Editorial Commentary: Small Labral Size on Magnetic Resonance Imaging Is an Indication for Labral Reconstruction in the Setting of Revision Hip Arthroscopy

Revision hip arthroscopy is an increasingly common procedure as rates of primary hip arthroscopy rise. Etiologies for symptom recurrence may include residual femoroacetabular impingement, cam over-resection, labral pathology, chondral wear, adhesions, and instability. This has spawned sophisticated surgical techniques in hip arthroscopy including labral reconstruction. Indications for labral reconstruction in the revision setting obviously include labral deficiency. In addition, in the absence of other obvious reasons for failure of the primary procedure, a labral reconstruction should be considered for diminutive labra. The ability to predict labral size before surgery based on magnetic resonance imaging can be invaluable.

Peri-operative platelet-rich plasma in arthroscopic femoroacetabular impingement surgery: a randomized controlled trial

This study aimed to determine whether the addition of platelet-rich plasma (PRP) during hip arthroscopy improves functional outcomes in femoroacetabular impingement (FAI) surgery. This was a prospective randomized single-blinded trial of arthroscopic hip patients aged between 16 and 50 years with a diagnosis of FAI conducted at a single centre. Patients with any previous hip surgery and significant osteoarthritic changes (Tonnis grade > 2) were excluded. Before surgery, patients were randomly assigned to receive either a PRP injection or a saline placebo. Efficacy was evaluated at 6 months, 1 year and 2 years post-surgery using patient-reported outcomes. The short version International Hip Outcome Tool (iHOT12) was the primary outcome. Recruited patients (n = 113) were aged 36.0 ± 10.5 (mean ± standard deviation) years and 56% male. At baseline, iHOT12 scores of the PRP (mean 43.8 ± 22.4) and placebo groups (mean 45.2 ± 21.5) were similar. At a minimum follow-up of 2 years, both groups had improved iHOT12 scores (PRP: mean 83.6 ± 13.4, control: mean 77.1 ± 23.3), with no significant difference in change between the two groups (P = 0.19). There were no significant group differences for the change in Non-Arthritic Hip and Hip Disability and Osteoarthritis Outcome Score—Shortform scores between the two groups (P = 0.22 and 0.46, respectively). The present study does not support the peri-operative use of PRP in arthroscopic surgery for FAI for mid-term improvement. There were no significant differences in outcome between PRP and placebo groups at 2-year minimum follow-up after surgery.

Hip arthroscopy distraction without the use of a perineal post: prospective study

Hip arthroscopy is being used with increasing frequency as the understanding of arthroscopic management of groin pain improves. To access the hip joint arthroscopically, traction must be placed on the leg. In most cases, countertraction is provided with a padded post in the groin. Complications of traction are often attributed to the post and include perineal or pudendal neuropraxias and skin complications. The purpose of this study was to investigate the safety of a traction technique that avoids a perineal post. A supine position is used with the foot in a standard traction boot. The patient is moved down the table such that his or her perineum is located 7 to 10 cm proximal to the traction post. The post is also located 5 to 10 cm lateral to midline. The operative table is placed in 15° to 20° of Trendelenburg. With this position, enough friction is generated between the patient's upper body and bed to allow successful hip distraction without the post contacting with the perineum. One hundred seventy patients (111 men and 59 women) were followed prospectively and evaluated for possible side effects of this traction technique immediately postoperatively and 1 and 14 days and 3 and 6 months postoperatively. Patients were examined at each visit. No significant complications related to traction occurred during follow-up. The described technique has been used in more than 2000 hip arthroscopies without a documented groin or perineal complication. It allows easy positioning and access to the central compartment.

Autologous diaphragm reconstruction with the pedicled latissimus dorsi flap

The latissimus dorsi (LD) muscle has been previously described to repair diaphragmatic defects, but as a "reverse" flap, relying on secondary blood supply from the perforating lumbar vessels rather than primary inflow from the dominant thoracodorsal artery. We report resection of a retroperitoneal synovial sarcoma, with reconstruction of the hemidiaphragm using the LD rotated on its primary neurovascular bundle. By using the dominant pedicle, the vascularity of the flap is improved, minimizing the chance of flap tip loss. Maintaining an intact nerve supply prevents atrophy. As the distal origin of the LD is broad and flat, it is ideally suited for diaphragm repair. A latissimus-sparing thoracotomy incision is required to enable this method of diaphragm reconstruction.