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Outcomes of Endoscopic Gluteus Medius Repair with Minimum 2-Year Follow-up
2013 ISHA ABSTRACTS
significantly. One patient had developed a subcutaneous infection in the area of anterior approach after the first procedure. After revision the healing was undisturbed. In 2 patients we performed a RE-arthroscopy because of recurrent pain symptoms after 5 and 8 months. In both cases we found scars and adhesions in the peripheral compartment. Macroscopically complete and stable healing of the acetabular cartilage defects could be shown in both cases. Conclusions: In this ongoing study, we could show that the arthroscopic ACT3D at the hip is a safe and promising method for the treatment of CAM-induced cartilage damage of the acetabulum. The improved symptom scores, the increase of activity and quality of life as well as first radiological results after 2 years are very encouraging, but need to be diversified in further studies. Outcome and Patient Satisfaction of Middle-aged Patients Undergoing Arthroscopic Treatment of Femoroacetabular Impingement (FAI) SIMON HERRMANN, GERMANY OLIVER HAUSCHILD, GERMANY Objectives: Arthroscopic treatment of FAI has been shown to be a safe and effective procedure. Few studies have, however, focused on the results of special age groups. Aim of the study was to analyze short-term outcome following arthroscopic treatmant of FAI in middle-aged patients. Methods: 83 consecutive middle-aged patients (range, 40 to 65 years at time of index surgery) with a one-year minimum follow up following arthroscopic treatment of symptomatic FAI were included in this analysis. Primary outcome parameters were hip outcome score (HOS) at latest follow-up and self-reported patient satisfaction and functional improvement or deterioration (on an analogous scale ranging from -100 to 100%). Secondary outcome parameters included radiologic assessment of changes in alpha angles and identifcation of adverse events. Moreover, time and rate of conversion to THR and presence of cartilage lesions at time of index surgery were assessed. Results: Mean follow up was 26 months. Mean age of patients included was 48.6 years. Preoperative alpha angle was 72 , postoperative alpha angle was 55 . Degenerative cartilage lesions grade I and higher according to ICRS classification were present in 86% of patients. 16% of patients underwent THR after mean of 21 months following index procedure. Mean HOS at latest follow up was 84 points with a self-reported improvement of symptoms of +84% on average. No major complications were observed, minor complications were rare and included temporary nerve palsy and hematoma. Conclusions: Arthroscopic treatment of FAI can be considered a safe and effective procedure for middle-aged patients. On average, middle-aged patients can expect good function and subjective improvement following. However, close to one-fifth of patients will not benefit from the procedure and require early conversion to THR. In an effort to improve patient selection future analyses aiming at identification of risk factors for treatment failure are warranted.
e193
Outcomes of Endoscopic Gluteus Medius Repair with Minimum 2-Year Follow-up BRIAN GIORDANO, USA BENJAMIN DOMB, USA ITAMAR BOTSER, USA Objectives: Gluteus medius (GM) tears may be present in as many as 25% of late middle-aged women, 10% of middle-aged men, and are often misdiagnosed. Outcomes of endoscopic repair of gluteus medius tears have seldom been reported. The purpose of this study was to report the early outcomes of endoscopic repair of partial and full thickness tears of the gluteus medius. Methods: Between April 2009 and January 2010, data was prospectively collected for all patients undergoing endoscopic gluteus medius repair. Inclusion criteria for the study were patients undergoing endoscopic gluteus medius repair for either high-grade partial or full thickness tears. Only patients with endoscopic evidence of gluteus medius tear were treated surgically. In the case of articular side GM tear, a trans-tendinous repair technique was used, whereas in the presence of full thickness tear the tendon was refixated to the bone directly. Results: A total of 15 hips met the inclusion criteria. Our cohort included 14 females and one male, with an average age of 58 years old (range, 44 to 74 years). Endoscopically, six cases were found to be partial-thickness tears. Nine were either full-thickness tears or near full-thickness tears which were completed for the repair. Follow-up was obtained on all patients at an average of 27 months postoperatively (range, 24 to 33). Fourteen of the 15 patients showed post-operative improvement in all four hip specific scores, with an average improvement of more than 30 points for all scores. Satisfaction with the surgery results was reported to be “good” to “excellent” (Seven to 10 out of 10) in 13 of 15 patients. Conclusions: This study demonstrates that endoscopic surgical repair, whether performed through a trans-tendinous or full-thickness technique, can be an effective treatment of GM tears at a minimum follow-up of two years. Longer-term follow-up studies are necessary to determine whether these therapeutic and functional gains are maintained. Non-invasive Dynamic Identification of Femoroacetabular Impingement : A Cadaveric Validation Study MAARTEN RÖLING, NETHERLANDS MONIQUE VISSER, NETHERLANDS ROLF BLOEM, NETHERLANDS EDWIN OEI, NETHERLANDS GERT JAN KLEINRENSINK, NETHERLANDS PETER PILOT, NETHERLANDS Objectives: Femoroacetabular impingement (FAI) is caused by anatomic deviation of the acetabular rim or proximal femur. These deformities cause chronic groin pain and can lead to osteoarthritis of the hip joint. Radiological identification of FAI can be challenging, especially if the deformities are small. Advances in 3D imaging with the use of CT scans enable simulation of FAI but require validation to be of clinical value. In this prospective
significantly. One patient had developed a subcutaneous infection in the area of anterior approach after the first procedure. After revision the healing was undisturbed. In 2 patients we performed a RE-arthroscopy because of recurrent pain symptoms after 5 and 8 months. In both cases we found scars and adhesions in the peripheral compartment. Macroscopically complete and stable healing of the acetabular cartilage defects could be shown in both cases. Conclusions: In this ongoing study, we could show that the arthroscopic ACT3D at the hip is a safe and promising method for the treatment of CAM-induced cartilage damage of the acetabulum. The improved symptom scores, the increase of activity and quality of life as well as first radiological results after 2 years are very encouraging, but need to be diversified in further studies. Outcome and Patient Satisfaction of Middle-aged Patients Undergoing Arthroscopic Treatment of Femoroacetabular Impingement (FAI) SIMON HERRMANN, GERMANY OLIVER HAUSCHILD, GERMANY Objectives: Arthroscopic treatment of FAI has been shown to be a safe and effective procedure. Few studies have, however, focused on the results of special age groups. Aim of the study was to analyze short-term outcome following arthroscopic treatmant of FAI in middle-aged patients. Methods: 83 consecutive middle-aged patients (range, 40 to 65 years at time of index surgery) with a one-year minimum follow up following arthroscopic treatment of symptomatic FAI were included in this analysis. Primary outcome parameters were hip outcome score (HOS) at latest follow-up and self-reported patient satisfaction and functional improvement or deterioration (on an analogous scale ranging from -100 to 100%). Secondary outcome parameters included radiologic assessment of changes in alpha angles and identifcation of adverse events. Moreover, time and rate of conversion to THR and presence of cartilage lesions at time of index surgery were assessed. Results: Mean follow up was 26 months. Mean age of patients included was 48.6 years. Preoperative alpha angle was 72 , postoperative alpha angle was 55 . Degenerative cartilage lesions grade I and higher according to ICRS classification were present in 86% of patients. 16% of patients underwent THR after mean of 21 months following index procedure. Mean HOS at latest follow up was 84 points with a self-reported improvement of symptoms of +84% on average. No major complications were observed, minor complications were rare and included temporary nerve palsy and hematoma. Conclusions: Arthroscopic treatment of FAI can be considered a safe and effective procedure for middle-aged patients. On average, middle-aged patients can expect good function and subjective improvement following. However, close to one-fifth of patients will not benefit from the procedure and require early conversion to THR. In an effort to improve patient selection future analyses aiming at identification of risk factors for treatment failure are warranted.
e193
Outcomes of Endoscopic Gluteus Medius Repair with Minimum 2-Year Follow-up BRIAN GIORDANO, USA BENJAMIN DOMB, USA ITAMAR BOTSER, USA Objectives: Gluteus medius (GM) tears may be present in as many as 25% of late middle-aged women, 10% of middle-aged men, and are often misdiagnosed. Outcomes of endoscopic repair of gluteus medius tears have seldom been reported. The purpose of this study was to report the early outcomes of endoscopic repair of partial and full thickness tears of the gluteus medius. Methods: Between April 2009 and January 2010, data was prospectively collected for all patients undergoing endoscopic gluteus medius repair. Inclusion criteria for the study were patients undergoing endoscopic gluteus medius repair for either high-grade partial or full thickness tears. Only patients with endoscopic evidence of gluteus medius tear were treated surgically. In the case of articular side GM tear, a trans-tendinous repair technique was used, whereas in the presence of full thickness tear the tendon was refixated to the bone directly. Results: A total of 15 hips met the inclusion criteria. Our cohort included 14 females and one male, with an average age of 58 years old (range, 44 to 74 years). Endoscopically, six cases were found to be partial-thickness tears. Nine were either full-thickness tears or near full-thickness tears which were completed for the repair. Follow-up was obtained on all patients at an average of 27 months postoperatively (range, 24 to 33). Fourteen of the 15 patients showed post-operative improvement in all four hip specific scores, with an average improvement of more than 30 points for all scores. Satisfaction with the surgery results was reported to be “good” to “excellent” (Seven to 10 out of 10) in 13 of 15 patients. Conclusions: This study demonstrates that endoscopic surgical repair, whether performed through a trans-tendinous or full-thickness technique, can be an effective treatment of GM tears at a minimum follow-up of two years. Longer-term follow-up studies are necessary to determine whether these therapeutic and functional gains are maintained. Non-invasive Dynamic Identification of Femoroacetabular Impingement : A Cadaveric Validation Study MAARTEN RÖLING, NETHERLANDS MONIQUE VISSER, NETHERLANDS ROLF BLOEM, NETHERLANDS EDWIN OEI, NETHERLANDS GERT JAN KLEINRENSINK, NETHERLANDS PETER PILOT, NETHERLANDS Objectives: Femoroacetabular impingement (FAI) is caused by anatomic deviation of the acetabular rim or proximal femur. These deformities cause chronic groin pain and can lead to osteoarthritis of the hip joint. Radiological identification of FAI can be challenging, especially if the deformities are small. Advances in 3D imaging with the use of CT scans enable simulation of FAI but require validation to be of clinical value. In this prospective