Probl Diagn Radiol 2023; 52:346-352. [PMID: 36842885 DOI: 10.1067/j.cpradiol.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
The purpose is to evaluate the trends in MR arthrogram utilization at a tertiary care academic institution and to determine if there are factors that can be implicated in the utilization trends. Number of MR arthrograms of the shoulder, hip, and elbow from 2013-2020 at our institution were identified (n = 1882). Patient demographics including age, sex, sports participation, history of prior surgery, and physician referral were obtained. Descriptive statistics were performed to determine the prevalence of MR arthrograms. Linear regression analyses were performed to determine the relationship of time with prevalence of arthrograms. Chi-square tests and posthoc analyses with Bonferroni correction were used to assess if categorical variables were different between the years. There was overall decrease in the prevalence of MR arthrograms of the shoulder, hip, and elbow despite an increase in the overall MR volume during the study period. Linear regression models significantly predicated decrease in arthrogram prevalence with each passing year (P < 0.001). The percentage of orthopedic referrals for arthrograms in the hip (P = 0.002) and shoulder (P = < 0.001) decreased significantly towards the end of the study period. None of the other variables assessed were significant. At our tertiary care academic institution, arthrogram utilization has been drastically decreasing over the past 8 years. The percentage of orthopedic referrals for shoulder and hip arthrograms significantly decreased at the end of the study period.
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Affiliation(s)
- Silvia Arora
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY 10032
| | - Charles A Popkin
- Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY 10032.
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Safran MR, Money AJ, Vaughn ZD, Brcka DA, Stone McGaver R, Giveans MR, Anderson CN, Dumont GD, Larson CM. Acetabular Rim Ossification Variants Are Found in Almost 20% of Patients Presenting With Hip Pain. Arthrosc Sports Med Rehabil 2023; 5:100742. [PMID: 37645395 PMCID: PMC10461137 DOI: 10.1016/j.asmr.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/27/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To determine the prevalence of 4 different types of acetabular rim ossifications, including partial labral ossification or punctate calcification, true os acetabuli, acetabular rim stress fracture, and complete labral ossification, and to determine whether different types of periacetabular ossifications are linked to demographic or radiological factors. Methods We retrospectively reviewed the medial records of patients presenting for hip-related complaints at 2 sports medicine practices from September 2007 to December 2009. An anteroposterior radiograph of both hips and a lateral radiograph of each hip was obtained for all patients and reviewed for findings of cam and pincer femoroacetabular impingement, degenerative changes (Tönnis grade), and periacetabular calcifications for both hips. These parameters were also evaluated with respect to symptoms, sex, and age. Results Four hundred ninety-one consecutive patients (982 hips) presented to 2 orthopaedic surgeons at 2 centers for "hip"-related complaints. There were 223 males and 268 females (age 39 ± 14 years). The overall prevalence of periacetabular calcifications in hips was 17.6%, with 56.6% of calcifications in the symptomatic hip and 43.4% in the contralateral hip. Four basic patterns of calcification were identified: punctuate calcifications within the labrum (8.0% hips), large rounded calcifications (os acetabuli) (4.2% hip), large fragments with a vertical line of the superior-lateral acetabular rim, consistent with healed or non-healed stress fracture (2.0% hips), and complete ossification of the labrum (3.4% hips). Overall, male sex (P = .002), increased lateral center-edge angle (P = .046), and higher Tönnis grade (P < .001) statistically predicted the presence of periacetabular ossification. Punctate calcifications were more prevalent in males (P = .002). Higher Tönnis grade (P = .029) and increased alpha angle (P = .046) were more prevalent with os acetabuli. Younger age (P = .001), male sex (P = .048), increased alpha angle (P = .012), and increased lateral center-edge angle (P < .001) were more prevalent in acetabular rim fractures. No factors were statistically significant at predicting the presence of an ossified labrum. Conclusions Periacetabular calcifications are not uncommon. Four particular patterns of calcification are identified: punctate labral calcifications (8%), larger rounded calcifications (i.e., os acetabuli) (4.2%), acetabular rim stress fractures (2%), and complete ossification of the labrum (3.4%) for a combined prevalence of 17.6% in patients presenting to an orthopaedic surgeon with "hip"-related complaints. Nearly half were in the asymptomatic hip. Male sex had a higher prevalence of periacetabular calcifications. An increased lateral center edge angle and higher Tönnis grade also had a higher prevalence of periacetabular calcifications. Younger male patients are more likely to have acetabular rim stress fractures. Patients with an increased alpha angle have a higher prevalence of os acetabuli and rim stress fractures. Clinical Relevance This study aims to identify, quantify, and categorize periacetabular calcifications about the hip. Their clinical relationships and relevance have been discussed, but no study has distinctly categorized the various types and their prevalence. This study provides a framework for identification and categorization.
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Affiliation(s)
| | - Adam J. Money
- Rothman Orthopaedic Institute, Winter Garden, Florida
| | | | - David A. Brcka
- Piedmont Orthopedics, OrthoAtlanta, Fayetteville, Georgia
| | - Rebecca Stone McGaver
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota
| | - M. Russell Giveans
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota
| | | | | | - Christopher M. Larson
- Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, Minnesota
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Pullen WM, Curtis DM, Jamero C, Segovia N, Safran MR. Gadolinium injected concurrently with anesthetic can result in false-negative diagnostic intra-articular hip injections. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07392-1. [PMID: 37039871 DOI: 10.1007/s00167-023-07392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 03/13/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE The purpose of this paper was to evaluate the response to intra-articular hip injections with and without concurrent gadolinium administration. Our secondary outcome was to compare post-operative outcomes between patients with an initial false-negative gadolinium-containing injection and a matched control group. METHODS Patients receiving a series of two hip diagnostic intra-articular injections (DIAI), the first with gadolinium for concurrent MRA and the second without gadolinium, were retrospectively identified. Pain response to DIAI, injectate volume, local anesthetic volume, inclusion of corticosteroids, and method of injection were compared between injections. False-negative injection was defined as < 50% pain relief with concurrent gadolinium, but ≥ 50% pain relief with subsequent anesthetic injection without gadolinium. False-negative injections in patients that ultimately underwent primary hip arthroscopy were identified from this cohort and matched in a 3:1 ratio to a control cohort to compare short-term post-operative single assessment numerical evaluation (SANE) outcomes. RESULTS Forty-three patients underwent a series of anesthetic injections with and without gadolinium and met inclusion and exclusion criteria. Pain response was significantly different in injections performed with and without gadolinium (18% vs. 81%; p < 0.001). There were significant differences in total injectate volume, local anesthetic volume, corticosteroid use, and method of injection between injections, but these variables were not correlated with pain response. Fifteen patients with false-negative responses to injection underwent primary hip arthroscopy and were matched in a 3:1 ratio to a control cohort. There was no difference in short-term post-operative SANE scores between the gadolinium-sensitive and control groups (81.6 vs. 80.0, n.s.). CONCLUSION Concurrent administration of intra-articular gadolinium with DIAI may result in a false-negative response to anesthetic. Additionally, in patients with initial false-negative DIAI with gadolinium, short-term post-operative outcomes after hip arthroscopy are similar to a matched cohort. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- W Michael Pullen
- Department of Orthopaedic Surgery, Medical University of South Carolina, 96 Jonathan Lucas St 708 CSB, Charleston, SC, 29425, USA.
| | | | - Christopher Jamero
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Nicole Segovia
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
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Klontzas ME, Vassalou EE, Zibis AH, Karantanas AH. Imaging of Anatomical Variants Around the Hip. Semin Musculoskelet Radiol 2023; 27:182-197. [PMID: 37011619 DOI: 10.1055/s-0043-1762593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Considering the current widespread use of imaging as an integral part of managing hip pain, variable hip geometries and anatomical variants are increasingly being detected. These variants are commonly found in the acetabulum and proximal femur, as well as the surrounding capsule-labral tissues. The morphology of specific anatomical spaces confined by the proximal femur and the bony pelvis may also vary significantly among individuals. Familiarity with the spectrum of imaging appearances of the hip is necessary to identify variant hip morphologies with or without potential clinical relevance and reduce an unnecessary work-up and overdiagnosis. We describe anatomical variations and variable morphologies of the bony structures comprising the hip joint and the soft tissues, around the hip. The potential clinical significance of these findings is further analyzed in conjunction with the patient's profile.
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Affiliation(s)
- Michail E Klontzas
- Department of Radiology, School of Medicine, University of Crete, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology, Heraklion, Crete, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Evangelia E Vassalou
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
- Department of Radiology, General Hospital of Sitia, Xerokamares, Sitia, Lasithi, Crete, Greece
| | - Aristeidis H Zibis
- Department of Anatomy, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Apostolos H Karantanas
- Department of Radiology, School of Medicine, University of Crete, Crete, Greece
- Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology, Heraklion, Crete, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
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Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive Capsulitis of the Hip: A Case Presentation and Review. Orthop Rev (Pavia) 2022; 14:37679. [DOI: 10.52965/001c.37679] [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] [Indexed: 11/06/2022] Open
Abstract
There remains a paucity of literature addressing adhesive capsulitis of the hip (ACH), making the diagnosis and treatment a continued challenge for healthcare providers. ACH encompasses restricted hip range-of-motion and pain that progresses through analogous Stages (1-4) to adhesive capsulitis of the shoulder. We report a case presentation of a middle-aged man that illustrates the significance of certain patient factors and provide a review of current literature to aid in the diagnostic evaluation and treatment for addressing ACH. Initial conservative treatment of ACH includes the appropriate management of associated comorbidities, oral and/or injectable pharmacologics, and physical therapy. While frequently resolving with time, refractory cases of ACH may require more aggressive approaches including pressure dilation, manipulation under anesthesia, synovectomy, capsular release and, for select patients, total hip arthroplasty. Given the limited available literature addressing ACH, healthcare providers may be forced to rely on a small number of published case reports and outdated review articles to guide their diagnostic evaluation and treatment approaches. Thus, this case presentation and review provides an updated approach to better diagnose and manage patients with ACH.
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Affiliation(s)
| | | | | | - Wendy M Meek
- Massachusetts General Hospital - Mass General Brigham
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7
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Morphological Parameters of the Hip Joint and Its Relation to Gender, Joint Side and Age-A CT-Based Study. Diagnostics (Basel) 2022; 12:diagnostics12081774. [PMID: 35892485 PMCID: PMC9332566 DOI: 10.3390/diagnostics12081774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Physiological reference values for morphological parameters of the hip (MPH) are of clinical importance for the treatment of painful, degenerated or fractured hip joints, as well as to detect morphological deformities, which could result in early osteoarthritis of the hip. Currently, sufficient data for MPH are lacking. Therefore, it remains unclear if age-dependent alterations in adult hip morphology are physiological and if there are side- and gender-dependent differences. The aim of the study was to analyze MPH according to gender, side and age in a large-scaled cohort by CT scans. Methods: A total of 1576 hip joints from 788 patients (female: 257, male: 531; mean age: 58.3 years (±18.9; 18−92 years)) were analyzed by CT. For all hips, acetabular anteversion (AcetAV); lateral centrum edge angle (LCE); acetabular index (AI); femoral neck version (FNV); centrum-collum-diaphyseal angle (CCD); and anterior alpha angle (AαA) were measured. Results: The mean values in this cohort were: AcetAV 20.5° (±6.9); LCE 40.8° (±8.8); AI 0.3° (±5.3); FNV 11.0° (±9.8); CCD 129.9° (±7.4); and AαA 41.2° (±7.7). There was a detectable side-specific difference for AcetAV (p = 0.001); LCE (p < 0.001); CCD (p < 0.001); and AαA (p < 0.001). All the analyzed parameters showed a significant gender-specific difference, except for AI (p = 0.37). There was a significant correlation between age and AcetAV (r = 0.17; p < 0.001); LCE (r = 0.39; p < 0.001); AI (r = −0.25; p < 0.001); CCD (r = −0.15; p < 0.001); and AαA (r = 0.09; p < 0.001), except FNV (p = 0.79). Conclusions: There are side-, gender- and age-specific alterations in hip morphology, which have to be considered in treating hip joint pathologies.
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Alam S, Yousaf A, Alborno Y, Shujauddin M, Ghouri SI, Abdelazeem B, Yasin ALF, Shabistan S, Ahmed G. Edema of the Ligamentum Teres as a Novel MRI Marker for Non-Traumatic Painful Hip Pathology: A Retrospective Observational Study. Cureus 2022; 14:e23388. [PMID: 35475106 PMCID: PMC9022606 DOI: 10.7759/cureus.23388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background The ligamentum teres has been recognized as an important stabilizer of the hip joint and can be affected by various hip pathologies. This study aims to introduce ligamentum teres edema as an MRI marker to diagnose the underlying cause of hip pathology, mainly femoral acetabular impingement (FAI) and adult developmental dysplasia of the hip (ADDH), in non-traumatic patients. Methodology Adult patients presenting with non-traumatic hip pain of variable duration and ligamentum teres edema on MRI between 2014 and 2020 were included. A high-resolution standard MRI hip protocol was used for all patients in this series. MRI and plain radiographs were assessed. Ligamentum teres edema, alpha angle, center edge angle of Wiberg, and retroversion were assessed. Results In total, 55 patients with 110 hip joints (males: 29 (52.7%), females: 26 (47.3%)) of different ethnicities were included in this study. Out of the 55 patients with ligamentum teres edema, one had only unilateral right-sided FAI, seven had only unilateral left-sided FAI, and 46 (94 hip joints) had either bilateral FAI or ADDH. Therefore, eight (14.5%) patients with unilateral FAI had the absence of the contralateral FAI or ADDH (6.5% false-positive) despite the presence of ligamentum teres edema bilaterally, and the rest of the patients with bilateral ligamentum teres edema (102 joints: 92.7% positive predictive value) had findings of either FAI or ADDH. Conclusions Ligamentum teres edema can be considered as an early MRI marker to diagnose the underlying pathology of symptomatic painful hip disorders, especially FAI.
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Cooper JD, Seiter MN, Ruzbarsky JJ, Poulton R, Dornan GJ, Fitzcharles EK, Ho CP, Hackett TR. Shoulder Pathology on Magnetic Resonance Imaging in Asymptomatic Elite-Level Rock Climbers. Orthop J Sports Med 2022; 10:23259671211073137. [PMID: 35174249 PMCID: PMC8842184 DOI: 10.1177/23259671211073137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 01/05/2023] Open
Abstract
Background: The prevalence of findings on shoulder magnetic resonance imaging (MRI) is
high in asymptomatic athletes of overhead sports. Purpose/Hypothesis: The purpose of this study was to determine the prevalence of atypical
findings on MRI in shoulders of asymptomatic, elite-level climbers and to
evaluate the association of these findings with clinical examination
results. It was hypothesized that glenoid labrum, long head of the biceps
tendon, and articular cartilage pathology would be present in >50% of
asymptomatic athletes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 50 elite climbers (age range, 20-60 years) without any symptoms of
shoulder pain underwent bilateral shoulder examinations in addition to
dedicated bilateral shoulder 3-T† MRI. Physical examinations were
performed by orthopaedic sports medicine surgeons, while MRI scans were
interpreted by 2 blinded board-certified radiologists to determine the
prevalence of abnormalities of the articular cartilage, glenoid labrum,
biceps tendon, rotator cuff, and acromioclavicular joint. Results: MRI evidence of tendinosis of the rotator cuff, subacromial bursitis, and
long head of the biceps tendonitis was exceptionally common, at 80%, 79%,
and 73%, respectively. Labral pathology was present in 69% of shoulders,
with discrete labral tears identified in 56%. Articular cartilage changes
were also common, with humeral pathology present in 57% of shoulders and
glenoid pathology in 19% of shoulders. Climbers with labral tears identified
in this study had significantly increased forward elevation compared with
those without labral tears in both active (P = .026) and
passive (P = .022) motion. Conclusion: The overall prevalence of intra-articular shoulder pathology detected by MRI
in asymptomatic climbers was 80%, with 57% demonstrating varying degrees of
glenohumeral articular cartilage damage. This high rate of arthritis differs
significantly from prior published reports of other overhead sports
athletes.
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Affiliation(s)
- Joseph D. Cooper
- The Steadman Clinic, Vail, Colorado, USA
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Max N. Seiter
- The Steadman Clinic, Vail, Colorado, USA
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Joseph J. Ruzbarsky
- The Steadman Clinic, Vail, Colorado, USA
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Ricky Poulton
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Eric K. Fitzcharles
- The Steadman Clinic, Vail, Colorado, USA
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Charles P. Ho
- The Steadman Clinic, Vail, Colorado, USA
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Thomas R. Hackett
- The Steadman Clinic, Vail, Colorado, USA
- Steadman Philippon Research Institute, Vail, Colorado, USA
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Dynamic Assessment of Femoroacetabular Impingement Syndrome Hips. Arthroscopy 2022; 38:404-416.e3. [PMID: 34126220 DOI: 10.1016/j.arthro.2021.05.062] [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] [Received: 01/21/2021] [Revised: 05/18/2021] [Accepted: 05/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to compare lower extremity rotational kinematics and kinetics (angles, torques, and powers) and hip muscle electromyography (EMG) activity between cam-type femoroacetabular impingement syndrome (FAIS) and age- and sex-matched controls during walking, fast walking, stair ascent, stair descent, and sit-to-stand. METHODS This study included 10 males with unilateral FAIS and 10 control males with no FAIS. We measured kinematics, kinetics, and electromyographic signals during stair ascent/descent, sit-to-stand, self-selected walk, and fast walk. Peak signal differences between groups were compared with independent t-tests with statistical significance when P < .05. RESULTS FAIS hips showed significant differences compared to controls, including increased hip flexion during walking (+4.9°, P = .048) and stair ascent (+7.8°, P =.003); diminished trunk rotation during stair ascent (-3.4°; P = .015), increased knee flexion during self-selected walking (+5.1°, P = .009), stair ascent (+7.4°, P = .001), and descent (+5.3°, P = .038); and increased knee valgus during fast walking (+4.7°, P = .038). gMed and MedHam showed significantly decreased activation in FAIS during walking (gMed: -12.9%, P = .002; MedHam: -7.4%, P = .028) and stair ascent (gMed: -16.7%, P = .036; MedHam: -13.0%, P = .041); decreased gMed activation during sit-to-stand (-8.8%, P = .004) and decreased MedHam activation during stair descent (-8.0%, P = .039). CONCLUSIONS Three-dimensional motion analysis and EMG evaluation of functional kinematics and kinetics in subjects with symptomatic unilateral cam-type FAIS across a spectrum of provocative tasks demonstrated significant differences compared to controls in hip flexion, trunk rotation, knee flexion, and valgus. FAIS hips had significantly decreased gMed and MedHam activity. These findings may explain altered torso-pelvic, hip, and knee mechanics in FAIS patients and suggest that evaluation of FAIS should include the patient's hip, knee, and torso-pelvic relationships and muscle function. CLINICAL RELEVANCE The clinical and functional manifestation of FAIS hip pathomechanics is not entirely understood, and previous literature to date has not clearly described the alterations in gait and functional movements seen in patients with cam-type FAIS. The current study used 3D motion analysis and EMG evaluation of functional kinematics and kinetics to identify a number of differences between FAIS and control hips, which help us better understand the lower extremity kinematics and kinetics and muscle activation in FAIS.
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Heerey J, Kemp J, Agricola R, Srinivasan R, Smith A, Pizzari T, King M, Lawrenson P, Scholes M, Link T, Souza R, Majumdar S, Crossley K. Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case-control study of 237 young adult football players with and without hip and groin pain. BMJ Open Sport Exerc Med 2022; 7:e001199. [PMID: 34987861 PMCID: PMC8679114 DOI: 10.1136/bmjsem-2021-001199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Football players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players. Methods For this case–control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score. Results Greater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189–0.937) Conclusion Cam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.
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Affiliation(s)
- Joshua Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ramya Srinivasan
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Matthew King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter Lawrenson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Thomas Link
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Richard Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Kay Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Kwon HM, Cho BW, Kim S, Yang IH, Park KK, Son NH, Lee WS. Acetabular labral tear is associated with high pelvic incidence with or without femoroacetabular impingement morphology. Knee Surg Sports Traumatol Arthrosc 2022; 30:3526-3534. [PMID: 35098340 PMCID: PMC9464139 DOI: 10.1007/s00167-022-06881-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to investigate the association between pelvic sagittal parameters and acetabular labral tears. METHODS Three-hundred and sixty-five patients (449 hips) who underwent magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) for hip pain were enrolled in this study. Pelvic sagittal parameters, including the pelvic incidence, pelvic tilt, and sacral slope, were measured with a standing lumbosacral lateral radiograph. All subjects were divided into two groups according to the presence or absence of radiologic acetabular labral tears and compared. Furthermore, the two groups were divided into subgroups according to whether femoroacetabular impingement (FAI) morphology was present or not and compared. RESULTS Pelvic incidence was greater in the labral tear group than in the non-labral tear group (52.3° ± 8.2° versus 47.1° ± 6.8°, p < 0.001). After accounting for potentially confounding variables, we found that higher age (odds ratio 1.04, 95% confidence interval [CI] 1.02 to 1.06, p = 0.001), FAI (odds ratio 15.11, 95% CI 7.43 to 30.75, p < 0.001), and high pelvic incidence (odds ratio 1.13, 95% CI 1.09 to 1.17, p < 0.001) were independently associated with acetabular labral tear. When only the patients without FAI (308 hips) were divided into groups with and without acetabular labral tear, we found that higher age (odds ratio 1.03, 95% CI 1.01 to 1.06, p = 0.008) and high pelvic incidence (odds ratio 1.15, 95% CI 1.11 to 1.19, p < 0.001) were independently associated with acetabular labral tear. CONCLUSION Acetabular labral tear is associated with high pelvic incidence with or without FAI morphology. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hyuck Min Kwon
- Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Woo Cho
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungjun Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ick-Hwan Yang
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Nak-Hoon Son
- Clinical Research (Biostatistician), Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273 Korea
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13
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Singh Y, Pettit M, El-Hakeem O, Elwood R, Norrish A, Audenaert E, Khanduja V. Understanding hip pathology in ballet dancers. Knee Surg Sports Traumatol Arthrosc 2022; 30:3546-3562. [PMID: 35305112 PMCID: PMC9464154 DOI: 10.1007/s00167-022-06928-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The literature on hip injuries in ballet dancers was systematically evaluated to answer (1) whether the prevalence of morphological abnormalities and pathology of hip injuries in dancers differs from the general population (2) if there are any specific risk factors which contribute to a higher rate of hip injury and (3) what are the outcomes of primary and secondary intervention strategies. METHODS A systematic literature search of Medline, EMBASE and the Cochrane Library was undertaken for all literature relating to hip injuries in ballet dancers using the PRISMA guidelines. Reference lists were also searched for relevant literature. Clinical outcome studies, prospective/retrospective case series published between 1989 and October 2021 were included. Review articles (non-original data), case reports, studies on animals as well as book chapters were excluded. RESULTS The search yielded 445 studies, of which 35 were included for final analyses after screening. This included 1655 participants, of which 1131 were females. The analyses revealed that damage at the chondrolabral junction and degenerative disease of the hip may develop at a higher rate in ballet dancers than in the general population (odds ratio > 1 in 15/18 cohorts). The intra-articular lesions were more frequently found in postero-superior region of the hip suggesting an alternative impingement mechanism. Furthermore, numerous risk factors specific for hip injury in ballet were highlighted amidst a wide body of literature which consistently reports risk factors for a more generic 'dancer vulnerability'. CONCLUSION Ballet dancers may suffer from both higher rates of chondrolabral damage and degenerative disease in their hips. In contrast to other sports, the intra-articular lesions are more frequently found in postero-superior region of the hip. Future research clarifying the prevalence of osseous abnormalities and prevention strategies in dancers may be pivotal in delaying the development of hip disease in this cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yash Singh
- Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Matthew Pettit
- Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Osama El-Hakeem
- Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Rachel Elwood
- Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Alan Norrish
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Emmanuel Audenaert
- Ghent University Hospital, C. Heymanslaan 10, Ingang 46-Verdieping 4, 9000, Ghent, Belgium
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
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14
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Kemp JL, Østerås N, Mathiessen A, Nordsletten L, Agricola R, Waarsing JH, Heerey JJ, Risberg MA. Relationship between cam morphology, hip symptoms, and hip osteoarthritis: the Musculoskeletal pain in Ullersaker STudy (MUST) cohort. Hip Int 2021; 31:789-796. [PMID: 32701366 DOI: 10.1177/1120700020943853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The primary aim of this study was to determine the prevalence of cam morphology in a cohort of people aged 40-55 years. Secondary aims were to: (1) determine differences in participant characteristics, physical impairments, radiographic and ultrasound appearances of people with and without cam morphology; and (2) explore associations between cam morphology and radiographic measures of hip osteoarthritis (OA). METHODS 107 people (68% women; 49 ± 4 years) from the Musculoskeletal pain in Ullensaker (MUST) Study underwent the clinical and imaging examinations. Examinations included questionnaires, hip range, functional task performance, pelvic radiographs and ultrasound. Alpha angle and radiographic hip OA (Kellgren Lawrence (KL) and minimal joint space (MJS)) were determined. RESULTS The prevalence of cam morphology was 42% and was bilateral in 47%. People with cam morphology were 6 times more likely to have a KL score ⩾2 (adjusted odds ratio [95% confidence intervals, p-value]) 6.386 [1.582-37.646, p = 0.012]) and 4 times more likely to have MJS <2.0 mm (adjusted odds ratio 4.032 [1.031-12.639, p = 0.045]). The prevalence of radiographic OA features ranged from 4-13% in people with cam morphology, and 0-3% in those without. Those with cam morphology also demonstrated reduced hip flexion and rotation range (p = 0.018-0.036) compared with those without. There was no association between ultrasonic features and patient reported outcomes, and cam morphology. CONCLUSIONS In a cohort aged 40-55 years, the prevalence of cam morphology was high (42%), with a significant relationship between cam morphology and radiographic measures of hip OA. Further longitudinal studies should explore the relationship between cam morphology and hip OA in younger people.
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15
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Acetabular labral tears in the adolescent athlete: results of a graduated management protocol from therapy to arthroscopy. J Pediatr Orthop B 2021; 30:549-555. [PMID: 32826727 DOI: 10.1097/bpb.0000000000000793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study sought to determine outcomes of a graduated management protocol from therapy to arthroscopy for adolescents presenting with hip pain and an associated acetabular tear. Thirty-seven hips with an MRI confirmed labral tear were prospectively enrolled in a graduated management protocol created for adolescents. The protocol began with activity modification and focused physical therapy. Patients with persistent symptoms were offered an intraarticular corticosteroid injection. Those with continued symptoms were treated with arthroscopic surgery. The modified Harris hip score (mHHS) and nonarthritic hip score (NAHS) were recorded at the initial visit. Patients were contacted by telephone at 1, 2, and 5 years from enrollment for repeat assessment with mHHS and NAHS. At presentation, the mean mHHS and NAHS for the entire cohort was 66.4 ± 11.4 and 70.2 ± 12.6, and these values improved significantly to 89.3 ± 10.6 and 87.0 ± 11.4 at a mean follow-up of 35.7 ± 18.3 months (range 11.7-64.4 months). Forty-two percent of hips were managed with physical therapy and activity modifications alone, 28% of hips progressed to a steroid injection but did not require surgery, and 31% required arthroscopic intervention. Seventy-three percent of hips treated with activity modification alone, 80% treated with an injection, and 82% of hips treated with arthroscopic repair met the minimal clinically significant difference (MCID) (P = 0.859). At an average of 36 months follow-up, the majority (78%) of adolescent patients with an acetabular labral tear will achieve the MCID utilizing a graduated management protocol.
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16
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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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Sajid IM, Parkunan A, Frost K. Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care. BMJ Open Qual 2021; 10:e001287. [PMID: 34215659 PMCID: PMC8256731 DOI: 10.1136/bmjoq-2020-001287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/07/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The largest proportion of general practitioner (GP) magnetic resonance imaging (MRI) is musculoskeletal (MSK), with consistent annual growth. With limited supporting evidence and potential harms from early imaging overuse, we evaluated practice to improve pathways and patient safety. METHODS Cohort evaluation of routinely collected diagnostic and general practice data across a UK metropolitan primary care population. We reviewed patient characteristics, results and healthcare utilisation. RESULTS Of 306 MSK-MRIs requested by 107 clinicians across 29 practices, only 4.9% (95% CI ±2.4%) appeared clearly indicated and only 16.0% (95% CI ±4.1%) received appropriate prior therapy. 37.0% (95% CI ±5.5%) documented patient imaging request. Most had chronic symptoms and half had psychosocial flags. Mental health was addressed in only 11.8% (95% CI ±6.3%) of chronic sufferers with psychiatric illness, suggesting a solely pathoanatomical approach to MSK care. Only 7.8% (95% CI ±3.0%) of all patients were appropriately managed without additional referral. 1.3% (95% CI ±1.3%) of scans revealed diagnoses leading to change in treatment (therapeutic yield). Most imaged patients received pathoanatomical explanations to their symptoms, often based on expected age or activity-related changes. Only 16.7% (95% CI ±4.2%) of results appeared correctly interpreted by GPs, with spurious overperception of surgical targets in 65.4% (95% CI ±5.3%) who suffered 'low-value' (ineffective, harmful or wasteful) post-MRI referral cascades due to misdiagnosis and overdiagnosis. Typically, 20%-30% of GP specialist referrals convert to a procedure, whereas MRI-triggered referrals showed near-zero conversion rate. Imaged patients experienced considerable delay to appropriate care. Cascade costs exceeded direct-MRI costs and GP-MSK-MRI potentially more than doubles expenditure compared with physiotherapist-led assessment services, for little-to-no added therapeutic yield, unjustifiable by cost-consequence or cost-utility analysis. CONCLUSION Unfettered GP-MSK-MRI use has reached unaccceptable indication creep and disutility. Considerable avoidable harm occurs through ubiquitous misinterpretation and salient low-value referral cascades for two-thirds of imaged patients, for almost no change in treatment. Any marginally earlier procedural intervention for a tiny fraction of patients is eclipsed by negative consequences for the vast majority. Only 1-2 patients need to be scanned for one to suffer mismanagement. Direct-access imaging is neither clinically, nor cost-effective and deimplementation could be considered in this setting. GP-MSK-MRI fuels unnecessary healthcare utilisation, generating nocebic patient beliefs and expectations, whilst appropriate care is delayed and a high burden of psychosocial barriers to recovery appear neglected.
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Affiliation(s)
- Imran Mohammed Sajid
- NHS West London Clinical Commissioning Group, London, UK
- University of Global Health Equity, Kigali, Rwanda
| | - Anand Parkunan
- Healthshare Community NHS Musculoskeletal Services, London, UK
| | - Kathleen Frost
- NHS Central London Clinical Commissioning Group, London, UK
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18
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Horga LM, Henckel J, Fotiadou A, Di Laura A, Hirschmann A, Hart A. 3.0 T MRI findings of 104 hips of asymptomatic adults: from non-runners to ultra-distance runners. BMJ Open Sport Exerc Med 2021; 7:e000997. [PMID: 34104474 PMCID: PMC8144041 DOI: 10.1136/bmjsem-2020-000997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives To determine and compare the health status of hip joints of individuals undertaking various lengths of long-distance running and of those who are not running. Methods Fifty-two asymptomatic volunteers underwent bilateral hip 3.0 Tesla MRI: (1) 8 inactive non-runners; (2) 28 moderately active runners (average half a marathon (21 km)/week) and (3) 16 highly active runners (≥ marathon (42 km)/week). Two musculoskeletal radiologists reported the hip MRI findings using validated scoring systems. Study participants completed a Hip disability and Osteoarthritis Outcome Score (HOOS) questionnaire to indicate their perceived hip function. Results The MRI findings show that there were no significant differences among inactive non-runners, moderately active runners and highly active runners in the amount of labral abnormalities (p=0.327), articular cartilage lesions (p=0.270), tendon abnormalities (p=0.141), ligament abnormalities (p=0.519). Bone marrow oedema was significantly more common in moderately active runners than in non-runners and highly active runners (p=0.025), while small subchondral cysts were more common in runners than in non-runners (p=0.017), but these were minor/of small size, asymptomatic and did not indicate specific exercise-related strain. Articular cartilage lesions and bone marrow oedema were not found in highly active runners. HOOS scores indicate no hip symptoms or functional problems among the three groups. Conclusion The imaging findings were not significantly different among inactive non-runners, moderately active runners and highly active runners, in most hip structures, suggesting that long-distance running may not add further damage to the hip joints.
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Affiliation(s)
- Laura Maria Horga
- Department of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, London, UK
| | - Johann Henckel
- Royal National Orthopaedic Hospital, Stanmore, London, UK
| | | | - Anna Di Laura
- Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Anna Hirschmann
- Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Alister Hart
- Department of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, London, UK.,Royal National Orthopaedic Hospital, Stanmore, London, UK
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19
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Knapik DM, Farivar D, Kunze KN, Gilat R, Nho SJ, Chahla J. Indications and Outcomes After Ligamentum Teres Reconstruction: A Systematic Review. Arthrosc Sports Med Rehabil 2021; 3:e939-e949. [PMID: 34195664 PMCID: PMC8220633 DOI: 10.1016/j.asmr.2021.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/27/2021] [Indexed: 10/30/2022] Open
Abstract
Purpose To systematically review the literature to better understand the current indications for ligamentum teres reconstruction (LTR), current graft and acetabular fixation options used, patient-reported outcomes after LTR, and incidence of complications and reoperations after LTR. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. All literature related to LTR published prior to July 2020 was identified. The inclusion criteria consisted of investigations reporting on human patients with pathology of the ligamentum teres who underwent LTR, including mentions of the indications, graft type, acetabular fixation method, postoperative patient-reported outcome scores, and incidence of complications and reoperations. Results Seven studies comprising 26 patients (28 hips) were included. The most commonly reported indication for LTR was persistent pain and instability after failed prior hip arthroscopy (68%, 19 of 28 hips). The mean postoperative modified Harris Hip Score, Non-arthritic Hip Score, and visual analog scale score all showed improvement when compared with preoperative values. A total of 2 complications occurred. Complication rates ranged from 0% to 100% in included case reports and 0% to 11% in included case series. A total of 9 reoperations were performed. Reoperation rates ranged from 0% to 100% for case reports and 18% to 100% for case series. Reoperation rates ranged from 33% to 100% in studies with patients receiving acetabular fixation using anchors versus 0% to 22% in studies performing LTR with buttons. Reoperation rates in athletic patients and patients with Ehlers-Danlos syndrome ranged from 0% to 100% and 0% to 50%, respectively. Conclusions The main indication for LTR was persistent hip or groin pain and instability after a prior hip arthroscopy. The short-term postoperative modified Harris Hip Score, Non-arthritic Hip Score, and visual analog scale score after LTR showed favorable outcomes. However, reoperations after LTR were not uncommon. Level of Evidence Level V, systematic review of Level IV and V studies.
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Affiliation(s)
- Derrick M Knapik
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A
| | - Daniel Farivar
- Rush University School of Medicine, Chicago, Illinois, U.S.A
| | - Kyle N Kunze
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A.,Rush University School of Medicine, Chicago, Illinois, U.S.A
| | - Ron Gilat
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A.,Rush University School of Medicine, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University, Chicago, Illinois, U.S.A.,Rush University School of Medicine, Chicago, Illinois, U.S.A
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20
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Hodgson F, Ibáñez A. DOLOR DE CADERA EN ADOLESCENTES: ESTUDIO Y TRATAMIENTO. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Gomes D, Ribeiro DC, Canella RP, Ferreira T, da Costa GV, Okubo R, de Castro MP. Association between severity of hip chondrolabral injuries, dynamic hip muscle strength and quality of life: A cross-sectional study in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy. Clin Biomech (Bristol, Avon) 2021; 84:105348. [PMID: 33857760 DOI: 10.1016/j.clinbiomech.2021.105348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND We assessed the association between: the severity of hip chondral or labral pathology with dynamic hip muscle strength or quality of life in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy. We also assessed the association between dynamic hip muscle strength with quality of life. METHODS Eighty-three participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy were included. We measured dynamic hip abduction and adduction muscle strength with an isokinetic dynamometer (Nm/kg), and quality of life with the iHoT-33 questionnaire. The severity of hip chondrolabral pathologies was scored using the modified Beck classification. Linear regression analyses were conducted to assess the association between severity of hip chondral or labral pathology with dynamic hip muscle strength and quality of life. FINDINGS The regression analyses showed no association between the (i) severity of hip chondral (adjusted r2: 0.14) or labral (adjusted r2: 0.08) pathology and quality of life (P > 0.05), (ii) between the severity of hip chondral or labral pathology and dynamic hip abduction and adduction muscle strength (P > 0.05). Significant correlation was observed for quality of life and hip abduction (adjusted r2:0.29; P < 0.001) or adduction (adjusted r2: 0.32; P < 0.001) muscle strength. INTERPRETATION The severity of hip chondral or labral pathologies were not associated with quality of life or dynamic hip muscle strength in participants with femoroacetabular impingement syndrome. Greater dynamic hip abduction and adduction muscle strength were associated with better quality of life in participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy.
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Affiliation(s)
- Diogo Gomes
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Brazil; Centre of Health and Sports Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR) - School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Richard P Canella
- Core Centre of Orthopedics and Rehabilitation, Florianópolis, Brazil
| | - Taylor Ferreira
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Brazil
| | - Guilherme V da Costa
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Brazil; Centre of Health and Sports Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Rodrigo Okubo
- Centre of Health and Sports Sciences, University of the State of Santa Catarina, Florianópolis, Brazil
| | - Marcelo P de Castro
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Brazil.
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22
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Morales-Avalos R, Tapia-Náñez A, Simental-Mendía M, Elizondo-Riojas G, Morcos-Sandino M, Tey-Pons M, Peña-Martínez VM, Barrera FJ, Guzman-Lopez S, Elizondo-Omaña RE, Vílchez-Cavazos F. Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes. Orthop J Sports Med 2021; 9:2325967120977892. [PMID: 33614808 PMCID: PMC7874354 DOI: 10.1177/2325967120977892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences (P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.
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Affiliation(s)
- Rodolfo Morales-Avalos
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México.,Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adriana Tapia-Náñez
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México.,Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario Simental-Mendía
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Guillermo Elizondo-Riojas
- Department of Radiology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | | | - Marc Tey-Pons
- Department of Orthopedic Surgery, Hospitals del Mar i l'Esperança, Barcelona, Spain
| | - Víctor M Peña-Martínez
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Francisco J Barrera
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Santos Guzman-Lopez
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Rodrigo E Elizondo-Omaña
- Department of Human Anatomy, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
| | - Félix Vílchez-Cavazos
- Department of Orthopedic Surgery and Traumatology, School of Medicine, University Hospital "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México
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Makovitch SA, Mills CA, Eng C. Update on Evidence-Based Diagnosis and Treatment of Acetabular Labral Tears. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ankem HK, Diulus SC, Maldonado DR, Ortiz-Declet V, Rosinsky PJ, Meghpara MB, Shapira J, Lall AC, Domb BG. Arthroscopic-Assisted Intraosseous Bioplasty of the Acetabulum. Arthrosc Tech 2020; 9:e1531-e1539. [PMID: 33134056 PMCID: PMC7587331 DOI: 10.1016/j.eats.2020.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/07/2020] [Indexed: 02/03/2023] Open
Abstract
Intraosseous bioplasty (IOBP), has been previously described for arthroscopic-assisted treatment of subchondral bone cysts in the proximal tibia associated with early stages of knee osteoarthritis (OA). This technique entails combining bone marrow aspirate concentrate or concentrated platelet-rich plasma with demineralized bone matrix as a bone substitute before injecting into a subchondral bone defect under fluoroscopic guidance. The principles of IOBP as a procedure that combines core decompression with biologic bone substitute augmentation can be extended to treat subchondral bone marrow lesions such as acetabular and femoral cysts in degenerative hip OA. Intraosseous bioplasty of the hip, in particular the acetabulum, when done using this technique, is a useful alternative that can be beneficial in treating young patients with early hip arthritis to achieve successful outcomes while delaying more invasive procedures. The Technical Note described here presents a step-by-step approach, including tips and pearls for arthroscopic-assisted IOBP with decompression of the subchondral cyst in the acetabulum followed by bone substitute injection under fluoroscopic guidance. We believe this method is a safe and reproducible way to treat subchondral defects in young patients with signs of early osteoarthritis of the hip joint.
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Affiliation(s)
- Hari K. Ankem
- American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A
| | - Samantha C. Diulus
- American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A
| | - David R. Maldonado
- American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A
| | | | - Philip J. Rosinsky
- American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A
| | - Mitchell B. Meghpara
- American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.,American Hip Institute, Des Plaines, Illinois, U.S.A
| | - Jacob Shapira
- American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A
| | - Ajay C. Lall
- American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.,American Hip Institute, Des Plaines, Illinois, U.S.A
| | - Benjamin G. Domb
- American Hip Institute Research Foundation, Des Plaines, Illinois, U.S.A.,AMITA Health St. Alexius Medical Center, Hoffman Estates, Illinois, U.S.A.,American Hip Institute, Des Plaines, Illinois, U.S.A.,Address correspondence to Benjamin G. Domb, M.D., 999 E Touhy Ave, Suite 450, American Hip Institute, Des Plaines, IL 60018 U.S.A.
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25
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Hip Joint Pathology Among Men Referred to Urology for Chronic Orchialgia: A Source for Misdiagnosis and Opportunity for Quality Improvement. Urology 2020; 146:96-100. [PMID: 32828869 DOI: 10.1016/j.urology.2020.06.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/01/2020] [Accepted: 06/28/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the findings of magnetic resonance imaging (MRI) of the ipsilateral hip(s) as part of the workup of men with chronic orchialgia (CO). METHODS Following IRB approval, a retrospective chart review was performed from a single surgeon database of all men with a diagnosis of CO from June 2018 to October 2019 who underwent subsequent hip MRI evaluation. RESULTS Ten men were identified. Median age was 51 years and median duration of pain was 10 months. MRI was obtained after testis pathology was ruled out. Pain was noted in the groin (100%) and hip (50%). Hip MRI identified overt labral tears in 8 men (10/12 hips evaluated, 83%) and labral fraying in the remaining 2 (16.7%). Standard plain film radiography was performed in 6 men prior to MRI, all of which were negative. Following MRI, 5 men underwent hip injection with steroid and local analgesic with lasting resolution (2 men) or significant improvement in pain (2 men; 80%, follow-up 3-15 months). Two men had complete resolution of pain with 8 weeks of physical therapy. CONCLUSION Hip MRI has a high rate of diagnosis of labral tear in appropriately selected men referred to the urologist for CO. Identification of orthopedic pathology may avoid unnecessary antibiotics, opiates, or urological surgery. Referrals to orthopedics and/or physical therapy for intervention may lead to resolution of pain.
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26
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Langner JL, Black MS, MacKay JW, Hall KE, Safran MR, Kogan F, Gold GE. The prevalence of femoroacetabular impingement anatomy in Division 1 aquatic athletes who tread water. J Hip Preserv Surg 2020; 7:233-241. [PMID: 33163207 PMCID: PMC7605769 DOI: 10.1093/jhps/hnaa009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022] Open
Abstract
Femoroacetabular impingement (FAI) is a disorder that causes hip pain and disability in young patients, particularly athletes. Increased stress on the hip during development has been associated with increased risk of cam morphology. The specific forces involved are unclear, but may be due to continued rotational motion, like the eggbeater kick. The goal of this prospective cohort study was to use magnetic resonance imaging (MRI) to identify the prevalence of FAI anatomy in athletes who tread water and compare it to the literature on other sports. With university IRB approval, 20 Division 1 water polo players and synchronized swimmers (15 female, 5 male), ages 18-23 years (mean age 20.7 ± 1.4), completed the 33-item International Hip Outcome Tool and underwent non-contrast MRI scans of both hips using a 3 Tesla scanner. Recruitment was based on sport, with both symptomatic and asymptomatic individuals included. Cam and pincer morphology were identified. The Wilcoxon Signed-Rank/Rank Sum tests were used to assess outcomes. Seventy per cent (14/20) of subjects reported pain in their hips yet only 15% (3/20) sought clinical evaluation. Cam morphology was present in 67.5% (27/40) of hips, while 22.5% (9/40) demonstrated pincer morphology. The prevalence of cam morphology in water polo players and synchronized swimmers is greater than that reported for the general population and at a similar level as some other sports. From a clinical perspective, acknowledgment of the high prevalence of cam morphology in water polo players and synchronized swimmers should be considered when these athletes present with hip pain.
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Affiliation(s)
| | - Marianne S Black
- Department of Radiology
- Department of Mechanical Engineering, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - James W MacKay
- Department of Radiology
- Department of Radiology, Cambridge University, The Old Schools, Trinity Ln, Cambridge CB2 1TN, UK
| | | | | | | | - Garry E Gold
- Department of Radiology
- Department of Orthopaedic Surgery
- Department of Bioengineering, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
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Rajappa R, Nazal MR, Stelzer JW, Hsu HP, Conaway WK, Rokkappanavar S, Niu W, Upadhyaya S, Alpaugh K, Spector M, Martin SD. Translational relevance of the goat as a preclinical model of the human labrum and chondrolabral junction-histological study. J Orthop Res 2020; 38:1070-1080. [PMID: 31788831 DOI: 10.1002/jor.24546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/24/2019] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to evaluate the histologic features of the caprine labrum, with emphasis on the chondrolabral junction, with the goal of informing the feasibility of the goat as an animal model. The left hip joint of six adolescent Spanish goats (Capra pyrenaica) was harvested and subjected to anatomical and histological assessments. Human acetabular and femoral head samples, collected during total hip arthroplasty, served as comparison samples. The caprine labrum was found to consist of mostly type I collagen with uniform crimp, with an average crimp length of 20.8 µm. Upon histological assessment, acetabular articular chondrocytes were found to express substance-P, especially near or in the chondrolabral junction. And the majority of nonvascular cells expressed α-smooth muscle actin (SMA), with no notable elastin and laminin expression. Human labrum demonstrated similar staining patterns. Overall, the goat hip was found to be homologous to the human hip, demonstrating potential as a useful animal model for future studies. This is the first report of a crimped collagen structure in the labrum. Crimped type I collagen at the chondrolabral junction imparts an extension-recovery property which allows for toleration of stress without permanent deformation, underlying the importance of its preservation during surgery. The high expression of substance-P reflects the degree to which the labrum is innervated. Finally, the expression of α-SMA with contractile characteristics could indicate the potential for chondrocyte (i.e., myochondrocytes) modeling of the extracellular matrix. Statement of Clinical Significance: Establishment of a large animal model and deeper knowledge of the histological composition of the hip joint will enhance our study of the acetabular labrum, including repair techniques. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1070-1080, 2020.
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Affiliation(s)
- Ravikumar Rajappa
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Mark R Nazal
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - John W Stelzer
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - Hu Ping Hsu
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - William K Conaway
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
| | - Swetha Rokkappanavar
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Wanting Niu
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Shivam Upadhyaya
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Kyle Alpaugh
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115
| | - Myron Spector
- Tissue Engineering Laboratories, VA Boston Healthcare System, 150S Huntington Avenue, Boston, Massachusetts, 02130.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, 02115.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts, 02139
| | - Scott D Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Partners Heath System, Boston, Massachusetts, 02114
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Abstract
Intriguing anatomists and surgeons for centuries, the exact function and biomechanical significance of the ligamentum teres (LT) remains incompletely understood. The LT, also described as the ligamentum femoris capitis, is an intra-articular extrasynovial ligament extending from the cotyloid fossa of the acetabulum to the fovea on the femoral head. Some studies have described it as a vestigial structure in the adult hip. More recent biomechanical studies, however, along with histological and anatomical studies, have suggested the LT to have an important function in proprioception, nociception, and as a secondary stabilizer of the hip joint. The advent and increased utilization of hip arthroscopy to treat hip pathology over the past two decades has ignited a renewed interest in the role of the LT, as well as techniques and indications for management of pathology. In the constellation of intra-articular pain generators of the hip, LT injuries have historically been difficult to diagnose through physical examination or advanced imaging. Numerous classification systems have been proposed based on arthroscopic appearance, and for most cases, conservative management is adequate. In patients undergoing hip arthroscopy, LT débridement usually suffices, although in cases of persistent pain and severe instability, reconstruction of the ligament may be indicated. Multiple methods for reconstruction have been described, with the greatest variation in the method of acetabular fixation of the graft. Future research should focus on clarifying the role of the LT, appropriate surgical indications for reconstruction, and optimization of graft fixation within the acetabulum.
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29
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Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology. Skeletal Radiol 2020; 49:555-561. [PMID: 31642975 DOI: 10.1007/s00256-019-03323-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the value of anesthetic injection during hip MR arthrography (anesthetic MRA) to differentiate between intra- and extra-articular pathology in patients with hip pain. MATERIALS AND METHODS This retrospective study was IRB-approved and HIPAA-compliant. We included 75 consecutive adult patients (46 women, mean age 38 ± 13 years) who were referred for MRA. All patients underwent a focused hip examination including active flexion, passive flexion, and passive flexion with internal and external rotation, immediately prior to injection. Anesthetic MRA was performed following fluoroscopically guided intra-articular injection of contrast mixed with anesthetic. Following the injection, the hip examination was repeated, and the pain response was recorded. Clinical records, including response to corticosteroid injections, physical therapy notes, and operative reports were reviewed for verification of intra- and extra-articular pathology as the source of hip pain (gold standard). The positive (PPV) and negative predictive values (NPP) of anesthetic MRA to differentiate between intra- and extra-articular pathology were calculated. RESULTS On MRI, 41 patients had only intra-articular and 5 patients only extra-articular pathology, while 29 patients had both, intra- and extra-articular pathology. Forty-three patients had pain relief and 32 patients had no pain relief after anesthetic injection. PPV of anesthetic MRA to detect intra-articular pathology was 91% and NPV was 67%. CONCLUSION Anesthetic MRA can be used as an adjunct to define the origin of hip pain. A positive response suggests intra-articular pathology which can be helpful to localize the source of pain in equivocal cases where both intra- and extra-articular pathology are evident on MRI.
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31
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Blankenstein T, Grainger A, Dube B, Evans R, Robinson P. MRI hip findings in asymptomatic professional rugby players, ballet dancers, and age-matched controls. Clin Radiol 2019; 75:116-122. [PMID: 31582172 DOI: 10.1016/j.crad.2019.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
AIM To investigate hip magnetic resonance imaging (MRI) findings in asymptomatic professional male rugby players and male ballet dancers compared to age-matched controls. MATERIALS AND METHODS After ethics committee approval and consent from participants, 11 professional rugby players, 10 professional ballet dancers, and 10 controls completed activity and symptom questionnaires and underwent 3 T MRI of their self-declared dominant hip. Each scan was independently scored by two musculoskeletal radiologists for multiple features, including: joint morphology, acetabular labrum appearance, cartilage loss, and capsular thickness. Clinical and MRI features were assessed for variance by group using one-way analysis of variance (ANOVA) tests and Tukey post-hoc pairwise comparison of means. RESULTS Labral tear prevalence was 87% with no significant difference between groups (p>0.05). Rates of paralabral cysts were significantly higher in ballet dancers (50%), compared to rugby players (0%) and controls (10%; p=0.01). Acetabular cartilage loss was present in 54% with no significant differences between groups. Superior capsular thickness was significantly greater in ballet dancers (5.3 mm) compared to rugby players (3.8 mm) and controls (3.8 mm; p=0.03). CONCLUSION Despite the difference in type of activity between groups, there were equally high rates of labral tears and acetabular cartilage loss, questioning the role that sport plays in the development of these findings and their relationship to symptoms. The focally increased superior capsular thickness in ballet dancers may be an adaptive response to extreme ranges of movement.
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Affiliation(s)
- T Blankenstein
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK
| | - A Grainger
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK; Leeds Musculoskeletal Biomedical Research Centre, University of Leeds, Leeds, UK
| | - B Dube
- Leeds Musculoskeletal Biomedical Research Centre, University of Leeds, Leeds, UK
| | - R Evans
- Leeds Musculoskeletal Biomedical Research Centre, University of Leeds, Leeds, UK
| | - P Robinson
- Musculoskeletal Centre X-Ray Department, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK; Leeds Musculoskeletal Biomedical Research Centre, University of Leeds, Leeds, UK.
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Ernat JJ, Song DJ, Cage JM, Lee GY, Tokish JM. Return to Duty After Mini-Open Arthroscopic-Assisted Treatment of Femoroacetabular Impingement in an Active Military Population. Arthrosc Sports Med Rehabil 2019; 1:e15-e23. [PMID: 32267252 PMCID: PMC7120864 DOI: 10.1016/j.asmr.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/09/2019] [Indexed: 12/01/2022] Open
Abstract
Purpose To report the return-to-duty rate and surgical outcomes in a military population after mini-open arthroscopic-assisted surgery for femoroacetabular impingement (FAI) in an effort to affirm its efficacy. Methods A retrospective review of consecutive active-duty patients receiving mini-open arthroscopic-assisted surgery for FAI between 2007 and 2011 was performed. Patients younger than 18 years, non–active-duty patients, and patients with prior hip surgery were excluded. Demographic, radiographic, and duty-status data were collected. The primary outcome measure was a return to duty. Outcome scores were obtained in a proportion of the cohort, including the modified Harris Hip Score, Single Assessment Numeric Evaluation score, Western Ontario and McMaster Universities Osteoarthritis Index score, patient satisfaction score, and Veterans RAND 12 (VR-12) score. All patients had achieved a minimum of 1 year of follow-up at the time of assessment. All P values for significance were set at .05 or lower. Results Of 182 patients (average age, 30.4 years), 156 (86%) were available for follow-up with return-to-duty data at an average of 2.8 years (range, 1-6 years). Of the patients, 78% returned to full duty (53%) or returned to duty with restrictions (25%). Outcome scores were available for 101 of 182 patients (55%) with duty rates similar to the total cohort (81% who returned to duty: 58% with no restrictions and 23% with restrictions). Return to duty correlated with improved outcomes compared with those who were medically discharged with respect to the modified Harris Hip Score (68.2 vs 54.5, P < .03), Single Assessment Numeric Evaluation score (48.2 vs 25.3, P < .02), and VR-12 physical (39.7 vs 33.2, P < .05) and VR-12 mental (54.5 vs 43.4, P < .005) scores. Conclusions Mini-open arthroscopic-assisted surgery for FAI is successful in returning most service members to duty at short-term follow-up. Return correlates with improved outcome scores, although previously reported minimally clinical important difference and patient acceptable symptomatic state threshold values were not uniformly achieved. Level of Evidence Level IV, retrospective case series.
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Affiliation(s)
- Justin J Ernat
- Blanchfield Army Community Hospital, Fort Campbell, Kentucky, U.S.A
| | - Daniel J Song
- Evans Army Community Hospital, Fort Carson, Colorado, U.S.A
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Burke CJ, Walter WR, Gyftopoulos S, Pham H, Baron S, Gonzalez-Lomas G, Vigdorchik JM, Youm T. Real-Time Assessment of Femoroacetabular Motion Using Radial Gradient Echo Magnetic Resonance Arthrography at 3 Tesla in Routine Clinical Practice: A Pilot Study. Arthroscopy 2019; 35:2366-2374. [PMID: 31395172 DOI: 10.1016/j.arthro.2019.02.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/22/2019] [Accepted: 02/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare femoroacetabular motion in a series of consecutive symptomatic patients with hip pain throughout the range of motion of the hip using a real-time radial gradient echo (GRE) sequence in addition to the routine hip protocol sequences for magnetic resonance (MR) arthrographic assessment of patients with and without clinical femoroacetabular impingement (FAI) syndrome. In particular, we sought to assess whether the additional dynamic sequence could differentiate between patients with and without a positive physical exam maneuver for FAI syndrome. METHODS Patients with hip pain referred for conventional hip MR arthrogram including those with and without a positive physical exam maneuver for FAI syndrome were imaged using routine hip MR arthrogram protocol and an additional real-time radial 2-dimensional GRE acquisition at 3 Tesla in an axial oblique plane with continuous scanning of a 9 mm thick slice through the center of the femoral head-neck axis. Patients who were unable to move through the range of motion were excluded (n = 3). Patients with acetabular dysplasia (defined by a lateral center-edge angle [CEA] of 20°) were also excluded, as were patients had Kellgren and Lawrence scores of > 0. The real-time cine sequence was acquired with the patient actively moving through neutral, flexion, flexion-abduction external-rotation, and flexion-adduction internal rotation (FADIR) positions aiming for 40° of abduction, then 25° of adduction at 80° to 90° flexion. Due to the placement of the coil over the hip, a true FADIR was precluded. Images were evaluated independently by 2 musculoskeletal radiologists measuring the joint space in the anterior, central, and posterior positions at each point during range of motion for femoroacetabular cortical space (FACS). Anterior FACS narrowing was calculated as the ratio of joint space in FADIR:neutral position, with lower ratios indicating greater narrowing. Static metrics including alpha angle, CEA, grade of cartilage loss according the Outerbridge classification, and patient demographics were also recorded. RESULTS Twenty-two painful hips in 22 patients (11 males and 11 females) with mean age 36 years (range, 15-67) were included. Twelve patients had a positive physical exam maneuver for FAI syndrome. The time to perform the dynamic sequence was 3 to 6 minutes. Interobserver agreement was strong, with intraclass correlation 0.91 and concordance correlation 0.90. According to results from both readers, patients with impingement on clinical exam had significantly lower anterior FACS ratios compared with those without clinical impingement (reader 1: 0.39 ± 0.10 vs 0.69 ± 0.20, P = .001; reader 2: 0.36 ± 0.07 vs 0.70 ± 0.17, P < .001). Decreased anterior FACS ratio was found to be significantly correlated to increased alpha angle by both readers (reader 1: R = -0.63, P = .002; reader 2: R = -0.67, P = .001) but not significantly correlated to CEA (reader 1: R = 0.13, P = .561; reader 2: R = 0.20, P = .378) or cartilage loss (reader 1: R = 0.03, P = .885; reader 2: R = -0.06, P = .784). Both readers found patients with an anterior FACS ratio of 1/2 to have significantly higher mean alpha angle (reader 1: 62.88 vs 52.79, P = .038; reader 2: 63.50 vs 50.58, P = .006); however, there were no significant differences in cartilage loss (reader 1: P = .133; reader 2: P = .882) or CEA (reader 1: P = .340; reader 2: P = .307). CONCLUSIONS A dynamic radial 2-dimensional-GRE sequence can be added to standard hip MR arthrogram protocols in <6 minutes, allowing assessment of dynamic femoroacetabular motion with strong interreader agreement. Patients with impingement on clinical exam had significantly lower anterior FACS ratios between FADIR and neutral positions, compared with those without clinical impingement. LEVEL OF EVIDENCE Level III, comparative diagnostic investigation.
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Affiliation(s)
- Christopher J Burke
- Department of Radiology, NYU Langone Health, Langone Orthopedic Hospital, New York, New York, U.S.A..
| | - William R Walter
- Department of Radiology, NYU Langone Health, Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Soterios Gyftopoulos
- Department of Radiology, Division of Musculoskeletal Radiology, Center for Musculoskeletal Care, NYU Langone Medical Center, New York, New York, U.S.A
| | - Hien Pham
- Department of Orthopaedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Samuel Baron
- Department of Orthopaedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Guillem Gonzalez-Lomas
- Department of Orthopaedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Jonathan M Vigdorchik
- Department of Orthopaedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Thomas Youm
- Department of Orthopaedic Surgery, NYU Langone Health, Langone Orthopedic Hospital, New York, New York, U.S.A
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Edgerton K, Hall J, Bland MK, Marshall B, Hulla R, Gatchel RJ. A physical therapist’s role in pain management: A biopsychosocial perspective. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Jarod Hall
- Greater Therapy Centers Lewisville Texas
| | - Michelle K. Bland
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Blaine Marshall
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Ryan Hulla
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Robert J. Gatchel
- Department of Psychology University of Texas at Arlington Arlington Texas
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Bastian SA, Rahmi H, Crues J, Bhanu S, Blout C, Rangarajan R, Lee B, Itamura J. Variations of magnetic resonance imaging findings in asymptomatic elbows. J Shoulder Elbow Surg 2019; 28:S154-S160. [PMID: 31196510 DOI: 10.1016/j.jse.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) findings in asymptomatic patients have been described for hips, knees, ankles, shoulders, and intervertebral disks. No such description exists for the elbow. METHODS MRI scans of 189 asymptomatic elbows divided into 3 groups by age (group 1, 20-39 years; group 2, 40-59 years; and group 3, ≥60 years) were evaluated for abnormalities within 13 anatomic structures using a novel classification system. RESULTS At least 1 variation was found in all elbows. Of the 13 structures, 8 showed an increase in the prevalence and intensity of signal changes with aging, 2 remained the same, and 2 showed a decrease. One anatomic structure showed no variations in any elbow. CONCLUSIONS Elbow MRI variations may be seen regardless of symptoms. These changes appear to increase in prevalence and intensity with age. Results from this study can be used to help guide the clinician in interpreting MRI findings of the elbow. We hope this study helps provide a contextual background for discussing MRI findings with patients and differentiating age-related variations from true pathology.
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Affiliation(s)
- Sevag A Bastian
- Department of Shoulder and Elbow Reconstruction, Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Glendale, CA, USA.
| | - Hithem Rahmi
- Department of Shoulder and Elbow Reconstruction, Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Glendale, CA, USA
| | - John Crues
- Department of Musculoskeletal Radiology, Cedars-Sinai Kerlan-Jobe Institute, Glendale, CA, USA
| | - Shiv Bhanu
- Department of Musculoskeletal Radiology, Cedars-Sinai Kerlan-Jobe Institute, Glendale, CA, USA
| | - Collin Blout
- Department of Shoulder and Elbow Reconstruction, Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Glendale, CA, USA
| | - Rajesh Rangarajan
- Department of Shoulder and Elbow Reconstruction, Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Glendale, CA, USA
| | - Brian Lee
- Department of Shoulder and Elbow Reconstruction, Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Glendale, CA, USA
| | - John Itamura
- Department of Shoulder and Elbow Reconstruction, Cedars-Sinai Kerlan-Jobe Institute at White Memorial Medical Center, Glendale, CA, USA
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Vahedi H, Aalirezaie A, Azboy I, Daryoush T, Shahi A, Parvizi J. Acetabular Labral Tears Are Common in Asymptomatic Contralateral Hips With Femoroacetabular Impingement. Clin Orthop Relat Res 2019; 477:974-979. [PMID: 30444756 PMCID: PMC6494314 DOI: 10.1097/corr.0000000000000567] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The number of patients undergoing hip arthroscopy for labral tears has increased, but labral tears are sometimes seen in asymptomatic patients with femoroacetabular impingement (FAI). The frequency of this finding, however, has not been well characterized nor is the proportion of patients with previously asymptomatic labral tears who may later become symptomatic. QUESTIONS/PURPOSES The purpose of this study was to determine (1) the prevalence of labral tears and other intraarticular pathology in the asymptomatic contralateral hip of patients undergoing surgery for symptomatic FAI; (2) the likelihood that the asymptomatic hip had become symptomatic at latest followup; and (3) any association between MRI findings and age, sex, and body mass index (BMI) in both symptomatic and asymptomatic sides. METHODS This study included patients who were diagnosed with unilateral symptomatic FAI between 2013 and 2015 and who had an available MRI of both hips. The study included 100 patients (47 females, 53 males) with a mean age of 33 years (range, 17-57 years). Patients with a symptomatic contralateral hip (n = 56) or an unsuitable MRI for review based on both reviewers' consensus (n = 344) were excluded. The MRI of both hips was independently evaluated by two orthopaedic surgeons and interobserver reliability tested. The interobserver reliability for the two surgeons' MRI ratings was almost perfect (κ ≥ 0.85). The presence of a labral tear, an acetabular chondral lesion, subchondral acetabular cysts, and fibrocystic changes in the femoral head-neck junction was documented for both hips. At latest followup, asymptomatic hips were investigated for any symptomatic labral tears or surgical procedures resulting from FAI. RESULTS A labral tear was recorded in 97 (97%) and 96 (96%) of symptomatic hips, respectively, for each surgeon's evaluation. A labral tear was also detected in 41 (41%) and 43 (43%) of asymptomatic hips. In addition, an acetabular chondral lesion was detected in 32 (32%) and 35 (35%) of the symptomatic hips and 15 (15%) and 17 (17%) of the asymptomatic hips. At latest followup, nine of the patients were diagnosed with symptomatic labral tears in the contralateral asymptomatic hip and were treated. None of the radiologic parameters examined demonstrated an association with patient age, sex, or BMI in either symptomatic or asymptomatic hips. CONCLUSIONS Labral tears and acetabular chondral lesions are common in the asymptomatic contralateral hip of patients undergoing surgery for FAI. The incidence of a symptomatic labral tear in these asymptomatic hips was 9% during 2 years of followup. We suggest that the decision to perform chondral or labral surgery in patients with FAI should be made with caution considering the relatively high prevalence of labral tears in asymptomatic hips and the low chance of development of symptoms. LEVEL OF EVIDENCE Level IV, case-series study.
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What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis. Sports Med 2019; 49:951-972. [DOI: 10.1007/s40279-019-01092-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Higher Prevalence of Concomitant Shoulder Labral Tears in Patients With Femoroacetabular Impingement. Arthroscopy 2019; 35:1074-1079.e1. [PMID: 30857906 DOI: 10.1016/j.arthro.2018.10.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the prevalence of concomitant symptomatic glenoid labral tears in patients with femoroacetabular impingement (FAI) in comparison to a control group of patients undergoing anterior cruciate ligament (ACL) reconstruction. METHODS We retrospectively identified 1,644 patients who underwent femoroacetabular osteoplasty (FAO) and labrum repair from January 2007 to September 2016 and 1,055 patients who underwent arthroscopic ACL reconstruction from January 2012 to December 2014, which acted as our control group. An electronic questionnaire, including 8 questions regarding history of shoulder pathology, was sent to all patients in both groups. Symptomatic shoulder labral tears were identified on the basis of a positive magnetic resonance imaging scan or history of labral repair by reviewing patients' medical records and the filled questionnaire. Continuous variables were compared by use of a Mann-Whitney U test, and categorical variables were compared using Fisher's exact test. The Holm-Bonferroni sequential correction method was used to adjust P values for multiple comparisons of the presence of shoulder pathology. RESULTS A total of 443 patients (405 cam lesion) in the FAO group and 307 patients in the ACL reconstruction group completed the prepared questionnaire and were included in the study. Patients in the FAO group were slightly older (36.3 years [range, 15.4-61.7] vs 32.3 years [range, 16.3-75.7]) and more commonly female in the FAO group (58.0%, n = 257) compared with those in the ACL group (48.9%, n = 150). The prevalence of shoulder labral tear was 12.0% (95% confidence interval [CI], 9.3%-15.3%) for the FAO group compared with only 3.3% (95% CI, 1.8%-5.9%) for the ACL group. This represents a 3.7-fold (95% CI, 1.9-7.1) increase in the risk of shoulder labral tear for patients in the FAO group. Furthermore, shoulder labral tears were reported to be traumatic in only 43.4% of patients in the FAO group compared with 80.0% of patients in the ACL group. A similar proportion of patients in both groups (66.0% for FAO vs 60.0% for ACL) underwent a shoulder labral repair procedure. CONCLUSION There appears to be an association between acetabular labral tear caused by FAI and shoulder labral lesions. Patients in the FAI group had a 3.7-fold increase in the risk of shoulder labral tear compared with the ACL group. Future studies are needed to examine a possible cause behind the current findings. LEVEL OF EVIDENCE Level III, comparative trial study.
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Quinlan NJ, Alpaugh K, Upadhyaya S, Conaway WK, Martin SD. Improvement in Functional Outcome Scores Despite Persistent Pain With 1 Year of Nonsurgical Management for Acetabular Labral Tears With or Without Femoroacetabular Impingement. Am J Sports Med 2019; 47:536-542. [PMID: 30557033 DOI: 10.1177/0363546518814484] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular labral tears are increasingly recognized as a source of hip pain in a younger active population. Given the significant focus on surgical intervention, there has been limited investigation on the nonsurgical management and natural history of such injuries. HYPOTHESIS Patients undergoing nonsurgical treatment for symptomatic acetabular labral tears experience functional improvement based on patient-reported outcome measures over the course of 1 year. STUDY DESIGN Case series; Level of evidence, 4. METHODS Seventy-one patients were identified who had acetabular labral injuries confirmed by magnetic resonance imaging or arthrography, received a minimum of 1 year of nonsurgical treatment, and completed baseline functional outcome questionnaires: modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living, HOS-Sports, and iHOT-33 (International Hip Outcome Tool-33). Of these, 52 (73.2%) completed the minimum 1-year follow-up questionnaires. Chart review was conducted to obtain demographic information. Statistical significance ( P < .05) was determined by paired t test, independent samples t test, and chi-square test. RESULTS Twenty-two male and 30 female patients completed 1-year follow-up questionnaires. Mean ± SD follow-up time was 16.2 ± 3.1 months. The cohort had a mean age of 38.9 ± 9.3 years. Baseline radiographs demonstrated minimal arthritis (Tönnis grades 0-2). Mean alpha angle differed significantly between men and women at 52.9°± 8.6° and 46.3°± 8.5°, respectively. At 1-year follow-up, patients experienced a significant improvement in all 4 functional outcome measures (mHHS: 72.6 vs 81.8, HOS-Activities of Daily Living: 78.6 vs 86.4, HOS-Sports: 56.0 vs 71.1, iHOT-33: 47.5 vs 67.9). Patients with and without femoroacetabular impingement demonstrated a significant improvement in the mHHS. However, 48.1% reported no improvement in their pain; 69.2% were limited in their activities; and 40.4% were still considering surgery. Overall, 71.2% were satisfied with nonsurgical treatment. CONCLUSION Patients with symptomatic labral tears can experience functional improvement after a minimum 1 year of nonsurgical treatment in the presence and absence of femoroacetabular impingement. However, many report residual pain, alteration of their activities, and interest in surgery. This information is important when patients are counseled in the treatment options for this injury. Identifying the population that responds best to nonsurgical management and comparing outcomes with those undergoing surgical management should be the focus of future research. Longer-term follow-up may be necessary to reevaluate pain, function, and return to activities.
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Affiliation(s)
- Noah J Quinlan
- Orthopaedic Surgery Residency, University of Utah, Salt Lake City, Utah, USA
| | - Kyle Alpaugh
- Orthopaedic Surgery Residency, University of Massachusetts, Worcester, Massachusetts, USA
| | - Shivam Upadhyaya
- Harvard Combined Orthopedic Residency Program, Boston, Massachusetts, USA
| | - William K Conaway
- Orthopedic Surgery Residency Program, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott D Martin
- Department of Orthopaedic Surgery, Mass General Hospital, Boston, Massachusetts, USA
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Reider B. Prologue to a Scope. Am J Sports Med 2019; 47:533-535. [PMID: 30822128 DOI: 10.1177/0363546519828735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Adib F, Johnson AJ, Hennrikus WL, Nasreddine A, Kocher M, Yen YM. Iliopsoas tendonitis after hip arthroscopy: prevalence, risk factors and treatment algorithm. J Hip Preserv Surg 2018; 5:362-369. [PMID: 30647926 PMCID: PMC6328754 DOI: 10.1093/jhps/hny049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
The incidence of iliopsoas tendonitis (IPT) has not previously reported following hip arthroscopy for femoroacetabular impingement with or without labral tears. (i) What is the incidence of IPT following hip arthroscopy; (ii) are there any demographic risk factors and (iii) are there any operative techniques that are risk for IPT? Retrospective study. Hip arthroscopy patients from 2005 to 2012 were included. Patients were diagnosed via physical examination findings and were excluded if they had pre-operative IPT. Records were reviewed for demographics, operative reports and operative procedures. All patients received either labral debridement, labral repair, osteoplasty or a combination of those procedures. A standardized rehabilitation protocol was used. Of 252 patients, 60 (24%) had IPT. Twenty-eight (47%) had symptom resolution with activity modification, physical therapy and NSAIDs. Thirty-two (53%) required corticosteroid injection at a mean of 25 weeks after surgery. Seven (12%) required revision arthroscopy and iliopsoas release to resolve the symptoms. There were no patient-specific risk factors, differences based on surgical technique, and number of portals did not matter. Patients should minimize exercises that activate the iliopsoas after hip arthroscopy. The cause of IPT could be related to unaddressed abnormal mechanics, tendon scarring or improper physical therapy. Further studies are needed to investigate the reasons for this, as well as specific techniques to lower its incidence. The incidence of IPT after hip arthroscopy has an incidence of 24%. Additionally, we provide readers with a rehabilitation protocol to minimize this complication.
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Affiliation(s)
- Farshad Adib
- Department of Orthopaedics, University of Maryland, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD, USA.,University of Maryland Medical System, Baltimore, MD, USA
| | - Aaron J Johnson
- Department of Orthopaedics, University of Maryland, 110 South Paca Street, 6th Floor, Suite 300, Baltimore, MD, USA.,University of Maryland Medical System, Baltimore, MD, USA
| | | | - Adam Nasreddine
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mininder Kocher
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yi-Meng Yen
- Department of Orthopaedics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Puetz J. Nano-evidence for joint microbleeds in hemophilia patients. J Thromb Haemost 2018; 16:1914-1917. [PMID: 30007042 DOI: 10.1111/jth.14242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/06/2018] [Indexed: 11/26/2022]
Abstract
The concept of joint microbleeding in hemophilia patients was first proposed over 10 years ago. This was based on unexpected abnormalities found in medical imaging studies of asymptomatic joints. Since then, there have been no published studies confirming the presence of joint microbleeds. This critique will review the evidence for and against joint microbleeding in hemophilia patients and the potential implications.
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Affiliation(s)
- J Puetz
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University, St. Louis, MO, USA
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Lansdown DA, Bendich I, Motamedi D, Feeley BT. Imaging-Based Prevalence of Superior Labral Anterior-Posterior Tears Significantly Increases in the Aging Shoulder. Orthop J Sports Med 2018; 6:2325967118797065. [PMID: 30238014 PMCID: PMC6141924 DOI: 10.1177/2325967118797065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Superior labral anterior-posterior (SLAP) tears can be associated with pain and shoulder dysfunction. Relatively little is known about the age-related prevalence of SLAP tears. Purpose To investigate the age-related prevalence of imaging-diagnosed SLAP tears in a heterogeneous grouping of shoulder conditions in a large cohort at a single institution with multiple blinded reviewers. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 281 shoulder magnetic resonance imaging (MRI) scans obtained over 8 months were reviewed by a musculoskeletal radiologist and an orthopaedic surgeon. The mean ± SD age of the group was 49.6 ± 15.5 years, and 107 of the patients were female (38.1%). Patients were divided into 4 age groups: 35 years or younger, 36 to 50 years, 51 to 65 years, and older than 65 years. Statistical analyses were completed by use of the Fisher exact test to compare proportions of SLAP tears between age groups, odds ratios to determine the likelihood of having a SLAP tear in each age group, and a logistic regression to control for associated abnormalities. Results There was a significant diffference in the proportion of SLAP tears found on the MRIs for each age group (P < .001). Patients were significantly more likely to have SLAP tears if aged 51 to 65 years (66.7%; odds ratio [OR], 2.00; 95% CI, 1.27-3.15) and if older than 65 years (81.2%; OR, 4.31; 95% CI, 2.36-7.88). No increased prevalence was observed in patients aged 35 years or younger (47.5%; OR, 0.91; 95% CI, 0.55-1.50) or 36 to 50 years (51.8%; OR, 1.08; 95% CI, 0.70-1.67). Logistic regression demonstrated that age was the only significant predictor for having a SLAP tear (P < .001). Kappa values were 0.46 to 0.65 between reviewers, indicating moderate to substantial agreement. Conclusion An increasing prevalence of MRI-based SLAP tears was observed with increasing patient age. Patients older than 50 years were significantly more likely to have superior labral abnormalities regardless of other shoulder injury or disease.
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Affiliation(s)
- Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ilya Bendich
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daria Motamedi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Atta H, Mourad AF, Elmorshidy E, Mahran M. Secondary signs of ligamentum teres injuries. A non-arthrographic and arthrographic MR findings correlation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Heiss R, Guermazi A, Jarraya M, Engebretsen L, Roemer FW. The epidemiology of MRI-detected pelvic injuries in athletes in the Rio de Janeiro 2016 Summer Olympics. Eur J Radiol 2018; 105:56-64. [PMID: 30017299 DOI: 10.1016/j.ejrad.2018.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To describe the prevalence, severity and location of pelvic injuries, including hip, muscle and tendon pathologies, as assessed on MRI in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games. METHODS We analyzed all pelvic MRIs that were acquired for suspected injury as reported by the National Olympic Committee (NOC) medical teams and the Organizing Committee medical staff during the Rio 2016 Summer Olympics. Diagnostic imaging was performed through the Olympic Village Polyclinic, using 3 T and 1.5 T MR scanners. Images were interpreted retrospectively according to standardized criteria. RESULTS A total of 11,274 athletes participated in the Games, of which 40 (0,4%) were referred for a pelvic MRI. Thirty-seven of the 40 (92%) had at least one abnormal finding, and some had as many as 17, for an average of 4.1 pathologies per examination. Almost half of all abnormal findings were assessed as pre-existing (46%). The majority of acute/subacute injuries were observed in track and field athletes (44%), whereas the highest number of pre-existing findings was seen in ball-sports athletes (39%). Forty-seven per cent of all acute/subacute injuries were muscle injuries with the gluteus maximus muscle the most commonly affected. In contrast, most pre-existing findings were detected at the symphysis (59%). CONCLUSION Our study demonstrated a high prevalence of both acute/subacute injuries and chronic changes in Olympic athletes undergoing pelvic MRI. Muscle injuries were the most common acute injuries, found mainly in track and field athletes. Most chronic changes were identified at the symphysis region in ball-sports athletes.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 3, 91054 Erlangen, Germany.
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
| | - Mohamed Jarraya
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA; Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Avenue, Darby, PA 19428, USA
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Route de Vidy 11, 1007 Lausanne, Switzerland; Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsveien 220, 0863 Oslo, Norway; Department of Orthopedic Surgery, Oslo University Hospital, University of Oslo, Sognsvannsveien 20, 0372 Osla, Norway
| | - Frank W Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 3, 91054 Erlangen, Germany; Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
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Lesions of Ligamentum Teres: Diagnostic Performance of MRI and MR Arthrography—A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:W52-W63. [DOI: 10.2214/ajr.17.19198] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Ejnisman L, Domb BG, Souza F, Junqueira C, Vicente JRN, Croci AT. Are femoroacetabular impingement tomographic angles associated with the histological assessment of labral tears? A cadaveric study. PLoS One 2018; 13:e0199352. [PMID: 29928035 PMCID: PMC6013197 DOI: 10.1371/journal.pone.0199352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/06/2018] [Indexed: 01/17/2023] Open
Abstract
Purpose This study sought to investigate the association between tomographic femoroacetabular impingement (FAI) angles and histologically evaluated labral tears. The authors hypothesized that cadavers presenting with cam and pincer morphologies would present a higher prevalence of acetabular labral tears. Methods Twenty fresh cadavers were submitted to computed tomography. Standard FAI angles were measured, including the alpha angle, femoral version, acetabular version, Tonnis angle and center-edge angle. A cam lesion was defined as an alpha angle greater than 50o. A pincer lesion was defined as a center-edge angle greater than 40o, a Tonnis angle less than 0o or acetabular version less than 0o. After dissection, three fragments of each acetabulum, corresponding to the antero-superior, superior and postero-superior acetabular rim, were obtained. These fragments were submitted to routine histological preparation. Each slide was evaluated for possible labral tears. Tears were classified according to their Seldes type. Results The mean age of the cadavers was 50.2 years (SD: 7.4; 13 males). Sixteen (80%) of the cadavers had a cam lesion, and eight cadavers (40%) had a pincer lesion. Histologically, 16 (80%) of the cadavers had a labral tear in at least one region. According to the Seldes classification, 60.7% and 28.6% of these labral tears were type 1 and type 2, respectively. A mixed type of labral tear (10.7%), which represented a new form of Seldes tear, was described. Cadavers with a labral tear had significantly higher alpha angles than other cadavers (53.29ovs 49.33o, p = 0.01). Pincer lesions were not associated with labral tears. We found no association between pincer or cam lesions and Seldes classification. Conclusion Cadavers presenting with higher alpha angles had a higher incidence of labral tears. No association was found between FAI and Seldes classification. Clinical relevance This study demonstrated a high prevalence of FAI abnormalities associated with histological alterations in a cadaveric sample. Joint damage may be present in the early stages of FAI.
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Affiliation(s)
- Leandro Ejnisman
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- * E-mail:
| | - Benjamin G. Domb
- American Hip Institute, Westmont, Illinois, USA Hinsdale Orthopedics, Westmont, Illinois, United States of America
| | - Felipe Souza
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Consuelo Junqueira
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jose Ricardo Negreiros Vicente
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alberto Tesconi Croci
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Scott E, Westermann R, Rosneck J. A posterior labral cyst associated with an anterior labral tear of the hip. Skeletal Radiol 2018; 47:849-852. [PMID: 29273830 DOI: 10.1007/s00256-017-2856-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/02/2017] [Accepted: 12/12/2017] [Indexed: 02/02/2023]
Abstract
Paralabral cysts are often associated with labral and other intraarticular hip pathology; MRI as well as diagnostic ultrasound can assist in diagnosis. Although often considered a coincidental finding, paralabral cysts can be a separate pain generator about the hip through compression of surrounding anatomy. They can also be initially mistaken for malignancy or other pathology by providers unfamiliar with their appearance. We present the case of an active 33-year-old female with right hip pain secondary to a large symptomatic posterior acetabular paralabral cyst with concomitant anterior labral tear. Following diagnosis on MRI, treatment included ultrasound-guided aspiration of the cyst, followed by arthroscopic anterior labral repair and separate cyst decompression from a posterior portal. The patient had complete resolution of her symptoms.
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Affiliation(s)
- Elizabeth Scott
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Robert Westermann
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - James Rosneck
- Cleveland Clinic, Sports Health Center, Mail Code SH02, 5555 Transportation Blvd., Garfield Heights, OH, 44125, USA
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Doss A. Wording wisely: Including prevalence data and evidence based clinical outcomes of spinal and musculoskeletal degeneration in radiology reports. J Med Imaging Radiat Oncol 2018; 62:599-604. [DOI: 10.1111/1754-9485.12751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/07/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Arockia Doss
- Image Guided Therapy Clinic; Perth Western Australia Australia
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