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Does Femoral Anteversion Play a Role in the Pathomechanics and Subsequent Surgical Treatment of Femoroacetabular Impingement? (SS-44)
ABSTRACTS vessels into the femoral head. During the arthroscopy the retinacular vessels were identified prior to the bump resection. One year after hip-arthroscopy a clinical evaluation was realized to exclude avascular necrosis (AVN) of the femoral head. Results: The mean distance between the most anterior foramina to the lateral limit of the femoral bump was 6.1 mm (1.1mm-17 mm). In the clinical evaluation 1 year after arthroscopy no patient presented with clinical signs suggesting AVN of the femoral head. Conclusion: A CTscan with 3-D reconstruction helps to identify the lateral limit of the femoral bump and the entry point of the retinacular vessels into the femoral head. Because the lateral limit of the femoral bump extends close to the retinacular vessels, we recommend arthroscopic visualization of these vessels prior to the resection of the lateral portion of the femoral bump. Does Femoral Anteversion Play a Role in the Pathomechanics and Subsequent Surgical Treatment of Femoroacetabular Impingement? (SS-44) Marc J. Philippon, M.D., Leandro Ejnisman, M.D., Andrew T. Pennock, M.D., Charles Ho, M.D., Ph.D., Mackenzie Herzog, B.A., Pisit Lertwanich, M.D., Karen K. Briggs, M.P.H. Introduction: While much attention has been given to variations in proximal femoral and acetabular anatomy in femoroacetabular impingement (FAI), less attention has been focused on the role of femoral version. We hypothesized that patients with significant variations in femoral version would have differing preoperative examinations and intraoperative hip pathology. The study purpose was to (1) describe values for femoral anteversion in FAI patients measured by MRI, (2) report the relationship between physical examination findings in patients undergoing hip arthroscopy for FAI and femoral version, and (3) report the relationship between increased and decreased femoral anteversion and intraoperative findings during hip arthroscopy. Methods: After IRB approval was obtained, we retrospectively reviewed prospectively collected data on 188 patients (204 hips). Data analyzed included patient demographics, physical examination measurements, radiographic data, and intra-operative findings. Femoral version was measured on MRI by a fellowship trained musculoskeletal radiologist. Results: The mean age of the patient population was 35 years (range, 18-62 years); 100 patients were males and 88 were females. Mean femoral version was 9 degrees (range, ⫺10 to 27). No relationship was found between
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femoral version and patient demographics (age, gender, weight, height and BMI). There was a significant correlation between version degrees and external rotation and internal rotation degrees, respectively (r⫽⫺0.208; p⫽0.027 and r⫽0.231; p⫽0.002). Intra-operative findings demonstrated that femoral version greater than 15 degrees was related to larger labral tears; patients with anteversion greater than 15 degrees had a mean tear size of 38mm, while patients with less than 5 degrees of anteversion had tear sizes of 30mm and patients with angles between 5 and 15 degrees had tear sizes of 34mm (p⫽0.008). Hips with femoral version greater than 15° were 2.2 times more likely (95% CI: 1.2 to 4.1) to have labral tears that extended beyond the 3 o’clock position (normalizing all hips as right hips), denoting more anterior tears. Patients requiring a psoas release were more likely to have higher version angles (8 vs. 11 degrees, p⫽0.023). Conclusion: Femoral neck version angles are similar between FAI patients and the normal population. Patients with increased anteversion may be more likely to develop “psoas impingement” causing larger labral tears that extend more anteriorly and frequently require a psoas release. Femoral version plays a role in FAI pathomechanics and should be taken in consideration during treatment planning. Arthroscopic Repair of Peripheral TFCC Tears; Long-Term Follow-Up (SS-45) Michael R. Redler, M.D., Steven P. Fries, PA-C Introduction: The purpose of this study is to evaluate long-term follow-up of arthroscopic repair of TFCC tears utilizing the shuttle relay technique. Methods: Wrist arthroscopy was performed on all patients using distraction with a wrist arthroscopy tower. Local synovectomy is performed using a 3.0 mm oscillating full radius shaver placed in the 4-5 portal. The shaver is also used to freshen the leading edge of the torn peripheral TFCC. The adjacent edge of the ulnotriquetral ligament can also be freshened using the shaver to improve healing potential. Percutaneous placement of an 18-gauge spinal needle is then placed in the safe zone along the ulnar aspect of the wrist between flexor carpi ulnaris and extensor carpi ulnaris. The tip of the spinal needle pierces the ulnotriquetral ligament and the leading edge of the torn peripheral TFCC. A shuttle relay is then passed through the spinal needle and brought out the cannula in the 4-5 portal using a grasper. The shuttle relay is then used to pull one end of the suture through the peripheral tear and out the 4-5 portal cannula.
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femoral version and patient demographics (age, gender, weight, height and BMI). There was a significant correlation between version degrees and external rotation and internal rotation degrees, respectively (r⫽⫺0.208; p⫽0.027 and r⫽0.231; p⫽0.002). Intra-operative findings demonstrated that femoral version greater than 15 degrees was related to larger labral tears; patients with anteversion greater than 15 degrees had a mean tear size of 38mm, while patients with less than 5 degrees of anteversion had tear sizes of 30mm and patients with angles between 5 and 15 degrees had tear sizes of 34mm (p⫽0.008). Hips with femoral version greater than 15° were 2.2 times more likely (95% CI: 1.2 to 4.1) to have labral tears that extended beyond the 3 o’clock position (normalizing all hips as right hips), denoting more anterior tears. Patients requiring a psoas release were more likely to have higher version angles (8 vs. 11 degrees, p⫽0.023). Conclusion: Femoral neck version angles are similar between FAI patients and the normal population. Patients with increased anteversion may be more likely to develop “psoas impingement” causing larger labral tears that extend more anteriorly and frequently require a psoas release. Femoral version plays a role in FAI pathomechanics and should be taken in consideration during treatment planning. Arthroscopic Repair of Peripheral TFCC Tears; Long-Term Follow-Up (SS-45) Michael R. Redler, M.D., Steven P. Fries, PA-C Introduction: The purpose of this study is to evaluate long-term follow-up of arthroscopic repair of TFCC tears utilizing the shuttle relay technique. Methods: Wrist arthroscopy was performed on all patients using distraction with a wrist arthroscopy tower. Local synovectomy is performed using a 3.0 mm oscillating full radius shaver placed in the 4-5 portal. The shaver is also used to freshen the leading edge of the torn peripheral TFCC. The adjacent edge of the ulnotriquetral ligament can also be freshened using the shaver to improve healing potential. Percutaneous placement of an 18-gauge spinal needle is then placed in the safe zone along the ulnar aspect of the wrist between flexor carpi ulnaris and extensor carpi ulnaris. The tip of the spinal needle pierces the ulnotriquetral ligament and the leading edge of the torn peripheral TFCC. A shuttle relay is then passed through the spinal needle and brought out the cannula in the 4-5 portal using a grasper. The shuttle relay is then used to pull one end of the suture through the peripheral tear and out the 4-5 portal cannula.