Paper # 43: Contributions of the Iliofemoral Ligaments and the Acetabular Labrum in Hip Stability

2011 ◽  
Vol 27 (10) ◽  
pp. e96-e97 ◽  
Author(s):  
Marc J. Philippon ◽  
Casey A. Myers ◽  
W. Wesley Pennington ◽  
Pisit Lertwanich ◽  
Leandro Ejnisman ◽  
...  
Keyword(s):  
Acetabular Labrum ◽  
Hip Stability

The Hip Suction Seal, Part I: The Role of Acetabular Labral Height on Hip Distractive Stability

2020 ◽  
Vol 48 (11) ◽  
pp. 2726-2732 ◽  
Author(s):  
Hunter W. Storaci ◽  
Hajime Utsunomiya ◽  
Bryson R. Kemler ◽  
Samuel I. Rosenberg ◽  
Grant J. Dornan ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Clinical Effects ◽  
Acetabular Labrum ◽  
Peak Negative Pressure ◽  
Hip Stability ◽  
New Strategy ◽  
Fresh Frozen ◽  
Articular Pathology ◽  
Distraction Force ◽  
Suction Seal

Background: The acetabular labrum has been found to provide a significant contribution to the distractive stability of the hip. However, the influence of labral height on hip suction seal biomechanics is not known. Hypothesis: The smaller height of acetabular labrum is associated with decreased distractive stability. Study Design: Descriptive laboratory study. Methods: A total of 23 fresh-frozen cadaveric hemipelvises were used in this study. Hips with acetabular dysplasia or femoroacetabular impingement–related bony morphologic features, intra-articular pathology, or no measurable suction seal were excluded. Before testing, each specimen’s hip capsule was removed, a pressure sensor was placed intra-articularly, and the hip was fixed in a heated saline bath. Labral size was measured by use of a digital caliper. Maximum distraction force, distance to suction seal rupture, and peak negative pressure were recorded while the hip underwent distraction at a rate of 0.5 mm/s. Correlations between factors were analyzed using the Spearman rho, and differences between groups were detected using Mann-Whitney U test. Results: Of 23 hips, 12 satisfied inclusion criteria. The maximum distraction force and peak negative pressure were significantly correlated ( R = −0.83; P = .001). Labral height was largely correlated with all suction seal parameters (maximum distraction force, R = 0.69, P = .013; distance to suction seal rupture, R = 0.55, P = .063; peak negative pressure, R = −0.62, P = .031). Labral height less than 6 mm was observed in 5 hips, with a mean height of 6.48 mm (SD, 2.65 mm; range, 2.62-11.90 mm; 95% CI, 4.80-8.17 mm). Compared with the 7 hips with larger labra (>6 mm), the hips with smaller labra had significantly shorter distance to suction seal rupture (median, 2.3 vs 7.2 mm; P = .010) and significantly decreased peak negative pressure (median, −59.3 vs −66.9 kPa; P = .048). Conclusion: Smaller height (<6 mm) of the acetabular labrum was significantly associated with decreased distance to suction seal rupture and decreased peak negative pressure. A new strategy to increase the size of the labrum, such as labral augmentation, could be justified for patients with smaller labra in order to optimize the hip suction seal. Clinical Relevance: The height of the acetabular labrum is correlated with hip suction seal biomechanics. Further studies are required to identify the clinical effects of labral height on hip stability.

Biomechanical evaluation contribution of the acetabular labrum to hip stability

2015 ◽  
Vol 24 (7) ◽  
pp. 2338-2345 ◽  
Author(s):  
Pisit Lertwanich ◽  
Anton Plakseychuk ◽  
Scott Kramer ◽  
Monica Linde-Rosen ◽  
Akira Maeyama ◽  
...  
Keyword(s):  
Acetabular Labrum ◽  
Hip Stability ◽  
Biomechanical Evaluation

Role of the Acetabular Labrum and the Iliofemoral Ligament in Hip Stability

2011 ◽  
Vol 39 (1_suppl) ◽  
pp. 85-91 ◽  
Author(s):  
Casey A. Myers ◽  
Bradley C. Register ◽  
Pisit Lertwanich ◽  
Leandro Ejnisman ◽  
W. Wes Pennington ◽  
...  
Keyword(s):  
Acetabular Labrum ◽  
Hip Stability ◽  
Iliofemoral Ligament

Effect of Acetabular Labrum Tears on Hip Stability and Labral Strain in a Joint Compression Model

2011 ◽  
Vol 39 (1_suppl) ◽  
pp. 103-110 ◽  
Author(s):  
Matthew V. Smith ◽  
Hemang B. Panchal ◽  
Ramon A. Ruberte Thiele ◽  
Jon K. Sekiya
Keyword(s):  
Acetabular Labrum ◽  
Compression Model ◽  
Hip Stability

Impairment Tutorial: Rating Tears of the Acetabular Labrum

2006 ◽  
Vol 11 (6) ◽  
pp. 4-7
Author(s):  
Charles N. Brooks ◽  
Richard E. Strain ◽  
James B. Talmage
Keyword(s):  
Magnetic Resonance ◽  
Hip Arthroscopy ◽  
Age Groups ◽  
Limited Range ◽  
Labral Repair ◽  
X Rays ◽  
Joint Stability ◽  
Acetabular Labrum ◽  
Complete Excision ◽  
Limited Range Of Motion

Abstract The primary function of the acetabular labrum, like that of the glenoid, is to deepen the socket and improve joint stability. Tears of the acetabular labrum are common in older adults but occur in all age groups and with equal frequency in males and females. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, is silent about rating tears, partial or complete excision, or repair of the acetabular labrum. Provocative tests to detect acetabular labrum tears involve hip flexion and rotation; all rely on production of pain in the groin (typically), clicking, and/or locking with passive or active hip motions. Diagnostic tests or procedures rely on x-rays, conventional arthrography, computerized tomography, magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and hip arthroscopy. Hip arthroscopy is the gold standard for diagnosis but is the most invasive and most likely to result in complications, and MRA is about three times more sensitive and accurate in detecting acetabular labral tears than MRI alone. Surgical treatment for acetabular labrum tears usually consists of arthroscopic debridement; results tend to be better in younger patients. In general, an acetabular labral tear, partial labrectomy, or labral repair warrants a rating of 2% lower extremity impairment. Evaluators should avoid double dipping (eg, using both a Diagnosis-related estimates and limited range-of-motion tests).

scholarly journals Allocation of Anchors During Labral Repair: A Multicenter Cohort Analysis of Labral Treatment in Hip Arthroscopy

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098198
Author(s):  
Ryan P. McGovern ◽  
John J. Christoforetti ◽  
Benjamin R. Kivlan ◽  
Shane J. Nho ◽  
Andrew B. Wolff ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Cohort Analysis ◽  
Arthroscopic Surgery ◽  
Labral Repair ◽  
Fixation Method ◽  
Entire Group ◽  
Acetabular Labrum ◽  
Level Of Evidence ◽  
Multicenter Cohort ◽  
Tear Size

Background: While previous studies have established several techniques for suture anchor repair of the acetabular labrum to bone during arthroscopic surgery, the current literature lacks evidence defining the appropriate number of suture anchors required to effectively restore the function of the labral tissue. Purpose/Hypothesis: To define the location and size of labral tears identified during hip arthroscopy for acetabular labral treatment in a large multicenter cohort. The secondary purpose was to differentiate the number of anchors used during arthroscopic labral repair. The hypothesis was that the location and size of the labral tear as well as the number of anchors identified would provide a range of fixation density per acetabular region and fixation method to be used as a guide in performing arthroscopic repair. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We used a multicenter registry of prospectively collected hip arthroscopy cases to find patients who underwent arthroscopic labral repair by 1 of 7 orthopaedic surgeons between January 2015 and January 2017. The tear location and number of anchors used during repair were described using the clockface method, where 3 o’clock denoted the anterior extent of the tear and 9 o’clock the posterior extent, regardless of sidedness (left or right). Tear size was denoted as the number of “hours” spanned per clockface arc. Chi-square and univariate analyses of variance were performed to evaluate the data for both the entire group and among surgical centers. Results: A total of 1978 hips underwent arthroscopic treatment of the acetabular labrum; the most common tear size had a 3-hour span (n = 820; 41.5%). Of these hips, 1645 received labral repair, with most common repair location at the 12- to 3-o’clock position (n = 537; 32.6%). The surgeons varied in number of anchors per repair according to labral size ( P < .001 for all), using 1 to 1.6 anchors for 1-hour tears, 1.7 to 2.4 anchors for 2-hour tears, 2.1 to 3.2 anchors for 3-hour tears, and 2.2 to 4.1 for 4-hour tears. Conclusion: Variation existed in the number of anchor implants per tear size. When labral repair involved a mean clockface arc >2 hours, at least 2 anchor points were fixated.

Inclination, hip abduction, orientation, and tone affect weight-bearing in standing devices

2021 ◽  
pp. 1-9
Author(s):  
Ginny Paleg ◽  
Wendy Altizer ◽  
Rachel Malone ◽  
Katie Ballard ◽  
Alison Kreger
Keyword(s):  
Muscle Tone ◽  
Weight Bearing ◽  
Typically Developing ◽  
Prone Positioning ◽  
Convenience Sample ◽  
Hip Stability ◽  
Normal Tone ◽  
Hip Abduction ◽  
Muscle Health ◽  
Low Tone

PURPOSE: With children who are unable to stand or walk independently in the community, therapists commonly use standing devices to assist lower-extremity weight-bearing which is important for bone and muscle health. In addition, positioning in hip abduction may improve hip stability and range of motion. This is the first study to explore the effect of angle of inclination, hip abduction, body orientation, and tone on weight-bearing in pediatric standing devices. METHODS: This descriptive exploratory study used a convenience sample of 15 participants (2 with normal tone, 5 with generalized hypotonia, and 8 with hypertonia) (mean age of 5 years and 10 months, range of 3 years 4 months to 9 years 7 months); 13 of whom used standing devices at home, as well as 2 typically developing siblings (normal tone). Each child stood in 36 positions to measure the amount of weight-bearing through footplates. RESULTS: Weight-bearing was highest with 60 degrees of abduction and no inclination (upright) in supine positioning for children with low and normal tone. Children with high muscle tone bore most weight through their feet with no abduction (feet together) and no inclination (upright) in prone positioning. Overall, supine positioning resulted in more weight-bearing in all positions for children with low and normal tone. Prone positioning resulted in slightly more weight-bearing in all positions for children with high tone. CONCLUSIONS: Weight-bearing was affected by all three of the variables (inclination, abduction, and orientation) for participants with high, normal, and low tone. To determine optimal positioning, all standers should include a system to measure where and how much weight-bearing is occurring in the device.

Constrained liners revisited: favourable mid-term results in patients with high-risk of dislocation: technical considerations for the optimal outcome

2021 ◽  
pp. 112070002110107
Author(s):  
Eustathios Kenanidis ◽  
Panagiotis Kakoulidis ◽  
Panagiotis Anagnostis ◽  
Michael Potoupnis ◽  
Eleftherios Tsiridis
Keyword(s):  
High Risk ◽  
Recurrent Dislocation ◽  
Deep Infection ◽  
Consecutive Series ◽  
Revision Thas ◽  
Hip Stability ◽  
Functional Scores ◽  
Revision Tha ◽  
The Mean

Background: The outcomes of constrained liners (CLs) in total hip arthroplasty (THA) remain inconclusive. We evaluated the mid-term performance of CLs in a consecutive series of high-risk dislocation patients undergoing primary or revision THA performed by a single surgeon. The survival, dislocation rate, complications, and functional patients’ scores were assessed. Surgical tips to enhance outcomes were reviewed. Methods: 45 patients who received the Trident Tripolar CL between 2010 to 2019 were retrospectively evaluated from Arthroplasty Registry Thessaloniki. There were 17 primary and 28 revision THAs. The primary indications for using CL were severe abductor insufficiency or comorbidities, increasing the dislocation risk in primary, and recurrent dislocation or abductor insufficiency in revision THAs. The mean patient’s age was 68.5 (±14.5) years, and the mean follow-up 3.81 (±1.66) years. Results: There were 2 dislocations and 1 deep infection in the revision group. For any reason, the cumulative 6-year survival rate was 93.3%, 100% for primary, and 89.3% for revision THAs. The mean overall CL survival was 76.3 months for any reason (95% CI, 68.1–84.5) and 80.5 months for dislocation (95% CI, 75.8–85.2). The mean postoperative functional scores were significantly improved ( p < 0.001) at the latest follow-up. Conclusions: CLs can provide hip stability and durable fixation in selected low-demand patients with high-risk for dislocation after primary and revision THA at mid-term follow-up. Careful patient selection and the refined surgical technique aiming at the neutral liner position and considering the high CLs’ offset relative to stem-neck impingement are necessary to maximise outcomes.

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