Endoscopic Shelf Acetabuloplasty Combined With Labral Repair, Cam Osteochondroplasty, and Capsular Plication for Treating Developmental Hip Dysplasia

Background: Knowledge of clinical outcomes and return to artistic activities after endoscopic shelf acetabuloplasty (ESA) for acetabular dysplasia in artistic athletes is lacking. Hypothesis: Hip arthroscopic surgery including ESA will enable artistic athletes to return to their activities with a high success rate, significantly improved acetabular coverage, and preserved joint cartilage. Study Design: Case series; Level of evidence, 4. Methods: We reviewed 28 hips in 23 female artistic athletes (14 ballet, 9 rhythmic gymnastics, 4 dance, and 1 baton twirling) who underwent arthroscopic labral preservation, capsular plication, and ESA. Their mean age was 25.8 ± 10.2 years. Preoperatively, all patients had generalized joint laxity (Beighton score, 7.1 ± 1.8). We evaluated preoperative and postoperative radiographs and outcome scores including the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), International Hip Outcome Tool 12 (iHOT-12), Vail Hip Score (VHS), and Hip Outcome Score–Sports (HOS— Sports). Statistical analysis was performed using paired t tests and Bonferroni correction. Results: The mean follow-up was 32.5 ± 12.5 months. The mean lateral center-edge angle significantly increased from preoperatively (15.7° ± 5.3°) to postoperatively (39.8° ± 8.2°; P < .001) and at the final follow-up (33.7° ± 8.6°; P < .001). The vertical-center-anterior angle significantly improved from preoperatively (16.2° ± 8.8°) to final follow-up (33.6° ± 8.0°; P < .001). All hips maintained a Tönnis grade of 0 or 1 at the final follow-up. Overall, 20 patients (87%) were able to return to their preinjury level. All outcome scores improved from preoperatively to postoperatively: mHHS, from 68.5 ± 18.1 to 88.3 ± 18.5; NAHS, from 50.8 ± 17.7 to 69.0 ± 11.4; iHOT-12, from 36.9 ± 19.3 to 75.2 ± 19.8; VHS, from 53.8 ± 13.7 to 79.4 ± 19.4; and HOS--Sports, from 59.9 ± 17.0 to 79.6 ± 21.3 ( P < .001 for all). In total, 3 patients could not return to artistic activities as the result of postoperative deep gluteal syndrome. Conclusion: ESA concomitant with labral repair, cam osteoplasty, and capsular plication to treat dysplastic hips in patients with joint laxity enabled artistic athletes to return to their activities with a high success rate.

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Long-term Outcome of Delayed Diagnosis of Developmental Hip Dysplasia

AAP Grand Rounds ◽

10.1542/gr.44-5-53 ◽

2020 ◽

Vol 44 (5) ◽

pp. 53-53

Keyword(s):

Hip Dysplasia ◽

Delayed Diagnosis ◽

Developmental Hip Dysplasia ◽

Term Outcome ◽

Long Term Outcome

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Mapping of the Inferior Glenohumeral Ligament for Suture Pullout Strength: A Biomechanical Analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120969640 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712096964

Author(s):

Sumit Raniga ◽

Joseph Cadman ◽

Danè Dabirrahmani ◽

David Bui ◽

Richard Appleyard ◽

...

Keyword(s):

Range Of Motion ◽

Biomechanical Study ◽

Labral Repair ◽

Pullout Strength ◽

Recurrent Instability ◽

Glenohumeral Ligament ◽

Time Zero ◽

Capsular Plication ◽

Inferior Glenohumeral Ligament ◽

The Impact

Background: Suture pullout during rehabilitation may result in loss of tension in the inferior glenohumeral ligament (IGHL) and contribute to recurrent instability after capsular plication, performed with or without labral repair. To date, the suture pullout strength in the IGHL is not well-documented. This may contribute to recurrent instability. Purpose/Hypothesis: A cadaveric biomechanical study was designed to investigate the suture pullout strength of sutures in the IGHL. We hypothesized that there would be no significant variability of suture pullout strength between specimens and zones. Additionally, we sought to determine the impact of early mobilization on sutures in the IGHL at time zero. We hypothesized that capsular plication sutures would fail under low load. Study Design: Descriptive laboratory study. Methods: Seven fresh-frozen cadaveric shoulders were dissected to isolate the IGHL complex, which was then divided into 18 zones. Sutures in these zones were attached to a linear actuator, and the resistance to suture pullout was recorded. A suture pullout strength map of the IGHL was constructed. These loads were used to calculate the load applied at the hand that would initiate suture pullout in the IGHL. Results: Mean suture pullout strength for all specimens was 61.6 ± 26.1 N. The maximum load found to cause suture pullout through tissue was found to be low, regardless of zone of the IGHL. Calculations suggest that an external rotation force applied to the hand of only 9.6 N may be sufficient to tear capsular sutures at time zero. Conclusion: This study did not provide clear evidence of desirable locations for fixation in the IGHL. However, given the low magnitude of failure loads, the results suggest the timetable for initiation of range-of-motion exercises should be reconsidered to prevent suture pullout through the IGHL. Clinical Relevance: From this biomechanical study, the magnitude of force required to cause suture pullout through the IGHL is met or surpassed by normal postoperative early range-of-motion protocols.

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