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Acetabular labrum

Victor Ortiz-Declet, Brian Mu, Austin W Chen, Jody Litrenta, Leslie C Yuen, Stephanie M Rabe, Benjamin G Domb
Arthroscopic acetabuloplasty involves trimming of bone from the acetabular rim. Although early techniques often involved detachment of the labrum prior to bone resection, recent studies have reported on acetabuloplasty without labral detachment. This method has the benefit of preserving the labro-osseous junction, but visualization of the acetabular rim may be more difficult. Compromised visualization can lead to incomplete resection and residual impingement. We describe an arthroscopic perspective called the "bird's eye" and "upper deck" views that facilitates optimal visualization of the acetabuloplasty without labral detachment...
January 2018: Arthroscopy Techniques
Ashley L Kapron, Stephen K Aoki, Jeffrey A Weiss, Aaron J Krych, Travis G Maak
PURPOSE: Develop a framework to quantify the size, location and severity of femoral and acetabular-sided cartilage and labral damage observed in patients undergoing hip arthroscopy, and generate a database of individual defect parameters to facilitate future research and treatment efforts. METHODS: The size, location, and severity of cartilage and labral damage were prospectively collected using a custom, standardized post-operative template for 100 consecutive patients with femoroacetabular impingement syndrome...
February 13, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Patrick Finton Carton, David Filan
Arthroscopic labral 'takedown' and refixation is utilized to permit adequate visualization and resection of the acetabular rim deformity, in patients with pincer or mixed femoroacetabular impingement. Deficiencies exist in present techniques, which include disruption of vital anatomical support and vascular structures to the labrum and chondrolabral junction, drill or anchor articular penetration risk, bunching, elevation and instability of the labrum. A new operative technique is described which preserves the important chondrolabral interface, accurately restoring the 'flap seal' of the acetabular labrum while minimizing vascular disruption and reducing the risk of drill and anchor penetration...
January 2018: Journal of Hip Preservation Surgery
Jan Weidner, Michael Wyatt, Martin Beck
Preservation of an intact labrum and reconstruction of a deficient or worn acetabular labrum are accepted techniques in modern hip surgery. If the remaining labrum is very thin, its intact tip can be preserved and its volume restored with a ligamentum teres graft. Technique and preliminary results of this augmentation technique are presented. Labral augmentation was performed in 16 hips (11 rights) in 16 patients (7 males, mean age 29 years) during surgical dislocation for treatment of femoroacetabular impingement...
January 2018: Journal of Hip Preservation Surgery
Nathan W Skelley, William K Conaway, Scott D Martin
The prevalence of hip arthroscopy has increased exponentially with the advent of arthroscopic labral repair techniques for femoroacetabular impingement. The goal of arthroscopic labral repair is to re-create the anatomic suction seal of the labrum against the femoral head. This important anatomic relationship has been demonstrated in several biomechanical studies. Performing the acetabular recession and evaluating the congruity of labral repairs during surgery is difficult with the application of traction distracting the femoral head from the chondrolabral junction...
October 2017: Arthroscopy Techniques
Itay Perets, Edwin O Chaharbakhshi, David E Hartigan, Victor Ortiz-Declet, Brian Mu, Benjamin G Domb
PURPOSE: To evaluate a delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) index designed to predict focal acetabular articular cartilage damage in patients with femoroacetabular impingement (FAI). METHODS: The inclusion criteria were patients who underwent dGEMRIC and hip arthroscopy between April 2010 and August 2015 for FAI syndrome. The exclusion criteria were previous hip conditions, a Tönnis grade greater than 1, and a delay between magnetic resonance imaging and surgery greater than 180 days...
January 17, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Songkiat Thanacharoenpanich, Sarah Bixby, Michael A Breen, Young-Jo Kim
BACKGROUND: Traumatic posterior hip dislocations in children and adolescents requires emergent closed reduction. Postreduction imaging is necessary to assess the concentricity of reduction and structural injuries to the hip. There is no a consensus for which imaging is a modality of choice in such condition. The purposes of this study are to describe magnetic resonance imaging (MRI) findings of traumatic posterior hip dislocations and to compare the effectiveness of MRI with computerized tomography (CT) in detecting structural abnormalities of the hip that impact patient management...
January 19, 2018: Journal of Pediatric Orthopedics
Kartik Shenoy, Amos Z Dai, Siddharth A Mahure, Daniel J Kaplan, Brian Capogna, Thomas Youm
The acetabular labrum and the transverse acetabular ligament form a continuous ring of tissue on the periphery of the acetabulum that provides a seal for the hip joint and increases the surface area to spread load distribution during weight-bearing. When a labral tear is suspected, the treatment algorithm always begins with conservative management, including physical therapy and nonsteroidal anti-inflammatory drugs. When conservative management fails, patients become candidates for arthroscopic labral repair...
December 2017: Arthroscopy Techniques
Soon Hyuck Lee, Woo Young Jang, Gi Won Choi, Young Keun Lee, Hae Woon Jung
PURPOSE: To investigate the arthroscopic pathoanatomy of the transverse acetabular ligament (TAL) and determine whether a TAL incision is necessary for the concentric reduction of developmental dysplasia of the hip (DDH) in infants and young children. METHODS: We retrospectively reviewed patients who underwent arthroscopic-assisted reduction for DDH between July 2008 and April 2016. The indications for this intervention included patients in whom closed reduction failed and those who did not require bone operations...
December 26, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
Carlos Suarez-Ahedo, Chengcheng Gui, Stephanie M Rabe, John P Walsh, Sivashankar Chandrasekaran, Benjamin G Domb
Background: Hip arthroscopic surgery is intended to treat multiple abnormalities in an effort to delay the progression to osteoarthritis, especially in young patients. However, the length of time in which patients experience joint pain before seeking a specialist for a diagnosis can delay hip preservation surgery and influence clinical outcomes. Purpose: To investigate the relationship between age at symptom onset and findings during hip arthroscopic surgery as well as outcomes after 2 years of clinical follow-up...
November 2017: Orthopaedic Journal of Sports Medicine
Yasuhiro Shirai, Kenjiro Wakabayashi, Ikuo Wada, Yoshiaki Tsuboi, Myongsu Ha, Takanobu Otsuka
BACKGROUND: The Herring lateral pillar classification is widely used for the classification of Legg-Calvé-Perthes disease, but is not applied at the early stage of Legg-Calvé-Perthes disease because it is typically applied at the late fragmentation stage. The purpose of this study was to investigate the correlation between the early appearance on magnetic resonance imaging of the acetabular labrum and lateral pillar involvement in Legg-Calvé-Perthes disease. METHODS: Non-contrast magnetic resonance images of 26 hips in 25 children with early-stage Legg-Calvé-Perthes disease were retrospectively reviewed...
November 17, 2017: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Austin W Chen, Leslie C Yuen, Victor Ortiz-Declet, Jody Litrenta, David R Maldonado, Benjamin G Domb
BACKGROUND: Arthroscopic labral debridement in the hip can be an effective treatment for labral tears but has demonstrated inferior outcomes compared with labral repair. Thus, the role for labral debridement has become unclear. Hypothesis/Purpose: The purpose was to evaluate the outcomes of a selective debridement with labral preservation (SDLP) group with a minimum 5-year follow-up. It was hypothesized that, with narrow indications, SDLP would produce statistically improved patient-reported outcome (PRO) scores, comparable with those of a matched-pair labral repair control group...
November 1, 2017: American Journal of Sports Medicine
K Studer, N Williams, P Studer, M Baker, A Glynn, B K Foster, P J Cundy
PURPOSE: Identification of anatomical structures that block -reduction in developmental dysplasia of the hip (DDH) is -important for the management of this challenging condition. Obstacles to reduction seen on arthrogram are well-known. However, despite the increasing use of MRI in the assessment of adequacy of reduction in DDH, the interpretation of MRI patho-anatomy is ill-defined with a lack of relevant literature to guide clinicians. METHOD: This is a retrospective analysis of the MRI of patients with DDH treated by closed reduction over a five-year period (between 2009 and 2014)...
October 1, 2017: Journal of Children's Orthopaedics
V Tiwari, S Gamanagatti, R Mittal, H Nag, S A Khan
BACKGROUND: Most of the information available about Legg-Calve-Perthes disease (LCPD) at present is gained through imaging modalities including plain radiographs and magnetic resonance imaging (MRI). But the accuracy of MRI in this disease and its predictive value to reveal various intra-articular pathologies is not known. We correlated the findings of MRI with those seen on hip arthroscopy in children with active stage of LCPD. METHODS: We conducted a prospective observational study in which MRI findings were correlated with corresponding findings on hip arthroscopy in a cohort of 25 patients of active LCPD below 12 years of age...
October 12, 2017: Musculoskeletal Surgery
S Kapetanakis, A Dermon, N Gkantsinikoudis, V Kommata, P Soukakos, C R Dermon
PURPOSE: Histological architecture of normal acetabular labrum regarding free nerve endings (FNEs) and mechanoreceptors (MRs) has been satisfactorily described in the literature. However, the presence of FNEs and MRs in acetabular labrum of hip joint has been analyzed only once in patients with osteoarthritis (OA). Aim of this article is to report histological distribution pattern of FNEs and MRs in acetabular labrum of patients with severe OA, at the same time conducting a comparison with normal acetabular labrum described in the literature...
September 2017: Journal of Orthopaedic Surgery
A Chopra, A J Grainger, B Dube, R Evans, R Hodgson, J Conroy, D Macdonald, Philip Robinson
OBJECTIVE: To compare the diagnostic accuracy of conventional 3T MRI against 1.5T MR arthrography (MRA) in patients with clinical femoroacetabular impingement (FAI). METHODS: Sixty-eight consecutive patients with clinical FAI underwent both 1.5T MRA and 3T MRI. Imaging was prospectively analysed by two musculoskeletal radiologists, blinded to patient outcomes and scored for internal derangement including labral and cartilage abnormality. Interobserver variation was assessed by kappa analysis...
October 6, 2017: European Radiology
Bernardo Aguilera-Bohorquez, Eduardo Gil, John Fonseca, Miguel Fernandez, Miguel Sánchez
Arthroscopy is a surgical technique useful in the treatment of intra- and extra-articular hip pathologies, including femoroacetabular impingement (FAI). In the arthroscopic treatment of pincer-type FAI, tendon interposition of the reflected head of the rectus femoris frequently hinders acetabular edge resection in the anterior-superior region (acetabuloplasty) and labrum repositioning, even causing tendon injury during the surgical procedure. Many surgeons do not give importance to the reflected head of the rectus femoris, and during the procedure they try to avoid it, giving 30° of flexion to the hip...
August 2017: Arthroscopy Techniques
Jan Hubert, Thelonius Hawellek, Martin Moe, Sandra Hischke, Matthias Krause, Tim Rolvien, Tobias Schmidt, Wolfgang Rüther, Andreas Niemeier
The acetabular labrum of the hip (ALH) is recognized as a clinically important structure, but knowledge about the pathophysiology of this fibrocartilage is scarce. In this prospective study we determined the prevalence of ALH calcification in patients with end-stage osteoarthritis (OA) and analyzed the relationship of cartilage calcification (CC) with hip pain and clinical function. Cohort of 80 patients (70.2 ± 7.6years) with primary OA scheduled for total hip replacement. Harris Hip Score (HHS) was recorded preoperatively...
September 14, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Huw L M Williams, Gavin E Bartlett, Mark R Norton, Rory G Middleton
INTRODUCTION: Incorrect acetabular component positioning during total hip arthroplasty (THA) may lead to dislocation, impingement, wear and revision. Surgeons commonly use the transverse acetabular ligament (TAL) as a landmark for acetabular component orientation. The posterior acetabular wall (PAW) is a structure easily viewed on plain radiography and its position can help guide acetabular component position. In this study, we examine the efficacy of preoperative radiographs in predicting cup position relative to the PAW...
September 7, 2017: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Ritesh Rathi, Jacek Mazek
BACKGROUND: The integrity of the acetabular labrum is crucial to normal biomechanics of the hip joint. Disruption of the labral seal could be detrimental to the overall nutrition of the cartilage, leading to its premature degeneration. PURPOSE: The aim of this study is to determine the clinical effectiveness of arthroscopic hip labral reconstruction using fascia lata allograft. The hypothesis is that labral reconstruction would provide good clinical outcomes. METHODS: We retrospectively reviewed all 10 patients who underwent labral reconstruction with fascia lata allograft from January 2013 to October 2015...
2017: Open Orthopaedics Journal
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