ABSTRACT: We report the results of arthroscopic management of femoroacetabular impingement with 2-year follow-up.
All patients undergoing hip arthroscopy were prospectively assessed with the modified Harris Hip Score. Arthroscopic correction of femoroacetabular impingement was first performed in 2003. The cohort of this study consists of the first 100 consecutive cases that had achieved 2-year follow-up.
There was 100% follow-up at 2 years. The mean age was 34 years (range, 13 to 76 years), with 67 male and 33 female patients. There were 63 cam, 18 pincer, and 19 combined lesions. Acetabular articular damage was found in 97 cases, femoral damage was present in 23, and there were 92 labral tears. The median improvement was 21.5 points, with 79 good and excellent results. No patient required revision to total hip arthroplasty, but 6 patients underwent a subsequent arthroscopic procedure. There were 3 complications including a transient neurapraxia of the pudendal nerve and a transient neurapraxia of the lateral femoral cutaneous nerve, which resolved uneventfully, and 1 mild case of heterotopic ossification.
We report favorable outcomes for the arthroscopic management of femoroacetabular impingement in our early experience in the first 100 consecutive cases. The high incidence of significant articular damage observed at the time of arthroscopic intervention is concerning.
Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2011; 27(10):1379-88. · 3.02 Impact Factor
ABSTRACT: Hip pathology is a significant source of pain and dysfunction among athletic individuals and femoroacetabular impingement is often a causative factor. Arthroscopic intervention has been proposed to address the joint damage and underlying impingement.
Arthroscopy may be effective in the management of symptomatic femoroacetabular impingement in athletes.
Case series, Level of evidence, 4.
All patients undergoing hip arthroscopy at 1 institution were prospectively assessed with a modified Harris hip score obtained preoperatively and postoperatively at 3, 12, 24, 60, and 120 months. This report consists of a cohort of 200 patients identified who underwent arthroscopic management of femoroacetabular impingement, participated in athletic activities, and had achieved minimum 1-year follow up.
There was 100% follow-up at an average of 19 months (range, 12-60 months). A total of 116 athletes had achieved 2-year follow-up. For the entire cohort, the average age was 28.6 years (range, 11-60 years) with 148 males and 52 females. There were 159 cam, 31 combined, and 10 pincer lesions. There were 23 professional, 56 intercollegiate, 24 high school, and 97 recreational athletes. The male:female ratio was 2.8:1 among cam lesions and 1:1 among pincer lesions. The median preoperative score was 72 with a postoperative score of 96 and the median improvement was 20.5 points, which was statistically significant (P < .001). Ninety-five percent of professional athletes and 85% of intercollegiate athletes were able to return to their previous level of competition. There were 5 transient neurapraxias (all resolved) and 1 minor heterotopic ossification. One athlete (0.5%) underwent conversion to total hip arthroplasty and 4 (2%) underwent repeat arthroscopy. For the group with minimum 2-year follow up, the median improvement was 21 points with a postoperative score of 96.
The data substantiate successful outcomes in the arthroscopic management of femoroacetabular impingement with few complications and most athletes were able to resume activities.
The American journal of sports medicine 07/2011; 39 Suppl:7S-13S. · 3.61 Impact Factor
ABSTRACT: Arthroscopy is a well-accepted technique in the management of many athletic-related hip disorders, yet little quantitative outcomes data have been reported.
To report the results of hip arthroscopy in a consecutive series of athletes with 10-year follow-up.
Case series; Level of evidence, 4.
Since 1993, all patients undergoing hip arthroscopy at our institution have been prospectively assessed with a modified Harris hip score preoperatively and then postoperatively at 1, 3, 6, 12, 24, 60, and 120 months or until a subsequent procedure was performed. The variables studied included age, sex, type of sport, level of sport, diagnosis, duration of symptoms, onset of symptoms, and center edge angle. Fifty-two procedures were performed on 50 patients who had achieved 10-year follow-up. Fifteen patients developed symptoms in the course of athletic activities and their cases represent the substance of this study.
Follow-up information was available for all 15 patients (11 men and 4 women). The average age was 31.7 years (range, 14-70 years). Type of sport involved included football (3), tennis (3), basketball (2), golf (2), and others (5); with 9 recreational, 4 high school, and 2 intercollegiate athletes. Diagnoses included chondral damage (8), labral tear (7), arthritis (5), avascular necrosis (1), loose body (1), and synovitis (1). The median improvement in the modified Harris hip score was 45 points (from 51 preoperatively to 96, on the 100-point scale), with 13 patients (87%) returning to their sport. All 5 athletes with arthritis eventually underwent total hip arthroplasty at an average of 6 years. There were no complications.
Arthroscopy to address hip injuries in athletes can result in substantial improvement with durable results. However, arthritis is a prognostic indicator of poor long-term outcomes.
The American journal of sports medicine 09/2009; 37(11):2140-3. · 3.61 Impact Factor
ABSTRACT: The purpose of this study was to investigate the results of arthroscopic treatment of acetabular labral tears (the most common indication for hip arthroscopy) in a consecutive series of patients with 10-year follow-up.
Since 1993, all of our patients undergoing hip arthroscopy have been prospectively assessed by use of a modified Harris Hip Score preoperatively and postoperatively at 3, 12, 24, 60, and 120 months. Variables recorded include age, sex, diagnosis, duration of symptoms, onset of symptoms, center-edge angle, Workers' compensation status, and pending litigation. From a cohort of 52 procedures performed on 50 patients who had achieved 10-year follow-up, 29 patients (31 hips) were treated for a tear of the acetabular labrum and represent the substance of this study.
There was 100% follow-up, excluding 3 patients (5 hips) who died before their 10-year assessment. The mean age was 46 years (range, 17 to 84 years); there were 13 male and 13 female patients. The median Harris Hip Score improvement was 29 points (from 52 points preoperatively to 81 points postoperatively). Among 18 patients without arthritis, 15 (83%) continued to show substantial improvement (>or=18 points) at 10-year follow-up. Among 8 patients with associated arthritis, 7 (88%) were converted to total hip arthroplasty at a mean of 63 months. Two patients underwent repeat arthroscopy, which did not preclude a successful outcome at 10-year follow-up. There were no complications.
Selective debridement of symptomatic tears can result in favorable long-term results. The presence of clinical findings of arthritis at the time of the index procedure is a poor prognostic indicator, with uniformly poor results at 10 years.
Level IV, therapeutic case series.
Arthroscopy The Journal of Arthroscopic and Related Surgery 04/2009; 25(4):365-8. · 3.02 Impact Factor
ABSTRACT: It is postulated that adhesive capsulitis of the hip is more common than suggested in the published literature, which recounts only a few isolated cases, and that this condition shares many of the same characteristics seen in the shoulder. The purpose of this study was to investigate and report the findings of the first clinical case series on this condition.
Clinical case series, retrospective review of prospectively collected data.
Since 1993, all hip arthroscopy cases have been prospectively assessed with a 100-point rating system. In 1999, adhesive capsulitis was first recognized as a causative factor. Since then, 9 patients have been identified with this condition with at least 1 year of follow-up.
There was 100% follow-up at an average of 17.3 months. The average age was 43.7 years. There were 8 women and 1 man. Radiographs were normal in 8 cases and revealed mild degenerative disease in the 1 male patient. Magnetic resonance imaging/arthrography failed to reveal evidence of adhesive capsulitis. Examination under anesthesia revealed an average loss of 25 degrees of rotational motion (19.4 external, 5.6 degrees internal). Full range of motion was regained with manipulation. Arthroscopy revealed characteristic findings of adhesive capsulitis in all cases and coexistent pathology in 6 cases (5 articular lesions, 3 labral tears, and 1 ruptured ligamentum teres). The 8 women with normal radiographs all improved with an average of 32 points (preoperative, 56.4; postoperative, 88.4). The 1 man with degenerative changes showed negligible improvement. There were no complications.
Adhesive capsulitis of the hip is not as rare as suggested by the paucity of available literature. The clinical characteristics are similar to the shoulder, principally consisting of painful restricted motion and a clear predilection for middle aged women. It may occur with or without associated intra-articular pathology. Arthroscopy can be beneficial in the treatment of recalcitrant cases, but may assume less of a role with improved diagnostic skills essential to implementing a proper management strategy.
Arthroscopy The Journal of Arthroscopic and Related Surgery 02/2006; 22(1):89-94. · 3.02 Impact Factor
ABSTRACT: Lesions of the ligamentum teres have only occasionally been reported in the literature. However, with arthroscopy, pathology of the ligamentum teres has been increasingly recognized. The purpose of this article is to report the clinical characteristics associated with rupture of the ligamentum teres and the results of arthroscopic treatment.
Case series study.
All patients undergoing hip arthroscopy have been prospectively assessed using a modified Harris Hip score (100 point maximum) obtained preoperatively and postoperatively at 3, 12, 24, and 60 months. In this study, 271 cases had at least 1 year of follow-up evaluation. From this population, 41 patients were identified with lesions of the ligamentum teres. Twenty-three of these were traumatic in origin and represent the substance of this study. The remainder (18) were hypertrophic or degenerative.
We noted 100% follow-up at an average of 29.2 months. Patients included 14 women and 9 men with an average age of 28.3 years. Duration of symptoms before surgery averaged 28.5 months. All patients experienced deep anterior groin pain. Nineteen patients experienced mechanical symptoms (catching, popping, locking, giving way), and 4 patients described simply pain with activities. Fifteen patients sustained major trauma (7 motor vehicle accidents, 3 falls from a height, 3 football, 1 snow skiing, 1 ice hockey), including 6 dislocations. The remaining 8 patients sustained a twisting injury. Evaluation included 20 magnetic resonance imaging (MRI) scans, 7 MR arthrograms, 7 computed tomography (CT) scans, and 3 bone scans. The diagnosis of a lesion of the ligamentum teres was made preoperatively in only 2 cases. Rupture of the ligament was complete in 12 cases and partial in 11. Ligament injury was an isolated finding in 8 cases, and associated pathology was found in 15 cases (9 labral tears, 5 loose bodies, 5 chondral damage). The average preoperative score was 47, and postoperative score was 90. No statistical difference was seen based on type of injury, complete versus partial rupture, or presence of coexistent pathology.
Rupture of the ligamentum teres is increasingly recognized as a source of persistent hip pain. The diagnosis remains elusive to various imaging techniques. An index of suspicion should be maintained, especially in the presence of mechanical symptoms and a history of significant trauma. However, rupture may occur simply from a twisting injury in absence of major trauma. These lesions can be diagnosed using arthroscopy and, based on these results, may respond remarkably well to arthroscopic debridement.
Arthroscopy The Journal of Arthroscopic and Related Surgery 05/2004; 20(4):385-91. · 3.02 Impact Factor
ABSTRACT: Intra-articular pathology of the hip is often associated with dysplasia. The presence of dysplasia is often believed to be a harbinger of poor results for arthroscopy. The purpose of this study was to report the results of operative hip arthroscopy in conjunction with dysplastic disease of the hip.
Prospective clinical case series.
All patients undergoing hip arthroscopy are prospectively assessed with a modified Harris hip score performed preoperatively and postoperatively at 3, 12, 24, and 60 months. A minimum of 1-year follow-up has currently accumulated for 184 consecutive cases. The center edge (CE) angle of Wiberg is measured on the anteroposterior pelvis film and categorized as normal (> 25 degrees ), dysplastic (< 20 degrees ), or borderline dysplasia (20 degrees -25 degrees ).
In this study, 48 patients were identified with either dysplasia (16) or borderline dysplasia (32). At an average of 27 months, 100% follow-up was noted. For the dysplastic group, the average preoperative score was 57 and postoperative score was 83. For borderline dysplasia, the average preoperative score was 50 and postoperative score was 77. Statistically, no difference was found between the 2 groups. Collectively, the average improvement was 27 points, with 79% (38 patients) of patients showing at least a 10-point improvement.
The results of arthroscopy in the presence of dysplasia compare favorably with the general population previously reported. The response to treatment is probably dictated more by the nature of the intra-articular pathology rather than simply the presence or absence of radiographic evidence of dysplasia.
Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2004; 19(10):1055-60. · 3.02 Impact Factor
ABSTRACT: An inverted labrum is an acknowledged but often elusive cause of osteoarthritis. The study goals were to define the characteristic radiographic features of secondary osteoarthritis of the hip due to an inverted labrum and report the results of arthroscopic treatment.
This is a case series study.
From 220 consecutive arthroscopic hip procedures, 9 patients were identified who had had secondary osteoarthritis caused by an inverted labrum and who underwent a minimum 2 years follow-up. All were prospectively assessed with a modified Harris hip score. All patients underwent excision of a torn inverted labrum and chondroplasty. Three patients who had well- circumscribed grade IV acetabular lesions also underwent microfracture of the subchondral bone.
Characteristic anteroposterior radiographic features included isolated narrowing of the superolateral joint space. This narrowing caused a lateral convergence in the normally parallel lines created by the radius of curvature of the subchondral bone of the acetabulum and the convex surface of the femoral head. These 2 features created a false appearance of dysplasia (pseudodysplasia), because the center edge angle of Weiberg was normal in 6 cases (range, 24 degrees to 41 degrees; average, 29 degrees ) and was indicative of true dysplasia in only 3 cases (17 degrees ). The median preoperative score was 51, and the postoperative hip score was 56. Only 4 patients showed significant improvement. The best results were in the group with microfracture; the average improvement in this group was 36.
An inverted labrum is an occasionally encountered cause of osteoarthritis of the hip. The radiographic features seen with this disorder are quite characteristic and essentially pathognomonic. Recognizing these features in this population may help the physician avoid an unnecessarily extensive work-up for poorly explained hip pain. The 3 patients with microfracture responded well to the arthroscopic technique; otherwise the results of arthroscopic treatment were poor. The outcomes were no better than those previously reported for arthritis of all causes.
Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2002; 18(7):741-7. · 3.02 Impact Factor
ABSTRACT: Osteochondritis dissecans of the capitellum of the humerus usually occurs in adolescence and is caused by the valgus forces associated with excessive throwing.
Arthroscopic surgery is an appropriate procedure for this condition.
Retrospective cohort study.
Arthroscopic surgery was performed on 10 baseball players (average age, 13.8 years) with osteochondritis dissecans whose symptoms had been apparent for an average of 9 months before the operation. Follow-up at an average of 3.9 years included use of a standard rating scale, radiographs, and a questionnaire regarding return to sport.
There were two grade I, one grade II, two grade IV, and five grade V lesions. Symptoms and objective findings correlated poorly with the grade of the lesion. The postoperative score averaged 195, reflecting excellent results. Radiographically, the primary lesion was still apparent in one patient, secondary degenerative changes were evident in one patient, and, in one patient, the lesion was still evident and degenerative changes had occurred. Only four athletes returned to organized baseball.
Arthroscopic surgery for symptomatic osteochondritis dissecans of the capitellum in adolescent baseball players can provide excellent rating scores with intermediate follow-up but does not assure return to baseball.
The American Journal of Sports Medicine 30(4):474-8. · 3.79 Impact Factor
ABSTRACT: Hip arthroscopy has defined elusive causes of hip pain. HYPOTHESIS/PURPOSE: It is postulated that the reliability of various investigative methods is inconsistent. The purpose of this study is to evaluate the diagnostic accuracy of these methods.
Retrospective review of prospectively collected data.
Five parameters were assessed in 40 patients: clinical assessment, high-resolution magnetic resonance imaging, magnetic resonance imaging with gadolinium arthrography, intra-articular bupivacaine injection, and arthroscopy. Using arthroscopy as the definitive diagnosis, the other parameters were evaluated for reliability.
Hip abnormality was clinically suspected in all cases with 98% accuracy (1 false positive). However, the nature of the abnormality was identified in only 13 cases with 92% accuracy. Magnetic resonance imaging variously demonstrated direct or indirect evidence of abnormality but overall demonstrated a 42% false-negative and a 10% false-positive interpretation. Magnetic resonance arthrography demonstrated an 8% false-negative and 20% false-positive interpretation. Response to the intra-articular injection of anesthetic was 90% accurate (3 false-negative and 1 false-positive responses) for detecting the presence of intra-articular abnormality.
In this series, clinical assessment accurately determined the existence of intra-articular abnormality but was poor at defining its nature. Magnetic resonance arthrography was much more sensitive than magnetic resonance imaging at detecting various lesions but had twice as many false-positive interpretations. Response to an intra-articular injection of anesthetic was a 90% reliable indicator of intra-articular abnormality.
The American Journal of Sports Medicine 32(7):1668-74. · 3.79 Impact Factor