Extra-articular Hip Impingement: Anterior Inferior Iliac Spine/Subspine Impingement, Ischiofemoral, and Anterior and Lateral Greater Trochanteric-Pelvic Impingement

2018 ◽  
Vol 02 (03) ◽  
pp. 126-134
Author(s):  
Ira Zaltz ◽  
Christopher Larson
Keyword(s):  
Femoral Neck ◽  
External Rotation ◽  
Treatment Options ◽  
Rectus Femoris ◽  
Ischial Tuberosity ◽  
Anterior Inferior Iliac Spine ◽  
Leg Length ◽  
Greater Trochanter ◽  
Avulsion Fractures ◽  
Hip Impingement

AbstractAlthough femoroacetabular impingement (FAI) is traditionally considered an intra-articular phenomenon, the result of abutment between the femoral head and/or neck and the acetabular rim, there are unique and relatively uncommon patterns of pathologic extra-articular hip impingement that can mimic the clinical presentation and clinical findings of traditional FAI. Anterior inferior iliac spine (AIIS) or “subspine” impingement may occur as a consequence of an abnormally anterior or distal prominence of the AIIS that may be developmental, posttraumatic, or the result of high range of motion (ROM) activities. This type of impingement can crush the capsule, labrum, and rectus femoris between the AIIS and distal femoral neck in straight hip flexion. Greater trochanteric/pelvic impingement is quite complex and can be further divided into three unique anatomic patterns. Anterior greater trochanteric–pelvic impingement is the result of impingement between the anterior hip soft tissue structures or the anterior facet/greater trochanter and anterolateral rim/lateral AIIS and pelvis when the hip is flexed, internally rotated, and abducted. This can occur in association with a prominent greater trochanter, short femoral neck, relative femoral retrotorsion, and high ROM activities. Lateral greater trochanteric–pelvic impingement is the result of impingement between an abnormally prominent or a high riding greater trochanter with a short femoral neck and the lateral pelvis when the hip is abducted. This type of impingement is characteristic of a Perthes-like hip and, in extreme cases, can be associated with severe leg length discrepancy (and abductor muscle dysfunction). Posterior greater trochanteric–pelvic/ischiofemoral impingement is the result of impingement of the quadratus femoris and/or proximal hamstring tendons between the lesser trochanter or posterior proximal femur and intertrochanteric line and the ischial tuberosity when the hip is extended and external rotated (ER). This can occur in association with deformities of the ischial tuberosity caused by prior avulsion fractures, lesser trochanteric overgrowth, extreme coxa valga, femoral antetorsion, complex proximal femoral developmental deformities, and activities requiring high degrees of extension and external rotation. A thorough understanding of these unique patterns of impingement, their clinical presentations, and complex treatment options can help in optimizing outcomes and minimizing complications in this very challenging patient population.

Hip morphology predicts posterior hip impingement in a cadaveric model

2018 ◽  
Vol 29 (3) ◽  
pp. 322-327 ◽  
Author(s):  
William Z Morris ◽  
Cody A Fowers ◽  
Douglas S Weinberg ◽  
Michael B Millis ◽  
Leigh-Anne Tu ◽  
...  
Keyword(s):  
Femoral Neck ◽  
External Rotation ◽  
Ischial Tuberosity ◽  
Acetabular Version ◽  
Lesser Trochanter ◽  
Neck Shaft Angle ◽  
Hip Impingement ◽  
Hip Morphology ◽  
Shaft Angle ◽  
Coxa Valga

Introduction: Posterior hip impingement is a recently-identified cause of hip pain. The purpose of this study is to characterise posterior femoroacetabular and ischiofemoral impingement and identify its predisposing morphologic traits. Methods: Two hundred and six cadaveric hips were randomly selected and taken through controlled motion in two pure axes associated with posterior hip impingement: external rotation (through the mechanical axis) and adduction (coronal plane). The range of motion and location of impingement was noted for each specimen. Morphologic traits including femoral/acetabular version, and true neck-shaft angle (TNSA) were also measured. Results: External rotation impingement occurred between the femoral neck and acetabulum in 83.0% of hips, and between the lesser trochanter and ischial tuberosity in 17.0%. Adduction impingement occurred between the lesser trochanter and ischial tuberosity in 78.6% of hips, and between the femoral neck and acetabulum in 21.4%. Multiple regression revealed that increased femoral/acetabular version predicted earlier external rotation and adduction impingement. Unstandardised betas ranging from −0.39 to −0.64 reflect that each degree of increased femoral/acetabular version individually accounts for a loss of external rotation or adduction of approximately half a degree before impingement ( p < 0.001 for each). Increased TNSA was associated with earlier adduction impingement only (unstandardised beta −0.35, p = 0.005). Discussion: Relative femoral/acetabular anteversion was associated with earlier posterior hip impingement. Coxa valga was associated with earlier adduction impingement, but protective against external rotation impingement. These findings highlight the importance of monitoring correction during femoral/acetabular osteotomies, as overcorrection of retroversion may predispose to earlier posterior impingement.

scholarly journals Adolescent Anterior Inferior Iliac Spine Avulsion Fracture Operative Treatment

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0021 ◽  
Author(s):  
Gökhan Polat ◽  
Gökhan Karademir ◽  
Yücel Bilgin ◽  
Fevzi Birişik ◽  
Mehmet Demirel ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Avulsion Fracture ◽  
Bone Fractures ◽  
External Rotation ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Pubic Bone ◽  
Anterior Inferior Iliac Spine ◽  
Avulsion Fractures

Objectives: Pelvic apophysis injuries are generally seen in adolescents and encountered in the form of avulsion fractures which occur with the short-term contractions of the muscles that hold apophysis, following a trauma. In general the iliac crest, the anterior superior iliac spine (ASIS) and the pubic bone fractures are frequently seen but anterior inferior iliac spine (AIIS) fractures are rare. These cases are often treated conservatively, surgical treatment is rarely necessary. In this presentation, AIIS avulsion fracture case that had undergone surgery and had been followed for 14 years was aimed to be stated. Methods: 16 year old male patient who was suffering from sports injuries that happened 40 days ago was admitted to our clinic in February 2000 with complaints about left hip and groin pain. Physical examination and radiographic evaluation of the patient identified left hip AIIS avulsion fracture. Due to more than 2 cm fracture fragment displacement and the patient being a professional football player who had high functional expectations, surgical treatment was planned. Under general anesthesia, after open reduction, internal fixation was performed with 1 cannulated screw. There were no complications observed at follow-up. Patient returned to training at 3 months postoperatively. 14 years after surgery, the patient admitted to a neurologist with complaints of headache and MRI was required to establish the cause. The patient admitted to our clinic in order to get the confirmation whether his implant was MRI compatible. Results: On clinical assessment, after 14 years, the patient didn’t have any complaints at left hip. Left hip flexion was 120°, extension was full, abduction was 40°, adduction was 20°, flexion internal rotation was 30° and flexion external rotation was 40°. Radiographs of the pelvis were normal. On the patient's functional assessment, modified Harris Hip Score was 100. Conclusion: Pelvic apophysis injuries are rare injuries seen in adolescents usually as avulsion fractures. These injuries are often treated conservatively however may require surgical treatment for professional athletes with a high functional expectations. In this patient who underwent surgery, at the end of the 14-years long follow-up, functional results were found to be close to perfect.

scholarly journals Operative Treatment of a Complete Rupture of the Origination of the Rectus Femoris

2009 ◽  
Vol 1 (6) ◽  
pp. 478-480 ◽  
Author(s):  
Craig R. Bottoni ◽  
Jean-Claude G. D’Alleyrand
Keyword(s):  
Surgical Repair ◽  
Treatment Options ◽  
Rectus Femoris ◽  
Operative Management ◽  
Anterior Inferior Iliac Spine ◽  
Resonance Imaging ◽  
Male Athlete ◽  
Military Duty ◽  
Direct Head ◽  
Bone Tunnels

A 23-year-old male athlete reported both feeling and hearing a pop in his anterior thigh while sprinting. This was followed by immediate pain and an inability to walk. He had swelling and tenderness in his inguinal region. Radiographs were normal. An magnetic resonance imaging revealed a complete avulsion of the rectus femoris from its origin on the anterior inferior iliac spine. Following discussions of his treatment options, the patient chose to undergo operative management of the injury. A surgical repair was performed of the tendon of the direct head to the anterior inferior iliac spine through bone tunnels. He had a full recovery over the next 6 months and subsequently returned to unrestricted active military duty.

scholarly journals Hip Impingement after Anterior Inferior Iliac Spine Avulsion Fractures: A Case Report with Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Mark J. Lambrechts ◽  
Aaron D. Gray ◽  
Dan G. Hoernschemeyer ◽  
Sumit Kumar Gupta
Keyword(s):  
Heterotopic Ossification ◽  
Health Care Providers ◽  
Return To Sport ◽  
Care Providers ◽  
Anterior Inferior Iliac Spine ◽  
Review Of The Literature ◽  
Avulsion Fractures ◽  
Excellent Outcome ◽  
Hip Impingement ◽  
Hip Flexion

Avulsion fractures of the anterior inferior iliac spine (AIIS) are rare injuries in adolescent athletes. We present a case of a 15-year-old male who sustained an avulsion injury to his right AIIS when kicking a soccer ball. The patient had chronic pain and extra-articular subspinal impingement leading to decreased hip flexion and rotation. The injury occurred 1.5 years prior to symptom onset, and we were the first health care providers to manage the injury. We attempted six months of nonoperative management including activity modifications and nonsteroidal anti-inflammatory (NSAID) therapy without improvement. Although this injury can often be managed nonoperatively, his symptoms required excision of the AIIS and associated heterotopic ossification. He had an excellent outcome with return to soccer and no pain at his final follow-up visit two years after surgery. Due to the limited literature guiding the surgeon’s management of AIIS avulsion injuries with associated heterotopic ossification, we provide a review of the literature detailing pre- and postoperative ranges of motion, surgical approach, fixation or excision of the avulsion fragment, and return to sport in this patient population.

Rare case of symptomatic calcific tendinopathy of the origin of rectus femoris tendon

2020 ◽  
Vol 13 (12) ◽  
pp. e236809
Author(s):  
Tarang Jethwa ◽  
Andre Abadin ◽  
George Pujalte
Keyword(s):  
Rare Case ◽  
Treatment Options ◽  
Rectus Femoris ◽  
Hip Pain ◽  
Anterior Inferior Iliac Spine ◽  
X Ray ◽  
Calcific Tendinopathy ◽  
X Ray Imaging ◽  
Inflammatory Drugs ◽  
Active Patients

Although calcific tendinopathy of the shoulder is a relatively common clinical diagnosis, calcific tendinopathy of the rectus femoris tendon near its origin at the anterior inferior iliac spine is rare. We present a case of a 53-year-old female avid runner with left hip pain. Clinical evaluation and X-ray imaging led to a diagnosis of calcific tendinopathy of the rectus femoris tendon. The patient was treated conservatively with non-steroidal anti-inflammatory drugs, physical therapy and rest. Calcific tendinopathy of the rectus femoris tendon can occur rarely in active patients and may be a cause of hip pain, responsive to conservative management, but with other treatment options possible if recalcitrant.

scholarly journals Impingement around the hip: beyond cam and pincer

2018 ◽  
Vol 3 (2) ◽  
pp. 30-38 ◽  
Author(s):  
Niels Hendrik Bech ◽  
Daniel Haverkamp
Keyword(s):  
Data Analysis ◽  
Surgical Treatment ◽  
Search Strategy ◽  
Treatment Options ◽  
Relevant Literature ◽  
Comparable Data ◽  
Anterior Inferior Iliac Spine ◽  
Clinical Tests ◽  
Hip Impingement ◽  
Different Types

In this review, we bring to the attention of the reader three relatively unknown types of hip impingement. We explain the concept of low anterior inferior iliac spine (AIIS) impingement, also known as sub-spine impingement, ischio-femoral impingement (IFI) and pelvi-trochanteric impingement. For each type of impingement, we performed a search of relevant literature. We searched the PubMed, Medline (Ovid) and Embase databases from 1960 to March 2016. For each different type of impingement, a different search strategy was conducted. In total, 19 studies were included and described. No data analysis was performed since there was not much comparable data between studies. An overview of symptoms, clinical tests and possible surgical treatment options for the three different types of extra-articular impingement is provided. Several disorders around the hip can cause similar complaints. Therefore, we plead for a standardized classification. In young and athletic patients, in particular, there is much to gain if hip impingement is diagnosed early. Cite this article: EFORT Open Rev 2018;3:30-38. DOI: 10.1302/2058-5241.3.160068

scholarly journals Neglected femoral neck fractures in cerebral palsy: a narrative review

2020 ◽  
Vol 5 (1) ◽  
pp. 58-64
Author(s):  
Giuseppe Toro ◽  
Antimo Moretti ◽  
Marco Paoletta ◽  
Annalisa De Cicco ◽  
Adriano Braile ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Femoral Neck ◽  
Motor Function ◽  
Treatment Options ◽  
High Morbidity ◽  
Fibular Graft ◽  
Motor Impairments ◽  
High Prevalence ◽  
Neck Fracture

Hip fractures are severe conditions with a high morbidity and mortality, especially when the diagnosis is delayed, and if formulated over 30 days after the injury, is termed a ‘neglected femoral neck fracture’ (NFNF). Cerebral palsy (CP) is probably one of the major risk factors for NFNF in Western countries, mainly because of both cognitive and motor impairments. However, considering the high prevalence of fractures in these patients, the incidence of NFNF in this population is probably underestimated, and this condition might result in persistent hip or abdominal pain. Several techniques are available for the treatment of NFNF (i.e. muscle pedicle bone graft, fixation with fibular graft, valgisation osteotomy), but most of them could affect motor function. Motor function must be preserved for as long as possible, in order to enhance the quality of life of CP patients. After discussing published NFNF cases in CP patients and available treatment options, a practical approach is proposed to facilitate the orthopaedic surgeon to both early identify and appropriately manage these challenging fractures. Cite this article: EFORT Open Rev 2020;5:58-64. DOI: 10.1302/2058-5241.5.190019

Changes in muscle activities and kinematics due to simulated leg length inequalities

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Hannah Lena Siebers ◽  
Jörg Eschweiler ◽  
Filippo Migliorini ◽  
Valentin Michael Quack ◽  
Markus Tingart ◽  
...  
Keyword(s):  
Muscle Activity ◽  
Rectus Femoris ◽  
Knee Extension ◽  
Pelvic Obliquity ◽  
Lateral Flexion ◽  
Leg Length ◽  
Joint Angles ◽  
Leg Muscles ◽  
Compensation Mechanisms ◽  
Musculoskeletal Problems

Abstract Muscle imbalances are a leading cause of musculoskeletal problems. One example are leg length inequalities (LLIs). This study aimed to analyze the effect of different (simulated) LLIs on back and leg muscles in combination with kinematic compensation mechanics. Therefore, 20 healthy volunteers were analyzed during walking with artificial LLIs (0–4 cm). The effect of different amounts of LLIs and significant differences to the reference condition without LLI were calculated of maximal joint angles, mean muscle activity, and its symmetry index. While walking, LLIs led to higher muscle activity and asymmetry of back muscles, by increased lumbar lateral flexion and pelvic obliquity. The rectus femoris showed higher values, independent of the amount of LLI, whereas the activity of the gastrocnemius on the shorter leg increased. The hip and knee flexion of the long leg increased significantly with increasing LLIs, like the knee extension and the ankle plantarflexion of the shorter leg. The described compensation mechanisms are explained by a dynamic lengthening of the short and shortening of the longer leg, which is associated with increased and asymmetrical muscle activity. Presenting this overview is important for a better understanding of the effects of LLIs to improve diagnostic and therapy in the future.

scholarly journals Epiphysiodesis for the treatment of tall stature and leg length discrepancy

2021 ◽  
Author(s):  
Madeleine Willegger ◽  
Markus Schreiner ◽  
Alexander Kolb ◽  
Reinhard Windhager ◽  
Catharina Chiari
Keyword(s):  
Surgical Planning ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Bone Age ◽  
Leg Length Discrepancy ◽  
Tall Stature ◽  
Complication Rates ◽  
Leg Length ◽  
Growth Prediction ◽  
Length Discrepancy

SummaryPainful orthopedic conditions associated with extreme tall stature and leg length discrepancy (LLD) include back pain and adopting bad posture. After failure of conservative treatment options, blocking of the growth plates (epiphysiodesis) around the knee emerged as gold standard in patients with tall stature and LLD in the growing skeleton. Surgical planning includes growth prediction and evaluation of bone age. Since growth prediction is associated with a certain potential error, adequate planning and timing of epiphysiodesis are the key for success of the treatment. LLD corrections up to 5 cm can be achieved, and predicted extreme tall stature can be limited. Percutaneous epiphysiodesis techniques are minimally invasive, safe and efficient methods with low complication rates. In general, a multidisciplinary approach should be pursued when treating children and adolescents with tall stature.

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