scholarly journals CONSERVATIVE TREATMENT CONTINUUM FOR MANAGING FEMOROACETABULAR IMPINGEMENT SYNDROME AND ACETABULAR LABRAL TEARS IN SURGICAL CANDIDATES: A CASE SERIES

2018 ◽  
Vol 13 (6) ◽  
pp. 1032-1048 ◽  
Author(s):  
Joel R. Narveson ◽  
Matthew D. Haberl ◽  
C. Nathan Vannatta ◽  
Daniel I. Rhon
Keyword(s):  
Conservative Treatment ◽  
Femoroacetabular Impingement ◽  
Case Series ◽  
Impingement Syndrome ◽  
Labral Tears ◽  
Femoroacetabular Impingement Syndrome

Acetabular Labral Tear Dimensions and Number of Suture Anchors Used to Repair in Patients with Femoroacetabular Impingement Syndrome

2021 ◽  
Author(s):  
Guillaume D. Dumont ◽  
Matthew J. Pacana ◽  
Adam J. Money ◽  
Thomas J. Ergen ◽  
Allen J. Barnes ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Impingement Syndrome ◽  
Labral Tear ◽  
Labral Repair ◽  
Suture Anchors ◽  
Labral Tears ◽  
Femoroacetabular Impingement Syndrome ◽  
The Mean ◽  
Tear Size ◽  
Anterior Extent

AbstractFemoroacetabular impingement syndrome (FAIS) is commonly associated with acetabular labral tears. Correction of impingement morphology and suture anchor repair of labral tears have demonstrated successful early and midterm patient-reported outcomes. The purpose of this study was to evaluate the posterior and anterior extent and size of labral tears in patients with FAIS undergoing arthroscopic labral repair, and to evaluate the number of suture anchors required to repair these tears. The design of this study was retrospective case series (Level 4). A single surgeon's operative database was retrospectively reviewed to identify patients undergoing primary arthroscopic hip labral repair between November 2014 and September 2019. Patient-specific factors and radiographic measurements were recorded. Arthroscopic findings including labral tear posterior and anterior extents, and the number of suture anchors utilized for the repair were recorded. Linear regression was performed to identify factors associated with labral tear size. The number of suture anchors used relative to labral tear size was calculated. Three-hundred and thirteen patients were included in the study. The mean posterior and anterior extent for labral tears were 11:22 ± 52 and 2:20 ± 34 minutes, respectively. Mean tear size was 2 hours, 58 minutes ± 45 minutes. The mean number of suture anchors utilized for labral repair was 3.1 ± 0.7. The mean number of anchors per hour of labral tear was 1.1 ± 0.3. Increased age, lateral center edge angle, and α angle were associated with larger labral tears. Our study found that acetabular labral tears associated with FAIS are, on average, 3 hours in size and centered in the anterosuperior quadrant of the acetabulum. Arthroscopic labral repair required 1.1 anchors per hour of tear size, resulting in a mean of 3.1 anchors per repair. Level of Evidence IV

Surgery is no more effective than conservative treatment for Femoroacetabular impingement syndrome: Systematic review and meta-analysis of randomized controlled trials

2020 ◽  
pp. 026921552096669 ◽  
Author(s):  
Robson Massi Bastos ◽  
Jorge Geraldo de Carvalho Júnior ◽  
Suellen Aline Martinez da Silva ◽  
Shirley Ferreira Campos ◽  
Matheus Vieira Rosa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Femoroacetabular Impingement ◽  
Methodological Quality ◽  
Impingement Syndrome ◽  
Level Of Evidence ◽  
Femoroacetabular Impingement Syndrome ◽  
Quality Evidence

Objective: To summarize the effects of surgical treatment compared to conservative treatment in femoroacetabular impingement syndrome in the short, medium, and long term. Study Design: Systematic review Methods: The following databases were searched on 14/09/2020: MEDLINE, EMBASE, CENTRAL, Web of Science, and PEDro. There were no date or language limits. The methodological quality assessment was performed using the PEDro scale and the quality of the evidence followed the GRADE recommendation. The outcomes pain, disability, and adverse effects were extracted. Results: Of 6264 initial studies, three met the full-text inclusion criteria. All studies were of good methodological quality. Follow up ranged from six months to two years, with 650 participants in total. The meta-analyses found no difference in disability between surgical versus conservative treatment, with a mean difference (MD) between groups of 3.91 points (95% CI –2.19 to 10.01) at six months, MD of 5.53 points (95% CI –3.11 to 14.16) at 12 months and 3.8 points (95% CI –6.0 to 13.6) at 24 months. The quality of the evidence (GRADE) varied from moderate to low across all comparisons. Conclusion: There is moderate-quality evidence that surgical treatment is not superior to conservative treatment for femoroacetabular impingement syndrome in the short term, and there is low-quality evidence that it is not superior in the medium term. Level of evidence: Therapy, level 1a. Registration number: PROSPERO CRD42019134118

scholarly journals Return to Sport and Athletic Function in an Active Population After Primary Arthroscopic Labral Reconstruction of the Hip

2020 ◽  
Vol 8 (2) ◽  
pp. 232596711990076 ◽  
Author(s):  
David R. Maldonado ◽  
Sarah L. Chen ◽  
Mitchell J. Yelton ◽  
Philip J. Rosinsky ◽  
Rafael Walker-Santiago ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Return To Sport ◽  
Impingement Syndrome ◽  
Rate Of Return ◽  
Harris Hip Score ◽  
Labral Tears ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
The Mean

Background: Labral reconstruction has been advocated as an alternative to debridement for the treatment of irreparable labral tears, showing favorable short-term results. However, literature is scarce regarding outcomes and return to sport in the nonelite athletic population. Purpose: To report minimum 1-year clinical outcomes and the rate of return to sport in athletic patients who underwent primary hip arthroscopy with labral reconstruction in the setting of femoroacetabular impingement syndrome and irreparable labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively analyzed for patients who underwent an arthroscopic labral reconstruction between August 2012 and December 2017. Patients were included if they identified as an athlete (high school, college, recreational, or amateur); had follow-up on the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS); and completed a return-to-sport survey at 1 year postoperatively. Patients were excluded if they underwent any previous ipsilateral hip surgery, had dysplasia, or had prior hip conditions. The proportions of patients who achieved the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for mHHS and HOS-SSS were calculated. Statistical significance was set at P = .05. Results: There were 32 (14 females) athletes who underwent primary arthroscopic labral reconstruction during the study period. The mean age and body mass index of the group were 40.3 years (range, 15.5-58.7 years) and 27.9 kg/m2 (range, 19.6-40.1 kg/m2), respectively. The mean follow-up was 26.4 months (range, 12-64.2 months). All patients demonstrated significant improvement in mHHS, NAHS, HOS-SSS, and VAS ( P < .001) at latest follow-up. Additionally, 84.4% achieved MCID and 81.3% achieved PASS for mHHS, and 87.5% achieved MCID and 75% achieved PASS for HOS-SSS. VAS pain scores decreased from 4.4 to 1.8, and the satisfaction with surgery was 7.9 out of 10. The rate of return to sport was 78%. Conclusion: At minimum 1-year follow-up, primary arthroscopic labral reconstruction, in the setting of femoroacetabular impingement syndrome and irreparable labral tears, was associated with significant improvement in PROs in athletic populations. Return to sport within 1 year of surgery was 78%.

scholarly journals Pre- and Post-Operative Walking Gait in Females with Acetabular Labral Tears and Femoroacetabular Impingement Syndrome

2021 ◽  
Author(s):  
Bret Freemyer ◽  
Robert Durkin ◽  
Scott Crawford ◽  
Derek Beeler ◽  
Christopher Stickley
Keyword(s):  
Femoroacetabular Impingement ◽  
Impingement Syndrome ◽  
Series Data ◽  
Painful Condition ◽  
Walking Gait ◽  
Labral Tears ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Hip Abduction ◽  
Hip Extension

Context: Symptomatic Femoroacetabular Impingement Syndrome (FAIS) is a painful condition that leads to decreased function. It is currently unknown how walking gait changes over time following surgery for FAIS earlier than one year, or how these changes present in females. Objective: The purpose was to determine biomechanical gait differences between females with FAIS/labral tears and controls pre-operatively, and three- and six-months post-operatively. Design: Case-Control Study. Setting: Gait laboratory. Participants: The study included 18 female participants (n=9 FAIS patients, n=9 controls). Main Outcome Measures: Between-group comparisons of the Hip Outcome Score activity of daily living subscale (HOSadl) and gait biomechanics were evaluated at pre-operative and three- and six-months post-operative sessions. Statistical parametric mapping was conducted on normalized time-series data. Results: Pre-operatively, the FAIS group had poor HOSadl scores [Pre-operative: 64.1 (15.4), Controls 100.0 (0), p&lt;0.001;], walked 15% slower, and had several gait differences compared to controls. Three months post-operatively, the FAIS group had greater vGRF (p=0.013), ankle dorsiflexion angles (p=0.021), and external dorsiflexion moment (p=0.012) in midstance, as well as greater knee flexion through the second half of stance (p&lt;0.001). The FAIS group also demonstrated less hip extension (p=0.024) and hip abduction (p=0.010) through the second half of stance, which transitioned into less hip extension (p=0.040) and hip abduction (p=0.025) during the subsequent swing phase. The FAIS improved their HOSadl to 87.6 (7.6) by 6-months post-operatively and had greater dorsiflexion moment (p=0.003) and ankle external rotation during stance (p=0.033). The FAIS patients also showed greater external hip ER moment in late stance (p&lt;0.001). Conclusions: The most biomechanical differences between groups occurred 3-months post-operatively, suggesting that female FAIS patients have more post-operative gait compensations in the short term after surgery. By six-month post-operatively, the patient reported outcomes greatly improved and there were few gait differences compared to the control group.

scholarly journals Preoperative Hip Extension Strength Is an Independent Predictor of Achieving Clinically Significant Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

2020 ◽  
Vol 12 (4) ◽  
pp. 361-372 ◽  
Author(s):  
Edward C. Beck ◽  
Benedict U. Nwachukwu ◽  
Laura M. Krivicich ◽  
Philip Malloy ◽  
Sunikom Suppauksorn ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Impingement Syndrome ◽  
Level Of Evidence ◽  
Hip Strength ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported ◽  
Hip Extension ◽  
Abduction Strength

Background: The effect of preoperative hip strength on outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is unclear. The purpose of this study was to determine whether preoperative isometric hip strength is associated with outcome scores at 6 months as well as achieving the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients undergoing hip arthroscopy for FAIS. Hypothesis: Increased preoperative isometric strength will be correlated with short-term postoperative outcomes and will be predictive of achieving higher functional status. Study Design: Case series. Level of Evidence: Level 4. Methods: Data from 92 consecutive patients undergoing primary hip arthroscopy for treatment of FAIS from March through August 2018 were analyzed. All patients included in the analysis had preoperative measures of isometric hip strength on both affected and unaffected limbs, as well as preoperative and 6-month patient-reported outcome (PRO) scores. Analysis was performed to determine correlations between normalized isometric hip strength measurements and PROs and whether strength measurements were predictive of achieving MCID or PASS. Results: A total of 74 (80.4%) patients had 6-month PROs and were included in the final analysis. Hip extension strength on both sides was correlated with all postoperative PROs (all P > 0.05). Abduction strength on both sides was correlated with postoperative Hip Outcome Score–Activities of Daily Living subscale score, achieving MCID on at least 1 score threshold, and reaching the international Hip Outcome Tool-12 threshold score for achieving PASS (all P < 0.05). Regression analysis showed that extension strength on the affected side was the only strength measurement predictor of achieving PASS (1.043; P = 0.049). Conclusion: Preoperative isometric hip extension and abduction strength are correlated with 6-month postoperative PRO scores. Furthermore, hip extension strength is a predictor of achieving clinically meaningful outcomes. Clinical Relevance: This study highlights the possible importance of preoperative optimization of hip function to maximize outcomes in patients undergoing hip arthroscopy for FAIS.

Defining the Clinically Meaningful Outcomes for Arthroscopic Treatment of Femoroacetabular Impingement Syndrome at Minimum 5-Year Follow-up

2020 ◽  
Vol 48 (4) ◽  
pp. 901-907 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
Edward C. Beck ◽  
Kyle N. Kunze ◽  
Jorge Chahla ◽  
Jonathan Rasio ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Case Series ◽  
Impingement Syndrome ◽  
Arthroscopic Treatment ◽  
Harris Hip Score ◽  
Outcome Score ◽  
Femoroacetabular Impingement Syndrome ◽  
Patient Reported

Background: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) have gained prominence as important variables in the orthopaedic outcomes literature. In hip preservation surgery, much attention has been given to defining early clinically meaningful outcome; however, it is unknown what represents meaningful patient-reported outcome improvement in the medium to long term. Purpose: (1) To define MCID, PASS, and SCB at a minimum 5 years after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to evaluate the time-dependent nature of MCID, PASS, and SCB. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing primary hip arthroscopy for FAIS between January 2012 and March 2014 were included. Clinical and demographic data were collected in an institutional hip preservation registry. MCID, PASS, and SCB were calculated for each outcome score including the Hip Outcome Score–Activities of Daily Living subscale (HOS-ADL), Hip Outcome Score–Sport-Specific subscale (HOS-SS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool (iHOT-12) at 1, 2, and 5 years. MCID was calculated by use of a distribution-based method, whereas PASS and SCB were calculated by use of an anchor method. Results: The study included 283 patients with a mean ± SD age of 34.2 ± 11.9 years. The mean changes in 1-year, 2-year, and 5-year scores, respectively, required to achieve MCID were as follows: HOS-ADL (8.8, 9.7, 10.2); HOS-SS (13.9, 14.3, 15.2); mHHS (6.9, 9.2, 11.4); and iHOT-12 (15.1, 13.9, 15.1). The threshold scores for achieving PASS were as follows: HOS-ADL (89.7, 88.2, 99.2); HOS-SS (72.2, 76.4, 80.9); mHHS (84.8, 83.3, 83.6); and iHOT-12 (69.1, 72.2, 74.3). Last, the threshold scores for achieving SCB scores were as follows: HOS-ADL (89.7, 91.9, 94.6); HOS-SS (78.1, 77.9, 85.8); mHHS (86.9, 85.8, 94.4); and iHOT-12 (72.6, 76.8, 87.5). More patients achieved MCID, SCB, and PASS at 2-year compared with 1-year follow-up; however, by 5 years, fewer patients had achieved clinically meaningful outcome (minimum 1-, 2-, and 5-year follow-up, respectively: MCID, 82.6%, 87.3%, 79.3%; PASS, 67.6%, 74.9%, 67.5%; SCB, 62.3%, 67.2%, 56.6%). Conclusion: The greatest proportion of patients achieved MCID, PASS, and SCB at 2-year follow-up after arthroscopic treatment of FAIS compared with 1- and 5-year time points. Improvements were maintained out to 5-year follow-up, although the proportion of patients achieving clinical significance was slightly decreased.

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