Anteromedial Labral Tears: Surgical Prevalence and Relationship with Chondral Damage of the Hip

2019 ◽  
Vol 03 (02) ◽  
pp. 073-077
Author(s):  
Maureen Dwyer ◽  
Jo Ann Lee ◽  
Joseph C. McCarthy
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Concomitant Injuries ◽  
Chondral Lesions ◽  
Labral Tears ◽  
Impingement Zone ◽  
Chondral Damage ◽  
High Prevalence ◽  
Structural Abnormalities ◽  
Treat All

AbstractStructural abnormalities of the hip joint have been identified as a common cause of labral and chondral lesions of the hip joint. However, labral and chondral damage can occur in the absence of structural abnormalities. The authors examined the incidence of anteromedial (AM) labral lesions, occurring in a nonimpinging region of the hip joint, and determined if the prevalence and location of concomitant chondral lesions differ between patients with AM lesions and those without. Between 2001 and 2013, they assessed 2,080 hips (1,818 patients) undergoing hip arthroscopy for the presence of AM labral lesions (between 4 and 6 o'clock position) and documented incidence of these lesions. The articular cartilage of the posterior, superior, and anterior regions of the acetabulum and femoral head was assessed. The degree of damage was classified as absent, mild (grades I/II), or severe (grades III/IV). The prevalence and severity of lesions in each region were compared between patients with AM lesions and those without. The authors identified 1,140 hips (1,028 patients) (55%) with labral tears in the AM region of the acetabulum. The cohort consisted of 689 females and 328 males, with an average age of 37.9 ± 12 years. Chondral lesions were present in all regions of the femoral head and acetabulum in both patients with AM lesions and those without. There is a relationship between the presence of AM lesion and prevalence of chondral lesions in the posterior and anterior femoral head and acetabulum, with a higher prevalence of lesions observed in patients without AM tears. Their findings show that lesions in the AM region of the acetabular labrum can occur with high prevalence in patients. These lesions are often associated with concomitant injuries to the anterior chondral surfaces, which may differ from lesions in the impingement zone. A thorough evaluation of all regions of the hip joint is warranted during arthroscopy to identify and treat all potential lesions.

scholarly journals Feasibility of arthroscopic placement of autologous matrix-induced chondrogenesis grafts in the cadaver hip joint

2013 ◽  
Vol 5 (3) ◽  
pp. 26 ◽  
Author(s):  
Fritz Thorey ◽  
Stefan Budde ◽  
Marco Ezechieli ◽  
Urs Vito Albrecht ◽  
Max Ettinger
Keyword(s):  
Clinical Trials ◽  
Femoral Head ◽  
Hip Joint ◽  
Hip Arthroscopy ◽  
Joint Movement ◽  
Chondral Lesions ◽  
Total Displacement ◽  
Human Cadavers ◽  
Time Reduction

An assortment of clinical trials have been done presenting the effectiveness of autologous matrix-induced chondrogenesis (AMIC) for the regeneration of chondral leasions. The purpose of the study was to underline the accessability of the acetabulum and the femoral head through the known portals and prove i) the feasibility of placing the AMIC in the different zones of the hip joint and ii) check for dislocation after joint movement. Six human cadavers underwent hip arthroscopy on both hips. Two chondral lesions were set on each femoral head and two in the acetabulum to evaluate a total of 48 defects. After microfracturing an autologous matrix-induced chondrogenesis graft was placed on these lesions arthroscopically. After repeated joint movement the dislocation of the graft was checked. It was possible to place the AMIC graft in all 48 chondral lesions. The time needed for placing the graft was 8±2.9 minutes. A trend of time reduction could be detected throughout this study as the surgeon gained more experience. For the femoral head, after twenty cycles of joint movement 18/24 spots showed no displacement, 4/24 showed minor displacement (&lt;3 mm) and 2/24 showed major displacement (&gt;3 mm). None showed total displacement. For the acetabulum 22/24 spots showed no displacement and 2/24 showed minor displacement. A combined microfracturing and placing of an AMIC graft of focal chondral lesions of the hip joint can be done arthroscopically. Prospective randomized <em>in vivo</em> studies should compare the results of arthroscopilally placed AMIC grafts with microfracturing and microfracturing alone.

scholarly journals Traumatic Hip Dislocation: Lecture

2021 ◽  
Vol 27 (2) ◽  
pp. 156-169
Author(s):  
P. A. Berezin ◽  
S. V. Bragina ◽  
A. L. Petrushin
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Hip Dislocation ◽  
High Energy ◽  
Diagnostic Methods ◽  
Acetabular Fractures ◽  
Associated Injuries ◽  
Stress Tests ◽  
Concomitant Injuries ◽  
Dislocation Reduction

Traumatic hip dislocations occupy the fourth place among dislocations of various localizations and, as a rule, are the result of  exposure  to  a  high-energy  traumatic  agent.  Such  injuries  are  more  often  observed  in  young  and  middle-aged  males. The main cause of hip dislocations is road accidents. The femoral head is more often dislocated posteriorly, but anterior dislocations  are  not  casuistic  and  account  for  approximately  10%.  Hip  dislocations  are  often  combined  with  acetabular fractures,  while  their  fairly  clear  clinical  picture  in  the  presence  of  fractures  can  be  leveled.  Traumatic  hip  dislocations require urgent diagnosis and treatment. After the clinical examination of the patient, an x-ray of the pelvis and hip joints are performed. Radiographic diagnosis of hip dislocation remains relevant, but modern imaging methods allows to study the hip joint in more detail and identify concomitant injuries. The main treatment for hip dislocation is closed reduction. Early dislocation reduction and the absence of damage to the structures forming the hip joint are important for the treatment results prognosis. The further patient management tactics after the dislocation reduction is determined by the results of stress tests and the CT data. When confirming the instability and associated injuries of the hip joint anatomical structures, surgical treatment is indicated. Among the complications of hip dislocation: sciatic nerve damage, post-traumatic coxarthrosis, the femoral head avascular necrosis, heterotopic ossification. Current literature data indicates the importance of early diagnosis of dislocation-associated injuries of the hip joint and periarticular tissues. Early and comprehensive repair of all existing injuries is crucial for favorable outcomes. A number of therapeutic and diagnostic methods, primarily arthroscopy, show optimistic results, but need further study.

Optimal parameters of abrasive flow finishing for hip joint implants

2021 ◽  
pp. 095440542199561
Author(s):  
Yahya Choopani ◽  
Mohsen Khajehzadeh ◽  
Mohammad Reza Razfar
Keyword(s):  
Surface Roughness ◽  
Standard Deviation ◽  
Femoral Head ◽  
Hip Joint ◽  
Spherical Shape ◽  
Shape Deviation ◽  
Head Surface ◽  
Joint Implants ◽  
Finishing Processes ◽  
Abrasive Flow Finishing

Total hip arthroplasty (THA) is one of the most well-known orthopedic surgeries in the world which involves the substitution of the natural hip joint by prostheses. In this process, the surface roughness of the femoral head plays a pivotal role in the performance of hip joint implants. In this regard, the nano-finishing of the femoral head of the hip joint implants to achieve a uniform surface roughness with the lowest standard deviation is a major challenge in the conventional and advanced finishing processes. In the present study, the inverse replica fixture technique was used for automatic finishing in the abrasive flow finishing (AFF) process. For this aim, an experimental setup of the AFF process was designed and fabricated. After the tests, experimental data were modeled and optimized to achieve the minimum surface roughness in the ASTM F138 (SS 316L) femoral head of the hip joint through the use of response surface methodology (RSM). The results confirmed uniform surface roughness up to the range of 0.0203 µm with a minimum standard deviation of 0.00224 for the femoral head. Moreover, the spherical shape deviation of the femoral head was achieved in the range of 7 µm. The RSM results showed a 99.71% improvement in the femoral head surface roughness (0.0007) µm under the optimized condition involving the extrusion pressure of 9.10 MPa, the number of finishing cycles of 95, and SiC abrasive mesh number of 1000.

scholarly journals Reliability of the classification of cartilage and labral injuries during hip arthroscopy

2020 ◽  
Vol 7 (3) ◽  
pp. 448-457
Author(s):  
Stephanie W Mayer ◽  
Tobias R Fauser ◽  
Robert G Marx ◽  
Anil S Ranawat ◽  
Bryan T Kelly ◽  
...  
Keyword(s):  
Femoral Head ◽  
Transition Zone ◽  
Central Compartment ◽  
Classification Systems ◽  
Cartilage Injury ◽  
Intraobserver Agreement ◽  
Acetabular Cartilage ◽  
Femoral Head Cartilage ◽  
Labral Tears

Abstract To determine interobserver and intraobserver reliabilities of the combination of classification systems, including the Beck and acetabular labral articular disruption (ALAD) systems for transition zone cartilage, the Outerbridge system for acetabular and femoral head cartilage, and the Beck system for labral tears. Additionally, we sought to determine interobserver and intraobserver agreements in the location of injury to labrum and cartilage. Three fellowship trained surgeons reviewed 30 standardized videos of the central compartment with one surgeon re-evaluating the videos. Labral pathology, transition zone cartilage and acetabular cartilage were classified using the Beck, Beck and ALAD systems, and Outerbridge system, respectively. The location of labral tears and transition zone cartilage injury was assessed using a clock face system, and acetabular cartilage injury using a five-zone system. Intra- and interobserver reliabilities are reported as Gwet’s agreement coefficients. Interobserver and intraobserver agreement on the location of acetabular cartilage lesions was highest in superior and anterior zones (0.814–0.914). Outerbridge interobserver and intraobserver agreement was &gt;0.90 in most zones of the acetabular cartilage. Interobserver and intraobserver agreement on location of transition zone lesions was 0.844–0.944. The Beck and ALAD classifications showed similar interobserver and intraobserver agreement for transition zone cartilage injury. The Beck classification of labral tears was 0.745 and 0.562 for interobserver and intraobserver agreements, respectively. The Outerbridge classification had almost perfect interobserver and intraobserver agreement in classifying chondral injury of the true acetabular cartilage and femoral head. The Beck and ALAD classifications both showed moderate to substantial interobserver and intraobserver reliabilities for transition zone cartilage injury. The Beck system for classification of labral tears showed substantial agreement among observers and moderate intraobserver agreement. Interobserver agreement on location of labral tears was highest in the region where most tears occur and became lower at the anterior and posterior extents of this region. The available classification systems can be used for documentation regarding intra-articular pathology. However, continued development of a concise and highly reproducible classification system would improve communication.

scholarly journals Assessment of acetabular chondral damage and labral pathologies via direct MR arthrography: specialization matters

2021 ◽  
Author(s):  
A. Zimmerer ◽  
MM. Schneider ◽  
K. Tramountanis ◽  
V. Janz ◽  
W. Miehlke ◽  
...  
Keyword(s):  
Predictive Value ◽  
Hip Arthroscopy ◽  
Mr Arthrography ◽  
Level Of Evidence ◽  
Chondral Lesions ◽  
Orthopaedic Surgeons ◽  
Femoroacetabular Impingement Syndrome ◽  
Chondral Damage ◽  
Direct Magnetic Resonance Arthrography ◽  
Sensitivity Specificity

Abstract Aims To compare the diagnostic accuracy of investigators from different specialities (radiologists and orthopaedic surgeons) with varying levels of experience of 1.5 T direct magnetic resonance arthrography (dMRA) against intraoperative findings in patients with femoroacetabular impingement syndrome (FAIS). Methods A total of 272 patients were evaluated with dMRA and subsequent hip arthroscopy. The dMRA images were evaluated independently by two non-hip-arthroscopy-trained orthopaedic surgeons, two fellowship-trained musculoskeletal radiologists, and two hip-arthroscopy-trained orthopaedic surgeons. The radiological diagnoses were compared with the intraoperative findings. Results Hip arthroscopy revealed labral pathologies in 218 (79%) and acetabular chondral lesions in 190 (69%) hips. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for evaluating the acetabular labral pathologies were 79%, 18%, 79%, 18%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 83%, 36%, 83%, 36%, and 74% (fellowship-trained musculoskeletal radiologists), and 88%, 53%, 88%, 54% and 81% (hip-arthroscopy trained orthopaedic surgeons). The sensitivity, specificity, PPV, NPV and accuracy of dMRA for assessing the acetabular chondral damage were 81%, 36%, 71%, 50%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 84%, 38%, 75%, 52%, and 70% (fellowship-trained musculoskeletal radiologists), and 91%, 51%, 81%, 73%, and 79% (hip-arthroscopy trained orthopaedic surgeons). The hip-arthroscopy trained orthopaedic surgeons displayed the highest percentage of correctly diagnosed labral pathologies and acetabular chondral lesions, which is significantly higher than the other two investigator groups (p < 0.05). Conclusion The accuracy of dMRA on detecting labral pathologies or acetabular chondral lesions depends on the examiner and its level of experience in hip arthroscopy. The highest values are found for the hip-arthroscopy-trained orthopaedic surgeons. Level of evidence Retrospective cohort study; III.

Acetabular Chondral Lesions in Hip Arthroscopy: Relationships Between Grade, Topography, and Demographics

2017 ◽  
Vol 45 (11) ◽  
pp. 2501-2506 ◽  
Author(s):  
Carlos Suarez-Ahedo ◽  
Chengcheng Gui ◽  
Stephanie M. Rabe ◽  
Sivashankar Chandrasekaran ◽  
Parth Lodhia ◽  
...  
Keyword(s):  
Traumatic Injury ◽  
Demographic Factors ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Chondral Lesion ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Chondral Lesions ◽  
Chondral Damage ◽  
Male Sex

Background: Hip pain remains a challenge given the multiple factors that can cause damage to the articular cartilage, such as traumatic injury, metabolic damage, and morphologic variations such as femoroacetabular impingement (FAI) and that can contribute to progression of osteoarthritis. However, a direct relationship between patient characteristics, the extent of acetabular chondral damage, and topologic characteristics of chondral lesions has not been established. Purpose: To compare the grade of acetabular chondral damage, measured in terms of acetabular labrum articular disruption (ALAD) classification, to the size and position of the chondral lesions, matching patients’ demographic factors such as age and body mass index (BMI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included all hip arthroscopies performed by the corresponding author from August 7, 2008, to November 19, 2014, in which acetabular chondral lesions were intraoperatively identified and measured in terms of ALAD grade, clockface location, and size. Bivariate analyses and multiple logistic regression were used to identify the demographic factors, characteristics of the acetabular chondral lesion, and other anatomic characteristics that were related to the ALAD grade of the acetabular chondral lesion. Results: Acetabular chondral lesions were measured in 1502 patients during the study period. Multivariate analysis showed that higher ALAD grade of acetabular chondral damage was significantly related to male sex, more advanced age, the area of the acetabular chondral lesion, anterior extension of the acetabular chondral lesion within the anterosuperior quadrant, labral detachment from the acetabular cartilage, and posterior extension of the labral tear. Conclusion: Higher grades of acetabular chondral damage were related to male sex, increased age, height, weight, BMI, and the size of the lesion. Chondral lesions were generally found in the anterosuperior region of the acetabulum, consistent with labral lesions and the weightbearing area of the acetabulum.

scholarly journals Microvascular Density of Rapidly Destructive Arthropathy of the Hip Joint

2005 ◽  
Vol 13 (1) ◽  
pp. 40-45 ◽  
Author(s):  
T Yamakawa ◽  
A Sudo ◽  
M Tanaka ◽  
A Uchida
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Joint Destruction ◽  
Bone Destruction ◽  
Microvascular Density ◽  
Blood Capillaries ◽  
Secondary Osteoarthritis ◽  
Femoral Heads ◽  
Formalin Fixed Paraffin Embedded ◽  
Destructive Arthropathy

Purpose. To assess the vascularity of the femoral head and determine how it is related to the destruction of the arthritic hip joint. The process of destructive arthropathy in arthritic hip joints is variable. Some patients with osteoarthritis of the hip have rapidly progressive destructive changes resulting in the disappearance of the femoral head. Method. Six femoral heads from patients diagnosed with rapidly destructive arthropathy and 6 femoral heads from patients with secondary osteoarthritis caused by acetabular dysplasia were analysed to reveal the association between blood capillaries and osteoclasts. The von Willebrand Factor immunostaining and counterstaining with Mayer's haematoxylin were used to label the microvessels and osteoclasts in formalin-fixed, paraffin-embedded specimens of femoral heads. The numbers of immunostained microvessels and osteoclasts in selected regions were counted. Result. The microvascular density of the bone surfaces of rapidly progressive arthritic hips was hypervascular. Osteoclasts were also found in increased numbers on the bone surfaces of rapidly progressive arthritic hips. The higher microvascular density coincided with extensive bone destruction and with the increased osteoclast count. Conclusion. These findings suggested that hypervascularity of the granulation in the femoral head may be associated with bone and joint destruction.

A method for visualizing the dorsal acetabular rim and the coverage of the femoral head

2001 ◽  
Vol 14 (03) ◽  
pp. 151-155 ◽  
Author(s):  
J. Hoskinson ◽  
W. C. Renberg
Keyword(s):  
Femoral Head ◽  
Hip Joint ◽  
Prognostic Value ◽  
Degenerative Change ◽  
Femoral Shaft ◽  
Normal Activity ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Anatomical Landmarks ◽  
Acetabular Rim

SummaryThe authors describe a new technique to visualize the dorsal acetabular rim and the coverage of the femoral head in the nonsedated dog. The technique involves using an overhead beam, directed at an angle tangential to the dorsal rim of the acetabulum, with a film positioned caudal to the standing dog. Anatomical landmarks that can routinely be identified include: the ilial crest, ilial shaft, ischial tuberosity, acetabulum, acetabular rim (particularly the dorsocaudal component), femoral head, greater trochanter, femoral neck, femoral shaft, rectum and the tail. Because the animal is standing and is not sedated, the technique may have additional value as a means of evaluating subluxation of the hip joint. It maintains a posture as close as possible to that experienced by the animal in normal activity. If the technique has prognostic value in that regard, more investigation is needed, but it is useful in itself as a technique to visualize the area of the acetabulum.A new radiographic technique to evaluate the canine hip joint is described. The view involves tangential projection of the acetabulum in the standing, awake dog. Nineteen dogs have been radiographed to develop the technique and the method has been found to be technically simple and consistent. It allows examination of the dorsal acetabular rim and may help examine the amount of subluxation of the hip as well as the presence of any degenerative joint disease. The authors advocate additional study to determine the technique’s prognostic value in predicting degenerative change associated with hip dysplasia.

scholarly journals Pathohistologic Changes in Hip Tissues and Clinical-Morphologic Correlations in Diseases Complicated by Femoroacetabular Impingement Syndrome

2014 ◽  
Vol 21 (2) ◽  
pp. 67-73
Author(s):  
V. V Grigorovskiy ◽  
V. V Filipchuk ◽  
M. S Kabatsiy
Keyword(s):  
Femoral Head ◽  
Femoroacetabular Impingement ◽  
Hip Joint ◽  
Comparison Study ◽  
Acetabular Labrum ◽  
Aseptic Necrosis ◽  
Association Coefficient ◽  
Absolute Value ◽  
Femoroacetabular Impingement Syndrome ◽  
Fai Syndrome

The purpose of the work was to detect clinical-morphologic correlative dependences in patients with clinically marked femoroacetabular impingement (FAI) syndrome basing on the study of pathomorphologic changes in hip joint tissues, semiquantitative quantification of pathologic changes intensity, frequency analysis of their occurrence in nosologic groups of comparison. Study was performed on specimens of hip joint tissues - femoral head, acetabulum, acetabular labrum and joint capsule, resected during indicated corrective surgeries for femoral head aseptic necrosis and juvenile epiphysiolysis. Clinical-morphologic study revealed various pathologic changes: dystrophic-destructive, ischemic-necrotic and productive-inflammatory. In patients with FAI syndrome clinical and morphologic correlative dependences varied by absolute value, sign and degree of reliability of association coefficient parameters, i.e. groups of patients with certain nosologic units retained the peculiarities of rate and characteristics proportions in correlative dependences

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