Making a Case for Anterior Inferior Iliac Spine/Subspine Hip Impingement: Three Representative Case Reports and Proposed Concept

Minnesota Orthopedic Sports Medicine Institute at Twin Cities Orthopedics, Edina, 55435, USA.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 12/2011; 27(12):1732-7. DOI: 10.1016/j.arthro.2011.10.004
Source: PubMed


Femoroacetabular impingement is typically described as occurring due to a conflict between the femoral head-neck junction and acetabular rim. A prior case report described an open decompression of the anterior inferior iliac spine (AIIS) due to impingement against the proximal femur. AIIS impingement may be developmental or the result of a prior AIIS avulsion or pelvic osteotomy. We describe 3 representative cases with minimum 1-year follow-up treated with an arthroscopic AIIS decompression.

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    • "However, femoroacetabular impingement due to hypertrophic malunion of avulsed fracture of anterior, inferior iliac spine has rarely been reported [9] [10] [11] [12]. "
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    ABSTRACT: Introduction: Avulsion fractures of the anterior inferior iliac spine are uncommon and such injuries are caused by the sudden forceful contraction of the straight head of rectus femoris muscle while the hip is hyperextended and the knee is flexed. Case presentation: This case report describes the condition of 17 year old male footballer who complained of pain in the right groin for duration of 2 years after being involved in forceful sport activity. Detailed history, clinical examination, X-rays and CT scan revealed hypertrophic malunion of avulsion fracture of anterior inferior iliac spine causing an extra-articular type of femoroacetabular impingement. The patient was surgically treated when conservative management was unsuccessful. Discussion: This is the first case of hypertrophic malunion of avulsion fracture of anterior inferior iliac spine with femoroacetabular impingement that has been recognized in Qatar. The patient was surgically treated in order to relieve symptoms and avoid osteoarthritis. Conclusion: Malunited avulsion fracture of anterior inferior iliac spine can cause extra-articular femoroacetabular impingement.
    International Journal of Surgery Case Reports 05/2015; 15. DOI:10.1016/j.ijscr.2015.04.025
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    • "Terminal hip flexion pain and limitations, tenderness to palpation of AIIS, imaging showing type 2 or 3 AIIS, intraoperative focal bruising and synovitis in region of AIIS Hetsroni et al. 6 (2012) Anterior hip pain, tenderness over AIIS, limited and painful terminal flexion, pain not resolved with intra-articular injection, prominent AIIS on imaging Larson et al. 11 (2011) Painful limited flexion, limited response to intra-articular injection, prominent AIIS on imaging Matsuda and Calipusan 12 (2012) Positive impingement sign/FABER, malunited prominent AIIS Pan et al. 13 (2008) Painful flexion with rotation, prominent AIIS on imaging Rajasekhar et al. 14 (2001) Limited painful deep flexion, tenderness anterior hip, malunited prominent AIIS on imaging Irving 15 (1964) Pain with rotation and abduction, palpable lump over AIIS, exostosis seen on imaging FABER, flexioneabductioneexternal rotation. "
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    ABSTRACT: Purpose Extra-articular hip impingement can be the result of psoas impingement (PI), subspine impingement (SSI), ischiofemoral impingement (IFI), and greater trochanteric/pelvic impingement (GTPI). Symptoms may be due to bony abutment or soft-tissue irritation, and often, it is a challenge to differentiate among symptoms preoperatively. Currently, the clinical picture and diagnostic criteria are still being refined for these conditions. This systematic review was conducted to examine each condition and elucidate the indications for, treatment options for, and clinical outcomes of surgical management. Methods We searched online databases (Medline, Embase, and PubMed) for English-language clinical studies published from database inception through December 31, 2013, addressing the surgical treatment of PI, SSI, IFI, and GTPI. For each condition, 2 independent assessors reviewed eligible studies. Descriptive statistics are presented. Results Overall, 9,521 studies were initially retrieved; ultimately, 14 studies were included examining 333 hips. For PI, arthroscopic surgery resulted in 88% of patients achieving good to excellent results, as well as significant improvements in the Harris Hip Score (P = .008), Hip Outcome Score–Activities of Daily Living (P = .02), and Hip Outcome Score–Sport (P = .04). For SSI, arthroscopic decompression, with no major complications, resulted in a mean 18.5° improvement in flexion range of motion, as well as improvements in pain (mean visual analog scale score of 5.9 points preoperatively and 1.2 points postoperatively) and the modified Harris Hip Score (mean of 64.97 points preoperatively and 91.3 points postoperatively). For both IFI and GTPI, open procedures anecdotally improved patient symptoms, with no formal objective outcomes data reported. Conclusions This review suggests that there is some evidence to support that surgical treatment, by arthroscopy for PI and SSI and by open surgery for IFI and GTPI, results in improved patient outcomes. Level of Evidence Systematic review of Level IV and V (case report) studies.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2014; · 3.21 Impact Factor
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    • "Acetabular retroversion occurs when the acetabulum faces in a more posterolateral orientation than usual. Acetabular retroversion has been a hot topic in the literature lately because it is considered important in the development of two common hip problems: (1) femoral acetabular impingement (FAI) and (2) osteoarthritis (OA) of the hip (Corten, Ganz, Chosa, and Leunig, 2011; Giori and Trousdale, 2003; Grant, Sala, and Schwarzkopf, 2012; Kim, Hutchinson, Andrew, and Allen, 2006; Kohl et al, 2011; Larson, Kelly, and Stone, 2011). Retroversion of the acetabulum is thought to be one of the primary reasons for the development of FAI (Grant, Sala, and Schwarzkopf, 2012). "
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    ABSTRACT: Abstract Acetabular retroversion has been recently implicated as an important factor in the development of femoral acetabular impingement and hip osteoarthritis. The proper function of the hip joint requires that the anatomic features of the acetabulum and femoral head complement one another. In acetabular retroversion, the alignment of the acetabulum is altered where it opens in a posterolaterally instead of anterior direction. Changes in acetabular orientation can occur with alterations in pelvic tilt (anterior/posterior), and pelvic rotation (left/right). An overlooked problem that alters pelvic tilt and rotation, often seen by physical therapists, is sacroiliac joint dysfunction. A unique feature that develops in patients with sacroiliac joint dysfunction (SIJD) is asymmetry between the left and right innominate bones that can alter pelvic tilt and rotation. This article puts forth a theory suggesting that acetabular retroversion may be produced by sacroiliac joint dysfunction.
    Physiotherapy Theory and Practice 12/2013; 30(4). DOI:10.3109/09593985.2013.867558
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