- Email: [email protected]
Hip arthroscopy for femoroacetabular impingement in professional and non-professional footballers and time to return to play
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Recueil des communications particulières / Revue de chirurgie orthopédique et traumatologique 101S (2015) e1–e38
recherchée. Le tableau clinique, le bilan radiologique et le test infiltratif permettent le plus souvent de faire le diagnostic. La reprise chirurgicale pour le changement des pièces prothétiques est une intervention lourde et incertaine. Les auteurs ont voulu démontrer l’intérêt de la ténotomie endoscopique chez des patients ayant bénéficié d’une échographie dynamique diagnostique avec un test infiltratif écho-guidé. Matériel Entre 2012 et 2015, le diagnostique échographique de conflit, par un unique radiologue, a permis l’inclusion de 20 patients porteur d’une PTH douloureuse. Ils ont tous bénéficié d’un test infiltratif sous échographie, puis d’une ténotomie endoscopique extra-articulaire du tendon de l’ilio-psoas dans le même centre. La chirurgie se déroulait en décubitus dorsal sur table ordinaire et par 2 voies d’abord antéro-latérales. Une hospitalisation de 24 heures a été nécessaire avec un appui complet et des consignes d’autorééducation en postopératoire. Une évaluation clinique pré- et postopératoire, à 6 mois minimum de la chirurgie, par les questionnaires de Womac et Harris a été réalisé. Résultats Dix-huit patients décrivaient des douleurs de l’aine lors de la flexion active de hanche. Cent pour cent des tests infiltratifs échographiques étaient positifs pour une durée variable (1 semaine à 2 ans). Dans 17 cas, il s’agissait d’un conflit contre cupule. Les voies d’abords et les couples de frottements des PTH douloureuses étaient divers et non significatifs. Chez un patient, le test infiltratif échographique est revenu positif, malgré 3 tests infiltratifs scannographiques négatifs. En préopératoire, le Harris moyen était de 58,8 points et le Womac moyen de 47,2 points. À 6 mois de la ténotomie, le Harris moyen était de 92,8 pts et le Womac moyen était de 8,3 pts. À 6 mois, 19 patients se disaient soulagés. Concernant les complications postopératoires : un hématome de cuisse a été observé, et 6 patients se sont plaint lors du suivi d’un déficit transitoire de force en flexion de hanche. Ce problème a été résolu chez l’ensemble des patients à l’aide d’un travail rééducatif. Discussion L’échographie est un examen dynamique fiable et non invasif pour le diagnostic du conflit et le test infiltratif, mais nécessite un radiologue expérimenté. La ténotomie endoscopique extra-articulaire du psoas à l’avantage d’être peu invasive, sans complication majeure, tout en permettant un résultat et une récupération rapides. Déclaration de liens d’intérêts Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts. http://dx.doi.org/10.1016/j.rcot.2015.09.320 14.
Traitement chirurgical arthroscopique des tendinopathies du tendon ilio-psoas après arthroplastie totale de hanche B. Adamczewski a,∗ , Y. Le Coniat b , M. De Gori a , P. Louis c , P. Clavert a , J.-F. Kempf a a Strasbourg, France b Auxerre, France c Reims, France ∗ Auteur correspondant. Adresse e-mail : [email protected] (B. Adamczewski) Introduction La tendinopathie de l’ilio-psoas est une des étiologies de douleurs après arthroplastie totale de hanche. La littérature est pauvre concernant sa prise en charge arthroscopique. L’objectif primaire de cette étude est d’évaluer les résultats cliniques des ténotomies arthroscopiques de l’ilio-psoas sur prothèse totale de hanche. Les objectifs secondaires sont : de préciser les étiologies de ces tendinopathies et d’analyser les facteurs influenc¸ant les résultats. L’hypothèse de l’étude est que la ténotomie arthroscopique de l’ilio-psoas permet une amélioration fonctionnelle significative sans compromettre la flexion de hanche.
Patients et méthodes Il s’agit d’une série continue, rétrospective, multicentrique, de 30 cas (28 patients). L’âge moyen était de 54,4 ans [33–69]. À la révision, une évaluation clinique selon les scores cliniques fonctionnels de Harris (HHS) et Postel–Merle d’Aubigné (PMA) a été effectuée ainsi qu’une évaluation de la force de flexion de hanche, de la douleur et de la satisfaction. Les étiologies de cette tendinopathie étaient évaluées à l’aide des données de l’imagerie ainsi que les facteurs prédictifs du résultat. Résultats Vingt-deux patients (24 hanches) étaient revus au recul moyen de 35 mois [3–62], 3 étaient perdus de vue et 3 re-opérés. On observait une amélioration fonctionnelle significative avec le score HHS passant de 42 à 79,2 au recul (p < 0,001) et le PMA moyen était de 15,6 [11–18]. La force de flexion de hanche était complète dans 15 cas (74 %), l’évaluation visuelle analogique de la douleur était à 2,4/10 [0–7]. Vingt patients (84 %) étaient satisfaits ou très satisfaits du résultat. Aucune complication n’était notée. Dix patients (37 %) étaient en échec clinique, principalement par erreurs diagnostiques. Les facteurs de bon résultat étaient : le caractère typique de la douleur et le score HHS préopératoire. Discussion La littérature confirme l’efficacité de l’arthroscopie dans cette indication avec une faible morbidité par rapport au changement acétabulaire. Conclusion Il s’agit d’une technique efficace lorsque le diagnostic est affirmé, mais ce n’est pas un « traitement de secours » pour une PTH douloureuse. Les échecs sont surtout dus à des erreurs diagnostiques. Déclaration de liens d’intérêts Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts. http://dx.doi.org/10.1016/j.rcot.2015.09.321 15.
Hip arthroscopy for femoroacetabular impingement in professional and non-professional footballers and time to return to play A. Dimitrakopoulou a,∗ , E. Schilders a , C. Kartsonaki b , C. Cooke c a Londres, UK b Oxford, UK c Leeds, UK ∗ Corresponding author. E-mail address: [email protected] (A. Dimitrakopoulou) Introduction Femoroacetabular impingement (FAI) with associated intra-articular hip pathologies is a recognised cause of pain and disability in athletes. The purpose of this study is to report the clinical outcomes and time to return to play football between professional and non-professional athletes following hip arthroscopic surgery for femoroacetabular impingement (FAI). Methods Football players were undergoing hip arthroscopy for symptomatic FAI. Demographic data, radiographic features of FAI and operative findings were recorded. The time to return to play soccer and their level of playing were documented. Athletes completed a patient satisfaction questionnaire, a visual analogue scale for pain (VAS for pain), the modified Harris Hip Score (mHHS) and Sports-score from the Hip Osteoarthritis Outcome Score (HOOS) pre- and postoperatively after an average of 3.6 years. For statistical analysis, a Cox proportional hazards model was used to examine whether professional or non-professional footballers were more likely to return faster to soccer at the same level. Results We included 50 soccer players (60 hips); 29 were professional players (36 hips) with a mean age at the time of operation 22.3 (16–35, SD 5.18) and 21 were non-professional (24 hips) with a mean age 31.6 (17–47, SD 7.78). The mean follow-up was 43.1 months (SD 14.09). Two non-professional athletes (2 hips) did not return to play because of ageing and one professional (2 hips) because of spinal surgery. For professional footballers, the mean patient satisfaction was 9.2 and for non-professional footballers was 8.75. The mean VAS scale for pain decreased considerably from
Recueil des communications particulières / Revue de chirurgie orthopédique et traumatologique 101S (2015) e1–e38
7.3 preop to 0.38 postoperatively for professional and from 6.5 preop to 1.29 postoperatively for non-professional athletes. The mean mHHS, sports score were improved for both groups. Professional footballers returned to their pre-injury level to play at a mean of 13.26 weeks (8–22, SD 2.95) and non-professional at a mean 23.3 weeks (8–54, SD 12.7). Statistical analysis showed that the hazard ratio was 1.99 (P value 0.016) suggesting that the professional players were about twice as likely to return to play football faster, at the same level than non-professional athletes. Conclusion This study demonstrates that arthroscopic treatment for FAI and associated intra-articular pathology in football players provides a significant clinical improvement and allows athletes to return to play at the same level. Professional football players are significantly more likely to return to play football faster compared to non-professional athletes. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rcot.2015.09.322 16.
Parafoveal chondral defects and associated lesions in hip arthroscopy patients
A. Acerbi , V. Ferrari , A. Fontana ∗ Fedele Intelvi, Italy ∗ Corresponding author. E-mail address: [email protected] (A. Fontana) Background Hip arthroscopy allows to accurately define and localize any chondral defect related to FAI. Both acetabular and femoral head CAM and PINCER associated lesions has been well described. To date, many concerns about their significance exist. More in detail, parafoveal chondral lesions (PCLs) are often associated with cartilage damage of other areas of the hip, and their presence could be a poor prognostic factor. Question/purposes We managed to define the arthroscopic characteristics of PCLs and to establish their importance as risk factor for other chondral defects. Methods We retrospectively review a case-control analysis of 97 patients with a PCL artroscopic diagnosed compared to 438 patients undergoing hip arthroscopy with other hip lesions. We assessed the frequency and distribution of each cartilage damage with descriptive statistics for both groups. We conducted a contingency table analysis using Chi2 (and Fisher’s exact) test to evaluate the relevance of the presence of a PCL as a risk factor for other hip lesions. We also compared the preoperative modified Harris Hip Scores between the groups in order to evaluate clinical differences. Results PCLs are more often associated with multiple hip chondral lesions in extensively damaged hips. Patients with PCLs are more symptomatic and have a worse quality of life. PCLs represent a risk factor for hip chondropathy and central osteophytes, labrum lesions and LT tears. PCLs are statistically related with PINCER morphotype of FAI. Conclusions The presence of PCLs is a very helpful index to the hip surgeon: it uncovers a major hip cartilage damage and the subsequent need to look for other hip lesions, especially in PINCER-type FAI. We expect to find a PCL in symptomatic patients with painful hip. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rcot.2015.09.323
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17.
Treatment of acetabular chondral defects in femoral acetabolar impingement. AMIC vs microfractures. A 5-year follow-up study
A. Fontana ∗ , V. Ferrari , A. Acerbi Fedele Intelvi, Italy ∗ Corresponding author. E-mail address: [email protected] (A. Fontana) Introduction Repair of chondral lesions stemming from femoroacetabular impingement requires specific therapeutic approaches, in addition to impingement treatment. This retrospective analysis of consecutive patients from a single centre compares microfracture (MFx) with the enhanced microfracture autologous matrix-induced chondrogenesis (AMIC) technique. The treatment modalities differ in that the AMIC procedure incorporates a collagen matrix, used to cover and protect the blood clot generated by microfracture (MFx). Methods Acetabular chondral lesions ranging from 2 to 8 cm2 in 77 and 70 patients were treated by MFx or AMIC, respectively. Treatment outcomes were assessed by the modified Harrison Hip Score with follow-up at 6 months, 1, 2, 3, 4, and 5 years. Both MFx and AMIC significantly improved the clinical status at 6 months and 1 year. Over the 2–5-year period, a progressive degradation of functionality was measured in the MFx group, while the positive outcomes of the AMIC group remained stable. In addition, the AMIC treatment group performed significantly better than MFx group at each long-term time point. No conversion to total hip arthroplasty (THA) was observed in the AMIC group, whereas THA was necessary in 7.8% of the patients in the MFx group. Results The results of this study provide proof that both MFx and AMIC therapy improve clinical outcomes associated with repair of acetabular chondral damage. The AMIC group showed long-term durable improvement, scoring significantly better than the MFx group, particularly in large (?4 cm2 ) lesions over the 2–5-year period examined. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rcot.2015.09.324 18.
A pitfall through the failure cases of hip arthroscopy for the labrum tear
T. Yamasaki ∗ , S. Izumi , S. Hachisuka , Y. Yasunaga , M. Ochi Hiroshima, Japon ∗ Corresponding author. E-mail address: [email protected] (T. Yamasaki) Objectives The acetabular labrum tear has been considered the most common cause of groin pain and the most frequent hip pathology. We have performed arthroscopic treatments for the labrum tear without obvious hip dysplasia. The purpose of this study is to investigate clinical outcomes of arthroscopic treatments in patients with labrum tear and to clarify the character of failure cases of hip arthroscopy for the labrum tear. Methods Seventy-four patients (78 hips) with CE angle more than 20◦ , who had labrum tear and were treated arthroscopically, were included in this study. The mean age at the primary hip arthroscopy was 42 years (12–68 years), and the mean follow-up period was 40 months (24–90 months). The labrum tear was treated with labrum debridement in 31 hips and labrum re-fixation in 47 hips. Clinical outcomes were evaluated using modified Harris Hip Score (mHHS), and fair or poor cases were investigated. FAI-related findings, including cross-over sign (COS),? angle, pistol grip deformity (PGD), head/neck offset ratio were radiographically observed. Results The mean mHHS revealed improvement from 71 points to 89 points after surgery. Progression of osteoarthritis was
Recueil des communications particulières / Revue de chirurgie orthopédique et traumatologique 101S (2015) e1–e38
recherchée. Le tableau clinique, le bilan radiologique et le test infiltratif permettent le plus souvent de faire le diagnostic. La reprise chirurgicale pour le changement des pièces prothétiques est une intervention lourde et incertaine. Les auteurs ont voulu démontrer l’intérêt de la ténotomie endoscopique chez des patients ayant bénéficié d’une échographie dynamique diagnostique avec un test infiltratif écho-guidé. Matériel Entre 2012 et 2015, le diagnostique échographique de conflit, par un unique radiologue, a permis l’inclusion de 20 patients porteur d’une PTH douloureuse. Ils ont tous bénéficié d’un test infiltratif sous échographie, puis d’une ténotomie endoscopique extra-articulaire du tendon de l’ilio-psoas dans le même centre. La chirurgie se déroulait en décubitus dorsal sur table ordinaire et par 2 voies d’abord antéro-latérales. Une hospitalisation de 24 heures a été nécessaire avec un appui complet et des consignes d’autorééducation en postopératoire. Une évaluation clinique pré- et postopératoire, à 6 mois minimum de la chirurgie, par les questionnaires de Womac et Harris a été réalisé. Résultats Dix-huit patients décrivaient des douleurs de l’aine lors de la flexion active de hanche. Cent pour cent des tests infiltratifs échographiques étaient positifs pour une durée variable (1 semaine à 2 ans). Dans 17 cas, il s’agissait d’un conflit contre cupule. Les voies d’abords et les couples de frottements des PTH douloureuses étaient divers et non significatifs. Chez un patient, le test infiltratif échographique est revenu positif, malgré 3 tests infiltratifs scannographiques négatifs. En préopératoire, le Harris moyen était de 58,8 points et le Womac moyen de 47,2 points. À 6 mois de la ténotomie, le Harris moyen était de 92,8 pts et le Womac moyen était de 8,3 pts. À 6 mois, 19 patients se disaient soulagés. Concernant les complications postopératoires : un hématome de cuisse a été observé, et 6 patients se sont plaint lors du suivi d’un déficit transitoire de force en flexion de hanche. Ce problème a été résolu chez l’ensemble des patients à l’aide d’un travail rééducatif. Discussion L’échographie est un examen dynamique fiable et non invasif pour le diagnostic du conflit et le test infiltratif, mais nécessite un radiologue expérimenté. La ténotomie endoscopique extra-articulaire du psoas à l’avantage d’être peu invasive, sans complication majeure, tout en permettant un résultat et une récupération rapides. Déclaration de liens d’intérêts Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts. http://dx.doi.org/10.1016/j.rcot.2015.09.320 14.
Traitement chirurgical arthroscopique des tendinopathies du tendon ilio-psoas après arthroplastie totale de hanche B. Adamczewski a,∗ , Y. Le Coniat b , M. De Gori a , P. Louis c , P. Clavert a , J.-F. Kempf a a Strasbourg, France b Auxerre, France c Reims, France ∗ Auteur correspondant. Adresse e-mail : [email protected] (B. Adamczewski) Introduction La tendinopathie de l’ilio-psoas est une des étiologies de douleurs après arthroplastie totale de hanche. La littérature est pauvre concernant sa prise en charge arthroscopique. L’objectif primaire de cette étude est d’évaluer les résultats cliniques des ténotomies arthroscopiques de l’ilio-psoas sur prothèse totale de hanche. Les objectifs secondaires sont : de préciser les étiologies de ces tendinopathies et d’analyser les facteurs influenc¸ant les résultats. L’hypothèse de l’étude est que la ténotomie arthroscopique de l’ilio-psoas permet une amélioration fonctionnelle significative sans compromettre la flexion de hanche.
Patients et méthodes Il s’agit d’une série continue, rétrospective, multicentrique, de 30 cas (28 patients). L’âge moyen était de 54,4 ans [33–69]. À la révision, une évaluation clinique selon les scores cliniques fonctionnels de Harris (HHS) et Postel–Merle d’Aubigné (PMA) a été effectuée ainsi qu’une évaluation de la force de flexion de hanche, de la douleur et de la satisfaction. Les étiologies de cette tendinopathie étaient évaluées à l’aide des données de l’imagerie ainsi que les facteurs prédictifs du résultat. Résultats Vingt-deux patients (24 hanches) étaient revus au recul moyen de 35 mois [3–62], 3 étaient perdus de vue et 3 re-opérés. On observait une amélioration fonctionnelle significative avec le score HHS passant de 42 à 79,2 au recul (p < 0,001) et le PMA moyen était de 15,6 [11–18]. La force de flexion de hanche était complète dans 15 cas (74 %), l’évaluation visuelle analogique de la douleur était à 2,4/10 [0–7]. Vingt patients (84 %) étaient satisfaits ou très satisfaits du résultat. Aucune complication n’était notée. Dix patients (37 %) étaient en échec clinique, principalement par erreurs diagnostiques. Les facteurs de bon résultat étaient : le caractère typique de la douleur et le score HHS préopératoire. Discussion La littérature confirme l’efficacité de l’arthroscopie dans cette indication avec une faible morbidité par rapport au changement acétabulaire. Conclusion Il s’agit d’une technique efficace lorsque le diagnostic est affirmé, mais ce n’est pas un « traitement de secours » pour une PTH douloureuse. Les échecs sont surtout dus à des erreurs diagnostiques. Déclaration de liens d’intérêts Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts. http://dx.doi.org/10.1016/j.rcot.2015.09.321 15.
Hip arthroscopy for femoroacetabular impingement in professional and non-professional footballers and time to return to play A. Dimitrakopoulou a,∗ , E. Schilders a , C. Kartsonaki b , C. Cooke c a Londres, UK b Oxford, UK c Leeds, UK ∗ Corresponding author. E-mail address: [email protected] (A. Dimitrakopoulou) Introduction Femoroacetabular impingement (FAI) with associated intra-articular hip pathologies is a recognised cause of pain and disability in athletes. The purpose of this study is to report the clinical outcomes and time to return to play football between professional and non-professional athletes following hip arthroscopic surgery for femoroacetabular impingement (FAI). Methods Football players were undergoing hip arthroscopy for symptomatic FAI. Demographic data, radiographic features of FAI and operative findings were recorded. The time to return to play soccer and their level of playing were documented. Athletes completed a patient satisfaction questionnaire, a visual analogue scale for pain (VAS for pain), the modified Harris Hip Score (mHHS) and Sports-score from the Hip Osteoarthritis Outcome Score (HOOS) pre- and postoperatively after an average of 3.6 years. For statistical analysis, a Cox proportional hazards model was used to examine whether professional or non-professional footballers were more likely to return faster to soccer at the same level. Results We included 50 soccer players (60 hips); 29 were professional players (36 hips) with a mean age at the time of operation 22.3 (16–35, SD 5.18) and 21 were non-professional (24 hips) with a mean age 31.6 (17–47, SD 7.78). The mean follow-up was 43.1 months (SD 14.09). Two non-professional athletes (2 hips) did not return to play because of ageing and one professional (2 hips) because of spinal surgery. For professional footballers, the mean patient satisfaction was 9.2 and for non-professional footballers was 8.75. The mean VAS scale for pain decreased considerably from
Recueil des communications particulières / Revue de chirurgie orthopédique et traumatologique 101S (2015) e1–e38
7.3 preop to 0.38 postoperatively for professional and from 6.5 preop to 1.29 postoperatively for non-professional athletes. The mean mHHS, sports score were improved for both groups. Professional footballers returned to their pre-injury level to play at a mean of 13.26 weeks (8–22, SD 2.95) and non-professional at a mean 23.3 weeks (8–54, SD 12.7). Statistical analysis showed that the hazard ratio was 1.99 (P value 0.016) suggesting that the professional players were about twice as likely to return to play football faster, at the same level than non-professional athletes. Conclusion This study demonstrates that arthroscopic treatment for FAI and associated intra-articular pathology in football players provides a significant clinical improvement and allows athletes to return to play at the same level. Professional football players are significantly more likely to return to play football faster compared to non-professional athletes. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rcot.2015.09.322 16.
Parafoveal chondral defects and associated lesions in hip arthroscopy patients
A. Acerbi , V. Ferrari , A. Fontana ∗ Fedele Intelvi, Italy ∗ Corresponding author. E-mail address: [email protected] (A. Fontana) Background Hip arthroscopy allows to accurately define and localize any chondral defect related to FAI. Both acetabular and femoral head CAM and PINCER associated lesions has been well described. To date, many concerns about their significance exist. More in detail, parafoveal chondral lesions (PCLs) are often associated with cartilage damage of other areas of the hip, and their presence could be a poor prognostic factor. Question/purposes We managed to define the arthroscopic characteristics of PCLs and to establish their importance as risk factor for other chondral defects. Methods We retrospectively review a case-control analysis of 97 patients with a PCL artroscopic diagnosed compared to 438 patients undergoing hip arthroscopy with other hip lesions. We assessed the frequency and distribution of each cartilage damage with descriptive statistics for both groups. We conducted a contingency table analysis using Chi2 (and Fisher’s exact) test to evaluate the relevance of the presence of a PCL as a risk factor for other hip lesions. We also compared the preoperative modified Harris Hip Scores between the groups in order to evaluate clinical differences. Results PCLs are more often associated with multiple hip chondral lesions in extensively damaged hips. Patients with PCLs are more symptomatic and have a worse quality of life. PCLs represent a risk factor for hip chondropathy and central osteophytes, labrum lesions and LT tears. PCLs are statistically related with PINCER morphotype of FAI. Conclusions The presence of PCLs is a very helpful index to the hip surgeon: it uncovers a major hip cartilage damage and the subsequent need to look for other hip lesions, especially in PINCER-type FAI. We expect to find a PCL in symptomatic patients with painful hip. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rcot.2015.09.323
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17.
Treatment of acetabular chondral defects in femoral acetabolar impingement. AMIC vs microfractures. A 5-year follow-up study
A. Fontana ∗ , V. Ferrari , A. Acerbi Fedele Intelvi, Italy ∗ Corresponding author. E-mail address: [email protected] (A. Fontana) Introduction Repair of chondral lesions stemming from femoroacetabular impingement requires specific therapeutic approaches, in addition to impingement treatment. This retrospective analysis of consecutive patients from a single centre compares microfracture (MFx) with the enhanced microfracture autologous matrix-induced chondrogenesis (AMIC) technique. The treatment modalities differ in that the AMIC procedure incorporates a collagen matrix, used to cover and protect the blood clot generated by microfracture (MFx). Methods Acetabular chondral lesions ranging from 2 to 8 cm2 in 77 and 70 patients were treated by MFx or AMIC, respectively. Treatment outcomes were assessed by the modified Harrison Hip Score with follow-up at 6 months, 1, 2, 3, 4, and 5 years. Both MFx and AMIC significantly improved the clinical status at 6 months and 1 year. Over the 2–5-year period, a progressive degradation of functionality was measured in the MFx group, while the positive outcomes of the AMIC group remained stable. In addition, the AMIC treatment group performed significantly better than MFx group at each long-term time point. No conversion to total hip arthroplasty (THA) was observed in the AMIC group, whereas THA was necessary in 7.8% of the patients in the MFx group. Results The results of this study provide proof that both MFx and AMIC therapy improve clinical outcomes associated with repair of acetabular chondral damage. The AMIC group showed long-term durable improvement, scoring significantly better than the MFx group, particularly in large (?4 cm2 ) lesions over the 2–5-year period examined. Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rcot.2015.09.324 18.
A pitfall through the failure cases of hip arthroscopy for the labrum tear
T. Yamasaki ∗ , S. Izumi , S. Hachisuka , Y. Yasunaga , M. Ochi Hiroshima, Japon ∗ Corresponding author. E-mail address: [email protected] (T. Yamasaki) Objectives The acetabular labrum tear has been considered the most common cause of groin pain and the most frequent hip pathology. We have performed arthroscopic treatments for the labrum tear without obvious hip dysplasia. The purpose of this study is to investigate clinical outcomes of arthroscopic treatments in patients with labrum tear and to clarify the character of failure cases of hip arthroscopy for the labrum tear. Methods Seventy-four patients (78 hips) with CE angle more than 20◦ , who had labrum tear and were treated arthroscopically, were included in this study. The mean age at the primary hip arthroscopy was 42 years (12–68 years), and the mean follow-up period was 40 months (24–90 months). The labrum tear was treated with labrum debridement in 31 hips and labrum re-fixation in 47 hips. Clinical outcomes were evaluated using modified Harris Hip Score (mHHS), and fair or poor cases were investigated. FAI-related findings, including cross-over sign (COS),? angle, pistol grip deformity (PGD), head/neck offset ratio were radiographically observed. Results The mean mHHS revealed improvement from 71 points to 89 points after surgery. Progression of osteoarthritis was