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Articular cartilage lesions of the acetabulum may result in significant pain and dysfunction for patients with treatment options consisting of either microfracture or various forms of cartilage restoration procedures. A systematic review of 529 patients demonstrated similar, if not lower, reoperation rates and patient-reported outcomes in patients receiving cartilage restoration procedures compared with microfracture. The primary outcomes examined in this review were reoperation rates and patient-reported outcomes with no clear mention of radiographic outcomes and no clearly defined indications as to who would benefit from a cartilage-based procedure. This raises the question as to whether there should be a consensus-based and standardized criteria established and standardized among the hip preservation expert community to evaluate the success of these cartilage restoration procedures from an imaging standpoint. These criteria can also be incorporated into a composite evaluation that combines clinical, imaging, and patient-reported outcomes to determine optimal patient candidacy for cartilage procedures as well. This would be a very useful steppingstone for much-needed future Level I randomized studies or prospective, registry-based data on this topic.
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Artroscopia , Cartilagem Articular , Medidas de Resultados Relatados pelo Paciente , Humanos , Cartilagem Articular/cirurgia , Cartilagem Articular/lesões , Cartilagem Articular/diagnóstico por imagem , Articulação do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Acetábulo/cirurgia , Acetábulo/diagnóstico por imagem , Acetábulo/lesõesRESUMO
The ligamentum teres (LT) is known to play a role as a secondary stabilizer of the hip joint. LT tears can be associated with hip instability. In patients with borderline developmental dysplasia of the hip (BDDH), the correlation between LT tears and microinstability is even more pronounced because of the increased mechanical stress placed on the ligament. This relationship may lead certain surgeons to consider new indications for LT reconstructions. However, caution is warranted regarding the potential role of LT reconstruction in these patients, particularly since the primary deficiency in BDDH is bony undercoverage. Addressing this bony undercoverage should be a primary consideration that may be supplemented with other procedures, which may include addressing soft-tissue injuries around the hip such as LT tears. This is especially the case in those patients with persistent symptoms after management of labral tears or LT disruption.
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Luxação do Quadril , Ligamentos Redondos , Humanos , Luxação do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Ligamentos Redondos/lesões , Artroscopia/métodosRESUMO
PURPOSE: To evaluate the current body of evidence surrounding the diagnosis, management, and clinical outcomes of adhesions that developed after hip arthroscopy (HA). METHODS: A systematic search of the MEDLINE, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases was designed and conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Eligible studies included patients with confirmed adhesions after HA that reported one or more of the following: (1) diagnostic procedures and criteria used; (2) indications for and details surrounding surgical management; and (3) clinical outcomes after the operative management of adhesions (e.g., patient-reported outcome measures). RESULTS: Nineteen studies involving a total of 4,145 patients (4,211 hips; 38% female sex) were included in this review. The quality of evidence was found to be fair for both comparative studies (mean, 17; range, 13-21) and noncomparative studies (mean, 10; range, 5-12) according to the Methodological Index for Non-randomized Studies (MINORS) instrument, with the level of evidence ranging from IIB to IV. Adhesions were often diagnosed intraoperatively at the time of revision surgery (10 of 19 studies, 53%), with only 3 studies specifying the criteria used to adjudicate adhesions. The most common indication for operative management (i.e., release or lysis of adhesions) was persistent pain (9 of 19, 47%), but this was often grossly stated for revision HA rather than being specific to adhesions. Patient-reported outcome measures were the most reported postoperative outcomes (9 of 19, 47%) and generally showed significant improvement from preoperative assessment across the short-term follow-up period (range, 24.5-38.1 months). There was a paucity of objective measures of clinical improvement (3 of 19, 16%) and of mid- and long-term follow-up (i.e., 5-7 years and ≥10 years, respectively). CONCLUSIONS: Despite the growing body of evidence suggesting that adhesions are highly contributory to revision HA, there is ambiguity in the diagnostic approach and indications for operative management of adhesions. Additionally, although the operative management of adhesions after HA has shown satisfactory clinical outcomes in the short term, there is a paucity of research elucidating the mid- to long-term outcomes, as well as minimal use of objective assessment of clinical improvement (e.g., biomechanics). LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.
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PURPOSE: The purpose of the study was to identify prognostic risk factors for prolonged opioid use at 2 and 6 weeks after hip arthroscopy using data from the Femoroacetabular Impingement RandomiSed controlled Trial and its external validation cohort study. METHODS: Opioids were prescribed for postoperative pain management at the surgeon's discretion, with a majority being prescribed a combination of oxycodone and paracetamol (5/325 mg). Prolonged opioid use was defined as the ongoing use of any dosage of opioids reported at either 2 or 6 weeks after surgery to treat femoroacetabular impingement, as recorded in the patient's study medication log. Multivariable logistic regressions were performed to evaluate patient and surgical characteristics, such as preoperative opioid use, type of surgical procedure and intraoperative cartilage state that may be associated with prolonged opioid use at either 2 and 6 weeks postoperatively. RESULTS: A total of 265 and 231 patients were included for analysis at 2 and 6 weeks postoperatively, respectively. The median age of participants was 35 years (interquartile range [IQR]: 27-42) and 33% were female. At 2 weeks postoperatively, female sex (odds ratio [OR]: 2.56; 95% confidence interval: [CI] 1.34-4.98, p = 0.005), higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02-1.18, p = 0.009), active tobacco use (OR: 4.06; 95% CI: 1.90-8.97, p < 0.001), preoperative opioid use (OR: 10.1; 95% CI: 3.25-39.1, p < 0.001) and an Outerbridge classification of ≥3 (OR: 2.33; 95% CI: 1.25-4.43, p = 0.009) were significantly associated with prolonged opioid use. At 6 weeks postoperatively, only preoperative opioid use was significantly associated with prolonged opioid consumption (OR: 10.6; 95% CI: 3.60-32.6, p < 0.001). CONCLUSION: Preoperative opioid use was significantly associated with continued opioid use at 2 and 6 weeks postoperatively. Specific patient factors including female sex, higher BMI, active tobacco use and more severe cartilage damage should be considered in developing targeted strategies to limit opioid use after surgery. LEVEL OF EVIDENCE: Level III.
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Analgésicos Opioides , Artroscopia , Impacto Femoroacetabular , Dor Pós-Operatória , Humanos , Feminino , Masculino , Impacto Femoroacetabular/cirurgia , Analgésicos Opioides/uso terapêutico , Analgésicos Opioides/administração & dosagem , Adulto , Dor Pós-Operatória/tratamento farmacológico , Fatores de Risco , Estudos de Coortes , Fatores Sexuais , Acetaminofen/uso terapêutico , Acetaminofen/administração & dosagemRESUMO
PURPOSE: To identify risk factors associated with increased postoperative opioid consumption and inferior pain outcomes following knee and shoulder arthroscopy. METHODS: Using the data set from the NonOpioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) trial, eight prognostic factors were chosen a priori to evaluate their effect on opioid consumption and patient-reported pain following arthroscopic knee and shoulder surgery. The primary outcome was the number of oral morphine equivalents (OMEs) consumed at 2 and 6 weeks postoperatively. The secondary outcome was patient-reported postoperative pain using the Visual Analogue Scale (VAS) at 2 and 6 weeks postoperatively. A multivariable linear regression was used to analyse these outcomes with eight prognostic factors as independent variables. RESULTS: Tobacco usage was significantly associated with higher opioid usage at 2 (p < 0.001) and 6 weeks (p = 0.02) postoperatively. Former tobacco users had a higher 2-week (p = 0.002) and cumulative OME (p = 0.002) consumption compared to current and nonsmokers. Patients with a higher number of comorbidities (p = 0.006) and those who were employed (p = 0.006) reported higher pain scores at 6 weeks. Patients in the 'not employed/other' category had significantly lower pain scores at 6 weeks postoperatively (p = 0.046). CONCLUSION: Former smoking status was significantly associated with increased post-operative opioid consumption following knee and shoulder arthroscopy at 2 and 6 weeks postoperatively. Increased pain was found to be significantly associated with employment status and an increasing number of comorbidities at 6 weeks postoperatively. These findings can aid clinicians in identifying and mitigating increased opioid utilization as well as worse pain outcomes in high-risk patient populations. LEVEL OF EVIDENCE: Level III, cohort study.
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PURPOSE: To evaluate the burden experienced by primary informal caregivers of patients who have undergone hip arthroscopy and to identify factors that predict increased caregiver burden. METHODS: A cross-sectional study was conducted at a single academic hospital centre, enroling caregivers of patients who underwent hip arthroscopy between November 2018 and November 2023. Caregiver burden was assessed using the Caregiver Burden Inventory (CBI) survey. Multivariable linear regression models were used to identify predictors of caregiver burden, with the global CBI score serving as the primary outcome measure. Secondarily, open-ended survey questions were analyzed qualitatively to elucidate specific challenges and facilitators of caregiving, as reported by the caregivers themselves. RESULTS: The study involved 99 eligible caregivers (mean [standard deviation] age; 47 [11] years), 58% were female, and 85% were relatives of the patient. The median global CBI score was 13.0 (interquartile range: 8.0-22.4), indicating a moderate burden. Regression analyses demonstrated that younger caregiver age and a higher number of caregiving tasks were significant predictors of increased global burden. Additionally, nonweightbearing status of patients, female gender of caregivers and working full-time statistically significantly increased specific dimensions of caregiver burden. CONCLUSION: This study highlights the meaningful burden faced by caregivers of patients undergoing hip arthroscopy, despite its minimally invasive nature and outpatient setting. Identified risk factors such as younger caregiver age, female gender of the caregiver, nonweight-bearing status and increased caregiving tasks suggest targeted areas for intervention. The qualitative analysis revealed that caregivers struggle with time management and physical and emotional strain, yet better communication and practical support from healthcare teams could help to alleviate these challenges. LEVEL OF EVIDENCE: Level IV, prognostic study.
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PURPOSE: The aim of this study was to determine how preoperative health-related quality of life (HRQoL) is affected by the duration of the wait time (WT) for anterior cruciate ligament reconstruction (ACLR) once a decision is made to proceed with surgery. METHODS: This was a multi-centre prospective cohort study. One hundred and twenty-two patients 14 years of age and above waiting for ACLR completed the International Knee Documentation Committee (IKDC) demographic, current health assessment and subjective knee evaluation (SKF) forms on the day of decision to operate and the day of surgery. Changes in scores were analyzed for the entire cohort, adjusted for WTs and a subset was compared for patients with isolated anterior cruciate ligament (ACL) tears and ACL tears with concurrent meniscal involvement. Changes in HRQoL scores from the day of the decision to operate to the 9-month postoperative appointments were also assessed. RESULTS: Energy/Fatigue (p < 0.05), Pain (p < 0.05), General Health (p < 0.05) and the IKDC-SKF Score (p < 0.05) significantly increased between the day of the decision to operate and the day of surgery. Only the change in IKDC-SKF score remained significantly higher after adjusting for WT. Baseline HRQoL scores significantly improved by the 9-month postoperative appointment. CONCLUSION: The length of time waiting for ACLR did not adversely influence HRQoL in this study. However, low preoperative HRQoL and the significant improvement in HRQoL of patients followed postoperatively suggest that timely surgery is beneficial for this patient population. LEVEL OF EVIDENCE: Level II.
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The incidence of hip arthroscopy (HA) has seen a dramatic rise over the past decade, with a bimodal distribution of patient age with peaks at both 18 and 42 years of age. Thus, it is essential to reduce complications, including venous thromboembolism (VTE), given reported incidences as high as 7%. Fortunately, more recent research, perhaps reflecting an evolution resulting in lower HA surgical traction times, has shown a VTE incidence of 0.6%. Perhaps because of such a low rate, recent research has also shown that generally, thromboprophylaxis does not significantly decrease the odds of VTE. The strongest predictors of VTE after HA are oral contraceptive use, prior malignancy, and obesity. Rehabilitation is also an important factor as some patients are ambulatory on postoperative day 1, reducing the VTE risk, whereas others require a few weeks of protected weight bearing, increasing their risk. A patient-specific approach to VTE prevention after HA, rather than a one-size-fits-all approach, is essential.
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Anticoagulantes , Tromboembolia Venosa , Humanos , Adolescente , Adulto Jovem , Adulto , Artroscopia , Obesidade , Duração da CirurgiaRESUMO
Hip arthroscopy patients often present with clinical features that help broadly categorize them as the younger patient with femoroacetabular impingement, the microinstability- or instability-related patient, those patients with predominant peripheral compartment disease, and the older patient with femoroacetabular impingement plus peripheral compartment disease. Outcomes in older patients can equal outcomes in younger patients with proper surgical indications. Specifically, older hip arthroscopy patients do well in the absence of degenerative articular cartilage changes. Although some studies have suggested a potential for greater conversion rate to hip arthroplasty in an older age group, with proper patient selection, hip arthroscopy may lead to durable and significant improvements.
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Artroplastia de Substituição , Impacto Femoroacetabular , Humanos , Idoso , Articulação do Quadril/cirurgia , Impacto Femoroacetabular/cirurgia , Artroscopia , Resultado do TratamentoRESUMO
PURPOSE: To assess the utility of the femoroepiphyseal acetabular roof (FEAR) index as a diagnostic tool in hip-preservation surgery. METHODS: MEDLINE, EMBASE, and PubMed were searched from database inception until May 2022 for literature addressing the utility of the FEAR index in patients undergoing hip-preservation surgery, and the results are presented descriptively. RESULTS: Overall, there were a total of 11 studies comprising 1,458 patients included in this review. The intraobserver agreement for the FEAR index was reported by 3 of 11 studies (intraclass correlation coefficient range = 0.86-0.99), whereas the interobserver agreement was reported by 8 of 11 studies (intraclass correlation coefficient range = 0.776-1). Among the 5 studies that differentiated between hip instability and hip impingement, the mean FEAR index in 319 patients in the instability group ranged from 3.01 to 13.3°, whereas the mean FEAR index in 239 patients in the impingement group ranged from -10 to -0.77° and the mean FEAR index in 105 patients in the control group ranged from -13 to -7.7°. Three studies defined a specific cutoff value for the FEAR index, with 1 study defining a cutoff value of 5°, which correctly predicted treatment decision between periacetabular osteotomy versus osteochondroplasty 79% of the time with an AUC of 0.89, whereas another defined a cutoff of 2°, which correctly predicted treatment 90% of the time and the last study set a threshold of 3°, which provided an AUC of 0.86 for correctly predicting treatment decision. CONCLUSIONS: This review demonstrates that the FEAR index has a high agreement and consistent application, making it a useful diagnostic tool in hip-preservation surgery particularly in patients with borderline dysplastic hips. However, given the variability in FEAR index cutoff values across studies, there is no absolute consensus value that dictates treatment decision. LEVEL OF EVIDENCE: Level IV; Systematic Review of Level II-IV studies.
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Luxação do Quadril , Humanos , Luxação do Quadril/cirurgia , Estudos Retrospectivos , Acetábulo/cirurgia , Osteotomia/métodos , Artroscopia/métodos , Resultado do Tratamento , Articulação do Quadril/cirurgiaRESUMO
PURPOSE: The purpose of this systematic review was to assess the indications, outcomes, and complications of hip arthroscopy in individuals 50 years of age or older over the past 5 years. METHODS: The electronic databases PUBMED, MEDLINE, and EMBASE were searched on March 3, 2022, for studies assessing the use of primary hip arthroscopy for patients aged 50 years or older from the past 5 years. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively. RESULTS: Overall, 17 studies were included, consisting of 6,696 patients (37.5%) with a mean age of 61.4 ± 5.0 years and a median follow-up of 24 months (range: 1.4-70.1). Indications for hip arthroscopy in patients aged 50 years or older were unspecified/undefined (93.8%), mixed pathology (i.e., combined femoroacetabular impingement [FAI], labral tear, osteoarthritis, etc.) (2.7%), and FAI (2.6%). Eleven studies demonstrated significant improvement in functional outcome scores from baseline to final follow-up. Of the 6 studies that compared outcomes across multiple age groups, 3 demonstrated significantly worse functional outcomes, and 2 demonstrated significantly higher rates of conversion to THA for older patients compared to younger patients. Lastly, the overall complication rates ranged from 0 to 38.3%. The rate of conversion to THA ranged from 0 to 34.6%, occurring between 6 and 60 months postoperatively. CONCLUSIONS: Hip arthroscopy for patients aged 50 years or older yields significant improvements in patient-reported outcomes postoperatively compared to baseline, with a moderate rate of conversion to THA (range: 0 to 34.6%). Clinicians should consider patient history (e.g., imaging, comorbidities, etc.) and values when electing for hip arthroscopy in the older population. LEVEL OF EVIDENCE: IV, systematic review of Level III and IV studies.
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Artroplastia de Quadril , Impacto Femoroacetabular , Osteoartrite , Humanos , Pessoa de Meia-Idade , Idoso , Artroplastia de Quadril/métodos , Articulação do Quadril/cirurgia , Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Osteoartrite/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: To assess differences in postoperative outcomes between male and female patients following hip arthroscopy. METHODS: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, Embase, Cochrane, and PubMed databases were searched. Key words included "hip," "arthroscopy," "outcome," "gender difference," "sex difference," "gender," and "patient-reported outcome." Studies were included that reported sex-specific analysis of outcomes following primary hip arthroscopy with minimum 2-year follow-up. Methodological Index for Non-Randomized Studies criteria were applied to each study. Data collected included patient-reported outcome measures (PROMs), complications, rates of revision arthroscopy (RA), and conversion to total hip arthroplasty (THA). Forest plots were generated for the most frequently reported PROMs, RA, and THA rates. RESULTS: In total, 38 studies met the inclusion criteria, with 40,194 (57% female) hips included. The most common indications for hip arthroscopy were femoroacetabular impingement and labral tears. Eighteen studies reported PROMs, with no clear trend towards sex differences. Eleven studies reported on RA rates, with 4 showing a significantly greater rate of RA in female patients. Seventeen studies reported on conversion to THA, with an overall conversion rate of 9.64%. There were no clear sex differences in conversion to THA. CONCLUSIONS: There was no difference between sexes for postoperative PROM scores. Male patients were less likely to reach the MCID for the HOS-SSS than female patients in the majority of studies, and there were no sex differences for PASS rates. There were no significant differences between sexes in revision arthroscopy rates and conversion to total hip arthroplasty. LEVEL OF EVIDENCE: Level IV, systematic review of Level II, III and IV studies.
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Artroplastia de Quadril , Impacto Femoroacetabular , Humanos , Masculino , Feminino , Articulação do Quadril/cirurgia , Artroscopia/efeitos adversos , Impacto Femoroacetabular/cirurgia , Artroplastia de Quadril/efeitos adversos , Quadril/cirurgia , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento , Seguimentos , Estudos RetrospectivosRESUMO
PURPOSE: The primary purpose of this study was to systematically review the literature on intraoperative findings during endoscopic treatment for greater trochanteric pain syndrome (GTPS). Secondary outcomes were preoperative imaging findings and postoperative functional outcome measures. METHODS: Medline, PubMED, and Embase databases were searched from inception (1946, 1966, and 1974, respectively), to July 15, 2021, for records reporting intraoperative findings during endoscopic surgery for GTPS. Studies of Level I-IV evidence were eligible. All studies were assessed for quality using the Methodological Index for Non-Randomized Studies (MINORS) score. RESULTS: Sixteen studies met the inclusion criteria. Most patients underwent endoscopic greater trochanteric bursectomy with repair of the gluteal tendons. Intraoperative conditions reported were gluteal tendon tears usually involving the gluteus medius tendon, labral tears, and chondral lesions. Three studies reported an average of 9% of patients who subsequently underwent conversion to total hip arthroplasty. Pain was assessed using the visual analog scale, and functional outcome measures were measured using the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score Sport-Specific subscale, Hip Outcome Score Activities of Daily Living subscale, and iHOT-12. Pain and functional outcomes demonstrated significant improvement in nearly all the studies where they were reported. CONCLUSIONS: Patients who underwent endoscopic management of GTPS commonly underwent repair of gluteal tendon tears, and in many cases had concomitant labral tears and chondral lesions identified intraoperatively. There were low rates of adverse events, repair failure, and revision surgery. Patient-reported functional outcomes were improved at follow-up at least 1 year postoperatively. LEVEL OF EVIDENCE: IV, systematic review of level IV or better investigations.
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Atividades Cotidianas , Endoscopia , Humanos , Resultado do Tratamento , Endoscopia/métodos , Tendões/cirurgia , Dor/etiologia , Seguimentos , Estudos Retrospectivos , Artroscopia/métodos , Articulação do Quadril/cirurgiaRESUMO
OBJECTIVE: To evaluate the progression, quality, and challenges associated with conducting and publishing randomized controlled trials (RCTs) in sports medicine. DESIGN: Systematic review and survey. SETTING: MEDLINE and Embase were searched for all publications before September 17, 2021. A targeted search of clinicaltrials.gov , BMC Musculoskeletal Disorders, PubMed, and Google Scholar were also conducted. The survey was administered to authors using REDCap. PARTICIPANTS: Where the systematic search revealed no corresponding published definitive trial, authors of the published pilots were surveyed. INTERVENTIONS: Survey assessing limitations to definitive trials. MAIN OUTCOME MEASURES: Protocol/method articles, pilot articles, and relevant clinical trial registry records with corresponding definitive trials were pooled. RESULTS: Our literature search yielded 27 006 studies; of which, we included 208 studies (60 (28.8%) pilot RCTs, 84 (40.4%) protocol/method articles, and 64 (30.8%) trial registry records). From these, 44 corresponding definitive RCTs were identified. Pilot study and definitive RCT methodological quality increased on average most significantly during the duration of this review (30.6% and 8.2%). Of the 176 authors surveyed, 59 (33.5%) responded; 24.6% (14/57) stated that they completed an unpublished definitive trial, while 52.6% (30/57) reported having one underway. CONCLUSIONS: The quality and number of RCT publications within the field of sports medicine has been increasing since 1999. The number of sports medicine-related protocol and pilot articles preceding a definitive trial publication showed a sharp increase over the past 10 years, although only 5 pilot studies have progressed to a definitive RCT.
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Medicina Esportiva , Esportes , Humanos , Inquéritos e Questionários , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como AssuntoRESUMO
PURPOSE: To investigate the thickness and intra-substance change of anterior capsule of the hip joint, and compare the difference of the capsular features in patients with different statuses of hip stability. METHODS: A retrospective study was performed to review a hip preservation database. Using the lateral center edge angle(LCEA), patients with borderline dysplasia of the hip (BDH) of 20° ≤ LCEA ≤ 25°, femoracetabular impingement(FAI) with LCEA > 30° and dysplasia of the hip (DH) of LCEA < 20° were enrolled and stratified into different treatment groups. The patients' imaging was reviewed by two experienced musculoskeletal radiologists who were blinded to clinical outcomes. Thickness and intra-substance change of the anterior hip capsule was measured on the sagittal oblique sequences of MRI. A surgeon measured the thickness of the anterior hip capsule during arthroscopy. The capsular thickness and intra-substance change were compared among different groups. RESULTS: Thirty patients (17 women and 13 men) enrolled in each group (FAI, BDH, and DH) matched by sex and ages were evaluated. There were no significant differences in terms of age, sex, BMI, Alpha angle, and Tönnis grade among all three groups. The mean thickness of the anterior capsule in the DH group was 3.2 ± 0.5 mm, which was significantly thinner than that in the BDH and FAI groups (4.5 ± 0.8 mm and 4.7 ± 0.6 mm), and there was no significant difference in capsular thickness between the BDH and FAI groups. The Median of anterior capsule thickness via arthroscopic measuring was 6 mm and 7 mm in the BDH and FAI groups respectively, which has no statistical difference. The intra-substance change of the anterior capsule shows a significant difference among the three groups, and a higher incidence of delamination of the capsule was found in DH groups (p < 0.001). CONCLUSIONS: Patients with hip dysplasia have a significantly reduced capsular thickness on MRI and delaminated anterior joint capsule, which could be a sequence of instability. The clinical relevance of this study is that capsular thickness and intra-substance changes of the anterior capsule vary which could alter capsular management strategies. LEVEL OF EVIDENCE: Level III of evidence, DIAGNOSTIC STUDIES, No consistently applied reference standard.
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Impacto Femoroacetabular , Luxação Congênita de Quadril , Luxação do Quadril , Masculino , Humanos , Feminino , Adulto Jovem , Estudos Retrospectivos , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Artroscopia/métodos , Resultado do TratamentoRESUMO
PURPOSE: To identify and assess the clinical impact of randomised controlled trials (RCTs) assessing the surgical management of femoroacetabular impingement syndrome (FAIS) through a citation analysis. METHODS: MEDLINE, EMBASE and CENTRAL were searched from inception to April 22, 2023 for RCTs assessing the surgical management of FAIS. Study characteristics were directly abstracted from included trials and citation metrics were obtained from the Clarivate Web of Knowledge database on May 19, 2023. The continuous fragility index (CFI) was calculated for eligible outcomes. Univariate regression models were used to explore correlations between total citations per year and various study characteristics. RESULTS: Ten studies comprising one thousand two hundred ninetypatients were eligible for analysis. Studies were published from 2013 to 2023. Eight countries were represented across various trials with 91% being either North American or European. The mean journal impact factor of published studies was 39.684 (median 2.982; range 1.31-202.73). The mean citation density was 14.17 (range 0.33-48.67). The median CFI was 4.8 (range 1-32.2). Correlation analysis demonstrated strong and statistically significant correlations to study sample size (R = 0.75, p = 0.012), journal impact factor (R = 0.80, p = 0.006) and continuous fragility index (R = 0.95, p = 0.015). CONCLUSION: Trials assessing the surgical management of FAIS present with a wide range of clinical uptake based on citation density and are published in journals of broadly variable impact factor. Despite promising citation metrics, high-quality evidence on arthroscopy for FAIS is limited to the United States and Europe with an unclear international impact. Future knowledge translation efforts are warranted to maximise the international uptake of evidence regarding arthroscopic management of FAIS. LEVEL OF EVIDENCE: I.
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Impacto Femoroacetabular , Humanos , Impacto Femoroacetabular/cirurgia , Artroscopia , Fator de Impacto de Revistas , Europa (Continente) , Resultado do Tratamento , Articulação do Quadril/cirurgia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
PURPOSE: The purpose of this systematic review is to present the most common causes, diagnostic features, treatment options and outcomes of patients with hip micro-instability. METHODS: Three online databases (MEDLINE, Embase, and PubMed) were searched from database inception March 2022, for literature addressing the diagnosis and management of patients with hip micro-instability. Given the lack of consistent reporting of patient outcomes across studies, the results are presented in a descriptive summary fashion. RESULTS: Overall, there were a total of 9 studies including 189 patients (193 hips) included in this review of which 89% were female. All studies were level IV evidence with a mean MINORS score of 12 (range: 10-13). The most commonly used features for diagnosis of micro-instability on history were anterior pain in 146 (78%) patients and a subjective feeling of instability with gait in 143 (81%) patients, while the most common feature on physical examination was the presence of anterior apprehension with combined hip extension and external rotation in 123 (65%) patients. The most common causes of micro-instability were iatrogenic instability secondary to either capsular insufficiency or cam over-resection in 76 (62%) patients and soft tissue laxity in 38 (31%) patients. CONCLUSION: The most common symptom of micro-instability on history was anterior hip pain and on physical exam was pain with hip extension and external rotation. There are many treatment options and when managed appropriately based on the precise cause of micro-instability, patients may demonstrate improved outcomes. LEVEL OF EVIDENCE: IV.
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Articulação do Quadril , Instabilidade Articular , Humanos , Feminino , Masculino , Articulação do Quadril/cirurgia , Artroscopia/métodos , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Artralgia/etiologia , MarchaRESUMO
BACKGROUND: Microinstability of the hip joint is a proposed cause of hip pain and reduced function in young individuals. The underlying mechanism is thought to be extraphysiological hip motion due to bony deficiency and/or soft tissue deficiency or decreased soft tissue function. Recently, the condition has gained increased attention, and despite the fact that treatment today includes both non-surgical and surgical approaches, there is limited evidence on diagnostic specificity and treatment effects. The aim of this study is to evaluate clinical outcomes of both non-surgical and surgical treatment for microinstability of the hip joint. METHODS: A multicenter prospective cohort study is planned to evaluating the outcome of physical therapy aimed at stabilizing the hip joint, as well as arthroscopic plication of the hip joint capsule, if the physical therapy fails. Outcomes will be evaluated using hip-specific patient-reported outcome measures: the short version of the International Hip Outcome Tool and the Copenhagen Hip and Groin Outcome Score, strength and function tests, health-related quality of life as determined using the European Quality of Life-5 Dimensions and the European Quality of Life-Visual Analog Scale, sports activity levels according to the Hip Sport Activity Scale, and reported complications. Patients will be evaluated at 6, 12 and 24 months after each treatment. DISCUSSION: It is important to evaluate the clinical outcomes of both non-surgical and surgical treatment for suspected microinstability of the hip joint, and the planned prospective evaluation will contribute to the understanding of non-surgical as well as surgical treatment outcomes, including complications. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04934462 . Registered June 22 2021.
Assuntos
Artroscopia , Qualidade de Vida , Artroscopia/efeitos adversos , Artroscopia/métodos , Articulação do Quadril/cirurgia , Humanos , Cápsula Articular , Estudos Multicêntricos como Assunto , Estudos ProspectivosRESUMO
PURPOSE: The purpose of this study was to establish an international expert consensus on operating room findings that aid in the diagnosis of hip instability. METHODS: An expert panel was convened to build an international consensus on the operating room diagnosis/confirmation of hip instability. Seventeen surgeons who have published or lectured nationally or internationally on the topic of hip instability were invited to participate. Fifteen panel members completed a pre-meeting questionnaire and agreed to participate in a 1-day consensus meeting on May 15, 2021. A review of the literature was performed to identify published intraoperative reference criteria used in the diagnosis of hip instability. Studies were included for discussion if they reported and intraoperative findings associated with hip instability. The evidence for and against each criteria was discussed, followed by an anonymous voting process. For consensus, defined a priori, items were included in the final criteria set if at least 80% of experts agreed. RESULTS: A review of the published literature identified 11 operating room criteria that have been used to facilitate the diagnosis of hip instability. Six additional criteria were proposed by panel members as part of the pre-meeting questionnaire. Consensus agreement was achieved for 8 criteria, namely ease of hip distraction under anesthesia (100.0% agreement), inside-out pattern of chondral damage (100.0% agreement), location of chondral damage on the acetabulum (93.3% agreement), pattern of labral damage (93.3% agreement), anteroinferior labrum chondral damage (86.7% agreement), perifoveal cartilage damage (97.6% agreement), a capsular defect (86.7% agreement), and capsular status (80.0% agreement). Consensus was not achieved for 9 items, namely ligamentum teres tear (66.7% agreement), arthroscopic stability tests (46.7% agreement), persistent distraction after removal of traction (46.7% agreement), findings of examination under anesthesia (46.7% agreement), the femoral head divot sign (40.0% agreement), inferomedial synovitis (26.7% agreement), drive-through sign (26.7% agreement), iliopsoas irritation (26.7% agreement) and ligamentum teres-labral kissing lesion (13.3% agreement). All experts agreed on the final list of 8 criteria items reaching consensus. CONCLUSION: This expert panel identified 8 criteria that can be used in the operating room to help confirm the diagnosis of hip instability. LEVEL OF EVIDENCE: Level V expert opinion.
Assuntos
Salas Cirúrgicas , Ligamentos Redondos , Acetábulo , Artroscopia/métodos , Consenso , HumanosRESUMO
OBJECTIVE: The objective of this review was to investigate the average glenohumeral internal rotation deficit (GIRD) in the dominant arm of adolescent overhead athletes and to examine the association with shoulder and elbow injuries. DESIGN: Systematic review and meta-analysis. SETTING: MEDLINE, Embase, and PubMed were searched from inception to August 1, 2020. PARTICIPANTS: Adolescent overhead athletes with glenohumeral range of motion (ROM) measurements. INTERVENTIONS: Nonoperative treatments of GIRD. MAIN OUTCOME MEASURES: Glenohumeral ROM measurements comparing the dominant and nondominant extremities were pooled in a meta-analysis. RESULTS: Twenty-five studies were included in this review, which involved 2522 overhead athletes. Pooled internal rotation (IR) deficit of the dominant arm was 9.60° (95% confidence interval [CI] 7.87°-11.32°, P < 0.00001), with an external rotation (ER) gain of 6.78° (95% CI 4.97°-8.59°, P < 0.00001) and a total ROM (TROM) deficit of 1.78° (95% CI -0.70° to 4.26°, P = 0.16). The association between GIRD and shoulder or elbow injury was not clearly defined. Two studies reported treatment, and both used nonoperative treatment in the form of physiotherapy and sleeper stretches. CONCLUSIONS: The adolescent overhead athlete has roughly 10° of IR deficit in their dominant arm, accompanied by nearly 7° of ER gain, with similar ROM measurements for injured and uninjured athletes. Those with pathological GIRD have a greater degree of IR deficit, but without an accompanying compensatory increase in ER, leading to a TROM deficit of nearly 15°. Surgical treatment in the absence of other indications is rare, whereas physiotherapy and sleeper stretches remain the first-line treatment.