Hip Osteoarthritis (HOA) is the most common joint disorder and a major cause of disability in the adult population, leading to total hip replacement (THR). Recently, evidence has mounted for a prominent etiologic role of femoroacetabular impingement (FAI) in the development of early OA in the non-dysplastic hip. FAI is a pathological mechanical process, caused by abnormalities of the acetabulum and/or femur leading to damage the soft tissue structures. FAI can determine chondro-labral damage and groin pain in young adults and can accelerate HOA progression in middle-aged adults. The aim of the study was to determine if the presence of calcium crystal in synovial fluid (SF) at the time of FAI surgery affects the clinical outcomes to be used as diagnostic and predictive biomarker. 49 patients with FAI undergoing arthroscopy were enrolled after providing informed consent; 37 SFs were collected by arthrocentesis at the time of surgery and 35 analyzed (66% males), median age 35 years with standard deviation (SD) 9.7 and body mass index (BMI) 23.4 kg/m. 2. ; e SD 3. At the time of surgery, chondral pathology using the Outerbridge score, labral pathology and macroscopic synovial pathology based on direct arthroscopic visualization were evaluated. Physical examination and clinical assessment using the Hip disability & Osteoarthritis Outcome Score (HOOS) were performed at the time of surgery and at 6 months of follow up. As positive controls of OA signs, SF samples were also collected from cohort of 15 patients with HOA undergoing THR and 12 were analysed. 45% FAI patients showed CAM deformity; 88% presented
Purpose of the study: The purpose of this work was to search for a relationship between the size of the femoral cam, the presence of cup retroversion, and the presence of labral or chondral lesions on the arthroscan in patients with an asymptomatic femoroacetabular impingement. Material and method: Fifty arthroscans were obtained to explore impingements. The patients complained of groin or trochanteric pain limiting their physical activities. Generally signs of an anterosuperior impingement were demonstrated with flexion-adduction-internal rotation. The localization, dimensions and depth of the cartilage lesions were measured on the arthroscan. The sagittal slice was used to describe the acetabular chondral lesions anteriorly to posteriorly in clockwise manner. Presence of an associated
Introduction: Periacetabular rotational osteotomy is a joint preserving reconstructive surgery indicated in hip dysplasia. However hip dysplasia is frequently accompanied by intraarticular pathology like labral tears. This study was undertaken to ascertain whether:. concomitant hip arthroscopy during osteotomy could identify intra-articular pathology associated with hip dysplasia;. hip arthroscopy combined with our technique of acetabular osteotomy was effective in treatment of intraarticular pathology;. this technique was associated with a favorable outcome over a mid term followup period. Materials: Between July 2001 and February 2005, 43 dysplastic hips with 40 patients consecutive of periac-etabular rotational osteotomy using modified Ollier’s approach and concomitant hip arthroscopy could be followed up at average 52 months (range, 42–67 months). On arthroscopic examination
Introduction: Hip pain in young adults can be associated with radiographic finding of acetabular labral tears in magnetic resonance arthrography. Acetabular labral tears can occur in dysplastic hips and in arthrotic hips as well, but often no comobidity is found. Up to now there is no prospective study published following patients with magnetic resonance arthrography verified acetabular labral tears over time and re-evaluating them with MR years later. There is also no stage related therapy published according to labral damage. The aim of this study was to follow 100 MRI verified acetabular labral tears for four years. Material and methods: Study design was prospective, observers were blinded. At primary investigation 36 clinical and 30 radiological parameters were recorded. At follow up these factors were recorded again and additionally SF36 and Harris Hip score were recorded. Results: 100 patients with average age 42 were included. 91% of all patients could be followed for over 48 months. 55 operations were performed in 50 patients . 20 patients showed concomitant developmental dysplasia of the hip, 16 patients arthrosis, 40 patients both and 15 patients had a
The traditional treatment for a primary anterior shoulder dislocation has been immobilisation in a sling with the arm in adduction and internal rotation. The recurrence rates after the initial traumatic event range from 20% to 94%. However, recent results have suggested that recurrent instability after primary shoulder dislocation may be reduced with immobilisation in external rotation. Since then, controversy exists regarding the position of immobilisation following these injuries. The objective of the present study was to compare immobilisation in internal and external rotation after a primary anterior shoulder dislocation. Fifty patients presenting to our fracture clinic with a primary traumatic anterior dislocation of the shoulder were randomly assigned to treatment with immobilisation in either internal rotation (IR; 25 patients) or external rotation (ER; 25 patients) for three weeks. In addition of a two-years clinical follow-up, patients underwent a magnetic resonance imaging (MRI) of the shoulder with intra-articular contrast within four days following the traumatic event, and then at three months of follow-up. The primary outcome was a recurrent dislocation within 24 months of follow-up. The secondary outcome was the healing rate of the
Purpose of the study: The aim of this work was to report our experience with arthroscopy for the treatment of acetabular
Background: Cam-type femoroacetabular impingement (FAI) is becoming more recognized. Cartilage lesions of the acetabulum and labral tears are frequently encountered. The goal of this study was to accurately describe and communicate these injuries and thus providing a standard for reporting injury, management, and outcome. Methods: We evaluated acetabular cartilage
Purpose: The confirmation of clinical findings as well as the accurate preoperative evaluation of patients with shoulder instability and rupture of the glenoid labrum. Material-Method: 180 patients with shoulder instability or suspected
Introduction: In the treatment of polytraumatised patients acetabular fractures are challenging because of the necessity of perfect open reduction of the articular surface over an anatomy respecting approach. Luxation of the femoral head with accompanying Pikin fracture, interponated fragments and
Aims. To describe the distribution and clinical presentation of SLAP tears in rugby players, and time taken for return to sport. Method. A retrospective review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period was carried out. All patients diagnosed with a SLAP lesion at arthroscopy were identified. Each patient's records were reviewed to record age, injury side, mechanism of injury, clinical diagnosis, investigations and results, management, and return to play. Results. The incidence of SLAP tears was 35%. All 18 patients were male with an average age of 27 yrs. There were 11 isolated SLAP tears (61%), 3 SLAP tears associated with a Bankart lesion (17%), 2 SLAP tears associated with a posterior
Shoulder Instability impacts on the ability of military personnel to fulfil their operational role and maintain sporting competence. Magnetic Resonance Imaging (MRI) and Arthrogram (MRA) are increasingly available as diagnostic adjuncts. We analysed MR reports from personnel undergoing stabilisation, correlating clinical diagnosis with operative findings and reviewed the literature in order to recommend improvements. We report a retrospective, consecutive case note analysis of 106 personnel undergoing open anterior capsulolabral reconstruction (ACLR) by a single surgeon. Seventy patients had MR (48 MRA, 22 MRI). Commonly reported pathology included Hill Sachs Lesions (41%), Soft tissue (59%) and bony Bankart lesions (16%), capsular laxity (20 %), supraspinatus lesion (20%), ACJ disease (13%) and SLAP tear (12%). The sensitivity of MR for identification of
The cause of unremitting hip joint pain often remains undiagnosed. In the knee, MRI often accurately detects soft tissue pathology, but there is a less than 5% chance that MRI will show an abnormality such as a labral tear. Because conventional surgery can lead to such complications as avascular necrosis, muscle weakness, trochanteric nonunion, heterotopic bone formation, neurovascular injuries and DVT, diagnostic open arthrotomy is seldom performed. Further, prolonged hospitalisation is costly and commits the patient to an extended rehabilitation program. Arthroscopic hip surgery, a relatively new but well-established procedure, permits the identification of previously unrecognised disorders and in some pathologies offers definitive treatment. In young selected patients with OA it serves as a temporary palliative procedure. This presentation is based on the first 50 hip arthroscopies performed by the author. Indications for operation were chronic hip pain without radiologically-discernible cause, the presence of loose bodies following trauma, chondrocalcinosis,
Aim: To determine whether isolated lesions of the glenoid labrum or capsulolabral lesios influence anterior and inferior shoulder stability in a cadaver model that leaves all other glenohumeral structures, including the capsule, intact. Methods: Sequential arthroscopic resection of the labrum was performed with a motorized shaver in seventeen fresh cadaver shoulders. A capsulolabral dehiscence was created arthroscopically in another eleven fresh cadaver shoulders. The capsulolabral complex was divided into five zones: from superior to posterior. Inferior and anterior stability were tested before and after each cutting step. Results: The hyper-abduction test showed progressive increase in abduction with each step, with a maximum of 120° reached after removal of the labrum in all four zones or after detachment of all zones. Resection of the superior to inferior labrum maximally resulted in subluxation, but not in dislocation of the shoulder. Capsulolabral dehiscence of all but the posterior zones resulted in a locked (6/11) or a metastable (4/11) dislocation. In the other specimens the posterior zone needed to be detached as well for a metastable dislocation. Conclusion: Purely
Background: Acetabular labral tears are increasingly recognised as a cause of hip pain in young adults and middle aged patients. Degenerative acetabular conditions and sporting activities can cause labral injury. Recent interest has focussed on anterior femoroacetabular impingement as a cause of labral injury, progressive articular cartilage damage and secondary osteoarthritis. Labral tears are difficult to diagnose clinically or with conventional radiographic techniques. Aim: The purpose of this study was to assess the accuracy of MR arthrography in locating labral tears and articular cartilage defects compared with hip arthroscopy. Materials and Methods: 200 consecutive patients with a diagnosis of acetabular labral tear underwent hip arthroscopy. All of them had a preoperative Magnetic Resonance Arthrogram done by a single musculoskeletal radiologist using a standard protocol. The labrum was assessed for abnormalities of morphology and signal intensity. Acetabular articular cartilage defects were expressed as a reduction in joint space. All hip arthroscopies were done by a single surgeon after a trial period of conservative therapy consisting of activity modification, physiotherapy and non-steroidal anti-inflammatory medications. All procedures were recorded digitally and documented in an operative report. Labral tears and acetabular cartilage abnormalities were described by location and appearance. Results: Comparison of MRA and hip arthroscopy findings demonstrate MRA to have a sensitivity of 100%, positive predictive value of 99%, negative predictive value of 100% and accuracy of 99% in predicting labral tears. MRA correctly identified the location of labral tears in 90% of cases. Acetabular cartilage abnormalities were under recognised by MRA (43 hips on MRA vs 54 hips on arthroscopy). MRA was not sensitive enough to pick up early delamination of cartilage adjacent to labral tear in 6 hips. Conclusion: Hip MRA with radial reformatting has high accuracy rates in diagnosing and localising hip
Shoulder Instability impacts on the ability of military personnel to fulfil their operational role and maintain sporting competence. Magnetic Resonance Imaging (MRI) and Arthrogram (MRA) are increasingly available as diagnostic adjuncts. We analysed MR reports from personnel undergoing stabilisation, correlating clinical diagnosis with operative findings and reviewed the literature in order to recommend improvements. This was a retrospective, consecutive case note analysis of 106 personnel undergoing open anterior capsulolabral reconstruction (ACLR) by a single surgeon. 70 patients had MR (48 MRA, 22 MRI). Commonly reported pathology included Hill Sachs Lesions (41%), Soft tissue (59%) and bony Bankart lesions (16%), capsular laxity (20 %), supraspinatus lesion (20%), ACJ disease (13%) and SLAP tear (12%). The sensitivity of MR for identification of
The spectrum of pathoanatomy in collision athletes with shoulder instability is wide, with a high incidence of extended
Shoulder instability and impingement are common in tennis players. During tennis, several impingements could occur: subcoracoid and anterosuperior impingements at the follow-through phase of forehand and the backhand preparation phase; subacromial and postero-superior impingements at the cocking phase of serve. The precise causes for these impingements remain unclear, but it is believed that repetitive contact, glenohumeral instability may play a role. Impingement and glenohumeral instability at critical tennis positions have never been dynamically evaluated in-vivo. The purpose of this study was to develop a patient-specific measurement technique based on motion capture and MRI to accurately determine glenohumeral kinematics (rotations and translations). The second objective was to evaluate impingements and stability in tennis. Shoulder MR arthrography and motion capture were performed in 10 tennis players. Motion data were recorded during tennis movements. Glenohumeral kinematics was computed from the markers trajectories using a global optimisation algorithm with loose constraints on joint translations (accuracy: translational error ≈3mm, rotational error <4°). The translations patterns computed with the model were in good agreement with previous works. The resulting computed motions were applied to the subject's shoulder 3D bony models reconstructed from MRI data. While simulating the shoulder joint, minimum humero-acromial, humero-coracoid and humero-glenoid distances were measured at critical tennis positions. Given the thickness of the potential impinged tissues, impingement was considered when the computed distance was <5 mm (<6 mm for the humero-acromial distance). During serve, glenohumeral stability was assessed at the cocking, deceleration and finish phases. Glenohumeral translation was defined as the anterior-posterior and superior-inferior motion of the humeral head centre relative to a glenoid coordinate system. Subluxation was defined as the ratio (in %) between the humeral head centre translation and the radius of the width (antero-posterior subluxation) or height (supero-inferior subluxation) of the glenoid surface. Instability was thus considered when the subluxation was >50%, corresponding to a loss of congruence superior to half the radius of the width (or height) of the glenoid. No subcoracoid impingement was detected. Antero-superior impingements were observed in two subjects (29%) during forehand. Anterior and lateral subacromial impingements occurred during the cocking phase of serve in three (29%) and four subjects (42%), respectively. Postero-superior impingements during the cocking phase of serve were the most frequent (7 subjects, 75%). In this position, glenohumeral translation was anterior (mean: 34%) and superior (mean: 13%). During the deceleration phase, anterior and superior translation varied between 8–57% and between 5–34%, respectively. During the finish phase, anterior translation was slightly more intense (mean: 44%), while superior translation remained low (mean: 1%). MRI revealed eleven rotator cuff lesions in five subjects, and six
Introduction. Acetabular labral pathology is now recognized as a more common injury than previously thought. With cost constraints of MRI and invasiveness of MRI arthrogram, physical examination remains essential for diagnosis. Most tests for labral pathology are currently done in the supine position. We have developed the “twist test,” which is done with the patient standing and can evaluate the patient in functional, weight bearing position. The purpose of this study is to describe the twist test and compare its reliability to MRI arthrogram. Material and methods. Between June 2009 and August 2010, the twist test was performed on all patients presenting to our clinic with complaint of hip pain. 371 patients had the twist test performed. Of these, 247 had an MRI arthrogram (MRA) of the affected hip. The twist test results were compared with MRA findings. A labral tear, degeneration, fraying and paralabral cyst were considered as a positive MRA. The twist test is done with the patient facing the examiner, toes pointing forward. The patient bends their knees to 30 degrees and performs a windshield wiper like action with maximal excursion to the left and right. If the patient tolerates this, then the patient first gets on the unaffected leg, again with the knee bent at 30 degrees, and “does the twist” one-legged, with the examiner holding their hands gently for balance. The test is then repeated on the affected hip. A positive test is groin pain on the affected hip, apprehension with performing the test on the affected hip, or gross range of motion deficits on the affected hip compared with the unaffected side. Results. Among 160 patients with positive twist test, 154 patients had positive MRA and 6 had negative MRA. Among 87 patients with negative twist test, 72 had positive MRA and 15 had negative MRA. In comparison with MRA, the sensitivity and specificity of twist test for labral injury were 68.14% and 71.5% respectively. Positive predictive value (precision) of twist test for diagnosis of
Aims To describe the distribution, clinical presentation of SLAP tears in rugby players, and time taken for return to sport. Method A retrospective review of 51 shoulder arthroscopies performed on professional rugby players over a 35 month period was carried out. All patients diagnosed with a SLAP lesion at arthroscopy were identified. Each patient’s records were reviewed to record age, injury side, mechanism of injury, clinical diagnosis, investigations and results, management, and return to play. Results The incidence of SLAP tears was 35%. All 18 patients were male with an average age of 27yrs. There were 11 isolated SLAP tears (61%), 3 SLAP tears associated with a Bankart lesion (17%), 2 SLAP tears associated with a posterior
Introduction. Posterior superior glenoid impingement as a cause of partial rotator cuff lesions and posterior superior labral tears in overhead athletes was first described in the early 90’s by Walch and Jobe. Material and methods. From January 1994 to January 2002, 71 patients were treated (48 men and 23 women). The majority were overhead athletes: handball (39), ketcher sports (12), volleyball (8), others (12). Indications for surgery were shoulder pain with athletic activity and a failed trial of conservative treatment. Mean age was 26 (range, 17–41) years. Mean duration of symptoms was 31 (range, 7–120) months. Following diagnostic arthroscopy–excluding anterior inferior ligament lesions and other significant intaarticular pathology–the partial rotator cuff lesions and posterior superior labral tears were debrided arthroscopically. During postoperative rehabilitation emphasis was placed on strengthening rotator cuff muscles, restoring normal scapulohumeral rhythm and avoiding stretching of the anterior static glenohumeral stabilizers. Results. In 97% of cases a partial rotator cuff were found, and 90% had significant posterior–superior