scholarly journals Posterolateral Acetabuloplasty and Distal Femoral Neckplasty, Labral Repair, and Capsular Plication for Hip Reverse Contre-Coupe Lesion

2017 ◽  
Vol 6 (3) ◽  
pp. e627-e634
Author(s):  
Sivashankar Chandrasekaran ◽  
John P. Walsh ◽  
David E. Hartigan ◽  
Parth Lodhia ◽  
Carlos Suarez-Ahedo ◽  
...  
Keyword(s):  
Labral Repair ◽  
Capsular Plication

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

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.

Arthroscopic separate labral repair and capsular plication with a suture anchor

2007 ◽  
Vol 128 (5) ◽  
pp. 535-538 ◽  
Author(s):  
Kyung Cheon Kim ◽  
Kwang Jin Rhee ◽  
Hyun Dae Shin ◽  
Young Mo Kim
Keyword(s):  
Suture Anchor ◽  
Labral Repair ◽  
Capsular Plication

scholarly journals Isolated arthroscopic treatment of intra-articular pathologies in mild hip dysplasia: a short-term case control study

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Enrico Tassinari ◽  
Federica Mariotti ◽  
Francesco Castagnini ◽  
Stefano Lucchini ◽  
Francesco Perdisa ◽  
...  
Keyword(s):  
Labral Repair ◽  
Control Group ◽  
Level Of Evidence ◽  
Capsular Plication ◽  
Small Series ◽  
Center Edge ◽  
Group A ◽  
Group B ◽  
Lateral Center Edge Angle

Abstract Purpose The aim is to compare the results of isolated hip arthroscopy in patients with borderline dysplasia with Lateral center edge angle (LCEA) between 18° and 25° with a control group of patients with normal LCEA (> 25°). Methods Fifty hip arthroscopies performed in 45 patients were retrospectively evaluated. Exclusion criteria were: age > 40, hip arthritis > grade 2 according to Tonnis classification, femoral head avascular necrosis, pediatric’s orthopaedics conditions and true dysplasia with LCEA < 18°.Two groups were identified: group A with 15 hips with LCEA between 25° and 18° and Group control B made of 35 hips with LCEA > 25°. Results The groups were homogeneous for demography and pre-operative WOMAC and HOOS. Osteoplasty for CAM were performed in 100% of patients in both groups, only in 12 hips (34.4%) in group B we had both femoral and acetabular osteoplasty. Labral repair was performed in 86% of patients in group A, in 60% of patients in group B, capsular plication in 93% of group A, in 5% of case of group B. WOMAC and HOOS statically significant improved in both groups at final follow-up (24 months). No cases in both groups required conversion to total hip arthroplasty. Clinical outcomes of study group were comparable to the control group. Conclusion Even if the present small series is not conclusive, we suggest isolated arthroscopic management of patients with FAI and LCEA between 18° and 25°, but capsular plication and careful labral management are strongly recommended. Level of evidence Level IV.

scholarly journals Endoscopic Shelf Acetabuloplasty Concomitant With Labral Repair, Cam Osteoplasty, and Capsular Plication to Treat Acetabular Dysplasia in Artistic Athletes: A Case Series

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110492
Author(s):  
Soshi Uchida ◽  
Yoichi Murata ◽  
Manabu Tsukamoto ◽  
Hajime Utsunomiya ◽  
Yoshiaki Yamanaka ◽  
...  
Keyword(s):  
Success Rate ◽  
Acetabular Dysplasia ◽  
Case Series ◽  
Labral Repair ◽  
High Success Rate ◽  
Capsular Plication ◽  
Outcome Scores ◽  
The Mean ◽  
Shelf Acetabuloplasty

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.

scholarly journals The Femoral Head “Divot” Sign: A Useful Arthroscopic Sign of Hip Microinstability

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712091791
Author(s):  
Philip J. Rosinsky ◽  
Ben C. Mayo ◽  
Cynthia Kyin ◽  
Jacob Shapira ◽  
David R. Maldonado ◽  
...  
Keyword(s):  
Femoral Head ◽  
Physical Examination ◽  
Hip Arthroscopy ◽  
Labral Repair ◽  
Edge Angle ◽  
Ligamentous Laxity ◽  
Capsular Plication ◽  
Center Edge ◽  
The Mean ◽  
Center Edge Angle

Background: A femoral head “divot” is a rare finding during hip arthroscopy. A linear chondral indentation can be observed on the femoral head, just lateral and parallel to the acetabular labrum. Purpose/Hypothesis: The purpose of this study was to describe a novel arthroscopic sign and retrospectively review patients with this finding. We hypothesized that this sign would be found in patients with characteristics consistent with hip microinstability. Study Design: Case series; Level of evidence, 4. Methods: Intraoperative images of patients undergoing primary hip arthroscopy between July 2017 and July 2019 were reviewed for evidence of a femoral head divot. Preoperative characteristics, physical examination findings, radiographic measurements, and magnetic resonance imaging (MRI) findings were described. Results: Of 690 available cases, 14 cases (13 patients; 2.0%) had evidence of a femoral head divot. The mean patient age was 29.1 years, and all but 1 patient (92.3%) were female. Ligamentous laxity was present in 81.8% of patients, anterior apprehension test was positive in 78.6%, and painful internal snapping was present in 50.0%. The mean lateral center-edge angle, anterior center-edge angle, and Tönnis angle were 19.2°, 20.3°, and 12.4°, respectively. The divot was identified in 5 of 12 available MRI scans, most commonly on axial proton density sequence. Intraoperatively, all hips had labral tears, iliopsoas bursitis was demonstrated in 78.6%, and the ligamentum teres was damaged in 42.9%. Labral repair was performed in 12 of the 14 hips, with 2 patients undergoing labral reconstruction. Iliopsoas fractional lengthening was performed in 50.0%, capsular plication was performed in 78.6%, and capsular repair was performed in the remainder. Conclusion: The femoral head divot sign is a rare arthroscopic finding during hip arthroscopy. The results of this study demonstrated that patients who have a divot also present with characteristic radiographic or physical examination findings of hip microinstability due to either acetabular dysplasia or ligamentous laxity. Recognition of a femoral head divot may be valuable for the diagnosis of microinstability during hip arthroscopy and may help guide appropriate management, such as capsular plication. Further studies are needed to determine the exact prevalence of the femoral head divot in patients with microinstability and to evaluate the effect of this finding on patient outcomes.

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

2014 ◽  
Vol 3 (1) ◽  
pp. e185-e191 ◽  
Author(s):  
Soshi Uchida ◽  
Takahiko Wada ◽  
Shinsuke Sakoda ◽  
Akihiro Ariumi ◽  
Akinori Sakai ◽  
...  
Keyword(s):  
Hip Dysplasia ◽  
Labral Repair ◽  
Developmental Hip Dysplasia ◽  
Capsular Plication ◽  
Shelf Acetabuloplasty

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.

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