Patients With Lateral and Anterolateral Cam Morphology Have Greater Deformities Versus Typical Anterolateral Deformity Alone but No Differences in Postoperative Outcomes: A Propensity-Matched Analysis at Minimum 5-Year Follow-Up.

PURPOSE: To compare pre- and postoperative findings between patients undergoing hip arthroscopy for femoroacetabular impingement syndrome with lateral impingement versus those without lateral impingement METHODS: Patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between 2012 and 2017 with minimum 5-year follow-up were included. Alpha angle (AA) was measured on preoperative anteroposterior (AP) and 90° Dunn radiographs. Patients with AA >60° on Dunn view but not AP view (no lateral impingement) were propensity matched by sex, age, and body mass index in a 1:3 ratio to patients with AA >60° on both views (lateral impingement). Demographic characteristics, radiographic and intraoperative findings, reoperation rates, and patient-reported outcomes (PROs) were compared between groups. Categorical variables were compared using the Fisher exact testing and continuous variable using 2-tailed Student t tests. RESULTS: Sixty patients with lateral impingement (65.0% female, age: 35.3 ± 13.0 years) were matched to 180 patients without lateral impingement (65.0% female, age: 34.7 ± 12.5 years, P ≥ .279). Patients with lateral impingement had larger preoperative AAs on both Dunn (71.0° ± 8.8° vs 67.6° ± 6.1°, P = .001) and AP radiographs (79.0° ± 12.1° vs 48.2° ± 6.5°, P < .001). However, there were no differences in postoperative AAs on either view (Dunn: 39.0° ± 6.1° vs 40.5° ± 5.3°, AP: 45.8° ± 9.0° vs 44.9° ± 7.0°, P ≥ .074). Labral tears began more superiorly in patients with lateral impingement (12:00 ± 0:49 vs 12:17 ± 0:41, P = .030), and they demonstrated greater rates of acetabular and femoral cartilage damage (P = .030 for both); however, there were no differences in PROs or reoperation rates between the groups at 5-year follow-up. CONCLUSIONS: Although cam deformities located laterally and anterolaterally are larger than those located anterolaterally alone, both can be resected adequately, resulting in similar postoperative radiographic measurements, PROs, and survivorship. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Making the cut: a technical note and literature review of Bernese periacetabular osteotomy techniques with special attention to ischial osteotomy initiation and completion with an inside to anterior curved osteotomy.

Periacetabular osteotomy includes a fluoroscopy-guided ischial cut without direct visualization. Previously described techniques include a mediolateral ischial cortex cut, which is associated with the risk of injuring nearby nerves. Another drawback of that technique is the difficulty connecting an ischial cortex cut with a retroacetabular cut due to orthogonal nature of the osteotomy. In general, an additional cut from medial to lateral is required. The present study aimed to describe a technique that eliminates those problems due to use of only a central cut of the ischium and the curved nature of the osteotomy.

Revision of a Failed Primary Total Hip Arthroplasty following Excessive Reaming with a Medial Cup Protrusion.

Background and Objectives: Atraumatic intrapelvic protrusion of the acetabular component following excessive reaming of the acetabulum with a far medial positioning of the cup is a rare, but serious complication of a total hip arthroplasty (THA). This study analyzes the factors contributing to this uncommon complication and presents the outcome after the revision surgery using the Ganz reinforcement ring combined with a bone graft and plating of the posterior column and/or screws for the anterior column. Materials and Methods: A retrospective case series study with seven patients (four males, mean age 76 ± 10 years (60−86)) that underwent a revision THA within 24 ± 17 days (5−60) after an atraumatic periprosthetic acetabular fracture with a medial cup protrusion was performed. All fractures were reconstructed with a Ganz reinforcement ring and bone graft with a mean follow-up of 1.7 ± 1.7 years (0.5−5). Radiographs were evaluated for the following: (i) cup positioning immediately after the primary THA and the revision surgery, (ii) cup migration in the follow-up, and (iii) fracture healing. Results: The position of the acetabular component as assessed on the postoperative radiographs after the index surgery and before the complete medial cup protrusion showed a cup placement beyond the ilioischial line indicative of a fracture of the medial wall. The revision surgery with the reconstruction of the medial wall with a Ganz reinforcement ring combined with a bone graft restored in the presented cases the center of rotation in the horizontal direction with a statistical significance (p < 0.05). During the follow-up, there was no aseptic loosening with the relevant cup migration or significant change in the position of the acetabular cup at the final follow-up (p > 0.05) after the revision. All seven fractures and bone grafts realized a bone union until the latest follow-up. Conclusions: Following excessive reaming, the acetabular component was placed too far medially and resulted in an intrapelvic cup protrusion. An unstable cup following a fracture of the medial wall was evident on the immediate postoperative radiographs. In the case of the medial wall perforation with an intrapelvic cup protrusion after the primary THA, the reconstruction with a Ganz reinforcement ring was a successful treatment option resulting in the fracture healing and a stable cup positioning. Surgeons should be aware of that rare and probably underreported complication and restore the anatomic center of rotation by treating the defect intraoperatively.

Autologous free iliac crest bone grafting of glenoid through the rotator interval using double-barrelled cannula.

PURPOSE: The primary aim of this study is to prove that reconstructing the anterior glenoid defect with iliac crest graft arthroscopically using double-barrelled cannula through the rotator interval is safe and prevents both recurrence of instability and the neurovascular injury because subscapularis muscle is not split and procedure is far away from important structures. METHODS: Thirteen patients with anterior shoulder instability and engaging Hill-Sachs lesion were reviewed after arthroscopic reconstruction of the anterior glenoid with iliac crest autogenous graft. Patient satisfaction and Western Ontario Instability Score (WOSI) were evaluated on clinical examination. Computed tomography was used to analyse graft position on sagittal and axial planes. RESULTS: The mean follow-up was 28.7 months (SD 7.1), and age at surgery was 31 years (21 to 64 years). Post-operatively there was only one dislocation due to trauma. There was statistically significant improvement of WOSI scores (p: 0.001). There was not any neurological injury. Graft position on the axial plane was described as flush in 5 cases (41%), lateral in 2 (16%), too lateral in one (8%) and medial in 4 of the cases (33%). Graft position could be accepted as high in only three patients (23%). CONCLUSION: Arthroscopic reconstruction of glenoid defect using autogenous iliac bone graft, through rotator interval, without splitting subscapularis is safe and effective without any neurological injury, producing substantial graft position and good functional outcomes in patients.

A comparison of ice wrap and subacromial injection for postoperative pain and edema control following arthroscopic rotator cuff repair.

BACKGROUND: Postoperative pain and edema are the most common problems associated with arthroscopic rotator cuff repair. The purpose of the present study was to compare ice wrap and subacromial injection (SI) as treatments for early postop pain and edema control and to contrast them with a control group. MATERIALS AND METHODS: 59 patients treated with arthroscopic rotator cuff repair were randomized into three groups: 23 patients who received an ice wrap, 20 patients who received a SI, and a control group of 16 patients. RESULTS: Patient demographics, comorbidities, tear retraction, degree of fatty muscle degeneration, surgical procedures, and amount of irrigation fluid were similar for the three groups, which also showed similar results regarding postoperative pain and edema control as well as analgesic consumption. CONCLUSIONS: The present study failed to show any difference in effectiveness between the two most common pain management modalities, or between those modalities and the control group. LEVEL OF EVIDENCE: IV, prospective observational study.

Suture anchor fixation strength in the Latarjet procedure: a biomechanical study in cadavers.

BACKGROUND: The use of metallic screws for graft fixation during the Latarjet procedure is not devoid of complications. The purpose of the present cadaver study was to determine the initial strength of coracoid graft fixation using suture anchors and compare it to that of the traditional screw fixation of the graft using a fresh frozen human shoulder cadaver model. MATERIALS AND METHODS: Twelve unpaired fresh frozen cadaver shoulders were utilized. In the first group, suture anchor fixation of the graft was used, while 3.75-mm cannulated screws were used in the second group. The specimens were then cyclically loaded from 5 to 150 N at a speed of 0.05 mm/s for 100 cycles. After cyclic loading, each specimen was then loaded at a constant rate of 0.5 mm/s until 7 mm of displacement. Cyclic elongation, peak-to-peak displacement, stiffness and maximum load were measured. RESULTS: There were no significant differences between the traditional screw fixation and fixation using suture anchors in elongation, peak-to-peak displacement, stiffness and maximum load. CONCLUSIONS: In this study, traditional screw fixation and fixation using suture anchors did not significantly affect biomechanical performance in a classic Latarjet procedure.

Suture Anchor Fixation in Osteoporotic Bone: A Biomechanical Study in an Ovine Model.

PURPOSE: To evaluate the load to failure strength of anchor techniques suitable for osteoporotic bone. METHODS: Using an osteoporotic ovine model in 72 humeri, 6 fixation techniques were tested. Group 1: two interlocking 5-mm anchors with fewer, wider threads; group 2: one 5-mm anchor; group 3: one 5-mm anchor reinforced laterally by a 6.5-mm cancellous screw; group 4: one 5-mm anchor in an area reinforced with a cancellous plug; group 5: two interlocking 5-mm anchors with smaller threads; group 6: one 5-mm smaller threaded anchor. After a 10-N preload, the specimens were cyclically loaded between 10 N and 30 N for 50 cycles and then destructively tested. Peak-to-peak displacement, cyclic elongation, ultimate load, stiffness, and failure mode were recorded. RESULTS: Group 1 had lower peak-to-peak displacement than group 3 (P = .001), group 5 (P = .001), and group 6 (P = .033). In addition, group 1 showed lower cyclic elongation than group 3 (P = .001), group 5 (P = .035), and group 6 (P = .001). Group 1 had a higher ultimate load than group 2 (P = .002), group 3 (P = .019), and group 6 (P = .006). Group 1 also showed higher stiffness than group 2 (P = .007) and group 3 (P = .022). Mode of failure was predominantly caused by anchor pullout for all of the groups except group 3, which mainly failed by suture rupture. CONCLUSIONS: Two interlocking suture anchors are stronger than a single anchor in osteoporotic bone. The anchor with fewer, wider threads and a smaller core diameter showed greater strength and less elongation than the other constructs. Reinforcement by cancellous autografting increased suture anchor strength. CLINICAL RELEVANCE: Considering concerns about suture anchor pullout from osteoporotic bone, interlocking a second suture anchor with the first increases load to failure resistance. Anchors with small core diameters and fewer but wider threads are more efficient in osteoporotic bone.

Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella.

PURPOSE: The aims of this study were to evaluate sagittal plane alignment in patients with chondromalacia patella via magnetic resonance imaging (MRI), analyse the relationships between the location of the patellar cartilaginous lesions and sagittal alignment and finally investigate the relationships between the sagittal plane malalignment and patellofemoral loadings using by finite element analysis. METHODS: Fifty-one patients who were diagnosed with isolated modified Outerbridge grade 3-4 patellar chondromalacia based on MRI evaluation and 51 control subjects were evaluated. Chondromalacia patella patients were divided into three subgroups according to the chondral lesion location as superior, middle and inferior. The patella-patellar tendon angle (P-PT) was used for evaluation of sagittal alignment of patellofemoral joint. Each subgroup was compared with control group by using P-PT angle. To investigate the biomechanical effects of sagittal plane malpositioning on patellofemoral joint, bone models were created at 30°, 60° and 90° knee flexion by using mean P-PT angles, which obtained from patients with chondromalacia patellae and control subjects. The total loading and contact area values of the patellofemoral joints were investigated by finite element analysis. RESULTS: The mean age of all participants was 52.9 ± 8.2 years. The mean P-PT angle was significantly lower in chondromalacia group (142.1° ± 3.6°) compared to control group (144.5° ± 5.3°) (p = 0.008). Chondral lesions were located in superior, middle and inferior zones in 16, 20 and 15 patients, respectively. The mean P-PT angles in patients with superior (141.8 ± 2.7) and inferior subgroups (139.2 ± 2.3) were significantly lower than the values in the control group (p < 0.05). The contact area values were detected higher in models with chondromalacia than in the control models at the same flexion degrees. There were increased loadings at 30° and 90° flexions in the sagittal patellar tilt models. CONCLUSION: This study revealed that sagittal plain malpositioning of the patellofemoral joint might be related to chondromalacia, especially in the presence of lesions in the upper and lower part of the patella. This condition leads to supraphysiological loadings on the patellofemoral joint. Sagittal patellar tilt should be considered in the evaluation and management of patellar cartilage defects. Taking sagittal plane malalignment into consideration in patellofemoral joint evaluation will enable us to design new physical and surgical modalities. LEVEL OF EVIDENCE: IV.

Biomechanical Performance of Hip Labral Repair Techniques.

PURPOSE: To determine the strength of various suture techniques and the impact of suture passer size on cyclically loaded hip labra. METHODS: We assigned 63 bovine hip labra to 9 simple knotless suture technique groups using OrthoCord suture: (1) penetrating grasper (2.6 mm)-placed horizontal mattress, (2) penetrating grasper-placed vertical mattress, (3) SutureLasso (1.8 mm)-placed vertical mattress, (4) penetrating grasper-placed oblique repair, (5) penetrating grasper-placed vertical mattress plus radiofrequency, (6) SutureLasso-placed horizontal mattress, (7) SutureLasso-placed oblique mattress, (8) SutureLasso-placed horizontal mattress plus radiofrequency, and (9) SutureLasso-placed oblique mattress plus radiofrequency. After 20 cycles of uniaxial tensile loading (5 to 80 N), destructive testing was performed. RESULTS: Penetrating grasper-placed horizontal mattress sutures showed lower ultimate failure loads than vertical and oblique mattress sutures (P < .05). Penetrating grasper-placed vertical mattress sutures had higher peak-to-peak displacement than SutureLasso-placed vertical mattress sutures (P = .04). SutureLasso-placed oblique mattress sutures had a higher ultimate load (P < .01) and stiffness (P = .04) than SutureLasso-placed horizontal mattress sutures. SutureLasso-placed horizontal mattress sutures had lower cyclic elongation than penetrating grasper-placed horizontal mattress sutures (P = .01) and lower ultimate load (P < .01) and stiffness than SutureLasso-placed vertical mattress sutures (P < .01). Horizontal mattress sutures with radiofrequency had a higher ultimate load (P = .02), stiffness, and cyclic elongation (P < .01) than without radiofrequency. CONCLUSIONS: A horizontal mattress hip labrum stitch shows a lower ultimate failure load than vertical or oblique mattress stitches. Smaller-diameter suture-passing devices show less cyclic displacement and elongation than larger-diameter devices. Radiofrequency labral treatment does not alter vertical stitch strength but does alter horizontal mattress stitch strength. CLINICAL RELEVANCE: Vertical and oblique stitches are stronger than horizontal stitches. A 1.8-mm passing device shows a better cyclic loading performance than a 2.6-mm device.

Operative treatment of chondroblastoma: a study of 11 cases.

Aim of the study was to review the radiological, clinical results of 11 chondroblastoma cases treated at our institute between 2003-2013. All patients with chondroblastoma included in this study underwent intra-lesional curettage+/-bone grafting. Follow up for healing of chondroblastoma lesions and detection of any local recurrence was assessed on clinical and radiological bases. The functional outcome was assessed by the Musculoskeletal Tumour Society scoring system. The mean follow-up period was 6.1 years. There were three recurrences (two femoral head, one proximal tibia). The mean Musculoskeletal Tumour Society functional score was 21. First line aggressive treatment seems appropriate for chondroblastoma especially when localized at lower extremities.

The effect of inclination angle on the strength of vertical mattress configuration for meniscus repair.

PURPOSE: Vertical mattress configuration is the strongest of all other configurations and the repairing devices of meniscus repair. The purpose was whether increasing the inclination angle between two strands of the vertical mattress configuration by increasing the amount of meniscus tissue captured would enhance the initial strength of the construction. METHODS: A 2-cm long anteroposterior vertical longitudinal incision was created in two groups of bovine medial menisci. In the first group, the distance between the two vertical suture strands and the vertical horizontal sutures on the capsular side of the meniscal lesion was 2 mm (Group 1). In the second group, the distance was 5 mm (Group 2). The following repair specimens underwent cyclic loading prior to loading the failure testing. The endpoints included ultimate failure load (N), stiffness (N/mm) and cyclic displacement (mm) after the 100 cycles and the mode of failure. RESULTS: Group 1 (2 mm) (90.7 (±19.9) N) had lower ultimate load than Group 2 (5 mm) (120.8 (±24.5)) (P < 0.05). Stiffness and displacements during the cycling were not different between the groups (n.s.). All specimens failed by suture rupture. CONCLUSION: Increased inclination angle with increased distance between the two vertical suture strands on the capsular side of the meniscal lesion resulted in higher failure load compared to control group with lower inclination angle and distance on the capsular side.

Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues.

Effects of body mass index, infrapatellar fat pad volume and age on patellar cartilage defect.

The aim of this study was to evaluate the associations between patellar cartilage defects and body mass index (BMI), infrapatellar fat pad (IPFP) volume and age. 100 patients who met the inclusion criteria and were aged 18 to 60, were evaluated retrospectively. For detecting and measuring patellar cartilage defects, axial sequences were used and sagittal sequences were used to evaluate IPFP volumes. In total, 40 patients had patellar cartilage defects. In this group, age and BMI were higher in both sexes when compared with the controls (p<0.05). The IPFP volume was lower in the group with the patellar cartilage defect when compared with the control group (p<0.05). The IPFP volume was statistically significantly lower in women (p<0.05). Patellar cartilage defect was found to be related to age and BMI. In women, the decrease in IPFP volume seems to be one of the causative factors for patellar cartilage defect.

Effect of surgical closing in total knee arthroplasty at flexion or extension: a prospective, randomized study.

PURPOSE: The aim of this study was to evaluate the effect of knee position during wound closure (flexed vs. extended) in total knee arthroplasty on knee strength and function, as determined by knee society scores and isokinetic testing of extensor and flexor muscle groups. METHODS: In a prospective, randomized, double-blind trial, 29 patients were divided in two groups: for Group 1 patients, surgical closing was performed with the knee extended, and for Group 2 patients, the knee flexed at 90°. All the patients were treated with the same anaesthesia method, surgical team, surgical technique, prosthesis type, and rehabilitation process. American Knee Society Score values and knee flexion degrees were recorded. Isokinetic muscle strength measurements of both knees in flexion and extension were taken using 60° and 180°/s angular velocity. The peak torque and total work values, isokinetic muscle strength differences, and total work difference values were calculated for surgically repaired and healthy knees. RESULTS: No significant difference in the mean American Knee Society Score values and knee flexion degrees was observed between the two groups. However, using isokinetic evaluation, a significant difference was found in the isokinetic muscle strength differences and total work difference of the flexor muscle between the two groups when patients were tested at 180°/s. Less loss of strength was detected in the isokinetic muscle strength differences of the flexor muscle in Group 2 (-4.2%) than in Group 1 (-23.1%). CONCLUSION: For patients undergoing total knee arthroplasty, post-operative flexor muscle strength is improved if the knee is flexed during wound closure. LEVEL OF EVIDENCE: II.

Young Bovine Hip Model for Hip Arthroscopy Training.

Hip arthroscopy is associated with risks for complications, especially for novice surgeons. The present article reports use of a young bovine hip as a valid educational tool for key components of arthroscopic treatment of femoroacetabular impingement syndrome, ie, labrum repair and cam excision. The purpose of this Technical Note is to describe the steps of arthroscopic femoroacetabular impingement treatment in the bovine hip.

The effect of arthroscopic coracoplasty on subscapularis strength in cases of subcoracoid impingement in the absence of subscapularis tear.

Subcoracoid impingement leads to anterior shoulder pain, and arthroscopic subcoracoid decompression (coracoplasty) is the preferred treatment in recalcitrant cases. The purpose of the present study was to evaluate the effect of coracoplasty on the severity of anterior shoulder pain and the strength of the subscapularis muscle and to correlate it with the preoperative and postoperative coracohumeral distance (CHD) (t:transverse, s:sagittal). Sixteen patients without any subscapularis tendon tears who underwent arthroscopic subcoracoid decompression and rotator cuff repair with 2 years follow-up were included. Preoperative and postoperative 2-year assessments of function and pain were performed using the modified Kennedy-Hawkins test, power grading of various subscapularis muscle tests, and ASES scores. Preoperative and postoperative coracohumeral distance (tCHD, sCHD) and coracoid overlap (CO) were measured using MRIs before and after surgery. The Mean Hawkins pain score and coracoid overlap were decreased. The strength scores for subscapularis strength testing, ASES score, maximum degree of internal rotation, and coracohumeral distance increased (P < .05). Changes in belly press strength were negatively correlated with postoperative tCHD (r = -0.6, P = .04) and postoperative sCHD (r = -0.7, P = .008). A significant increase in the internal rotation range of the shoulder, subscapularis strength, and relief of anterior shoulder pain was observed. However, this increase was inversely proportional to the postoperative CHD, indicating the mechanical effect of the coracoid on subscapularis strength.

Factors affecting medium-term patient satisfaction after arthroscopic repair of small to medium-sized rotator cuff tears: An observational study.

This study aimed to assess the effect of the status of the tendon and patient factors on patient satisfaction after rotator cuff repair. Forty-six patients treated for tears with a minimum of 5-year follow-up were included. Gender, age, and active smoking status were recorded. Pain visual analogue scale, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Simple Shoulder Test, and Single Assessment Numeric Evaluation were recorded preoperatively and at the last follow-up. Patients were divided into groups of highly satisfied (HS) and vaguely satisfied (VS) patients. Patients were evaluated with MRI both preoperatively and at their last follow-up. Of the 46 patients, 17 were HS and 29 were VS. The HS group had 7 re-ruptures, 4 of which were progressed tears, whereas the VS group had 15 re-ruptures, 4 of which were progressed tears. There was no difference in the rate of re-ruptures or progressed tears between groups. The HS group had a higher frequency of males. However, frequencies of active smoking or osteoarthritis of grade 2 or higher were lower in the HS group. It was shown that patient satisfaction after repair depends on patient-related factors like gender and smoking rather than tendon healing or degeneration.

Effect of cam resection depth on clinical outcomes after primary hip arthroscopy.

BACKGROUND: The amount of resection or the starting point of the resection on the femoral head for cam lesions in femoroacetabular impingement (FAI) is controversial. AIM: The purpose of this study was to study the effect of postoperative resection depth, and resection arc ratio of cam lesion on the frequency of achieving substantial clinical benefit (SCB), patient acceptable state (PASS) in modified Harris Hip Score (mHHS) and Hip Outcome Score Activity of Daily Living (HOSADL), 2 years postoperatively. PATIENTS AND METHODS: All patients who underwent first-time hip arthroscopy for FAI with a 2-year follow-up were included in this study. Patient-reported outcomes included the mHHS, HOSADL, and visual analogue scale for pain (Pain VAS). Radiological parameters such as alpha angletraditional (αT), alpha anglecartilage (αC), resection arc ratio (% alpha anglecartilage-alpha angletraditional/360°), resection depth (''D''mm) and resection depth ratio 'D%' (D/femoral head diameter %) were measured using the 45° Dunn view. RESULTS: We identified 26 patients (27 hips) with 2-year follow-up. There were 10 female and 16 male patients. The mean age of the patients was 33 ± 12 years.Higher frequency of achieving SCB threshold for mHHS was related to labrum repair (73% vs. debridement '27%' p = 0.03), lower preoperative αT (64° vs. 76°, p = 0.04), lower preoperative mHHS (54 vs. 81, p < 0.001) and higher preoperative VAS scores (8 vs. 7, p = 0.02). Higher frequency of reaching PASS threshold for mHHS was associated with lower αC (82°vs. 92° p:0.02), lower RA (8% vs. 11%, p = 0.03), lower D (2.8 mm vs. 4.5 mm p:0.03), lower D% (4.7% vs. 8.4% p = 0.04) and higher postoperative mHHS (97 vs. 82 p < 0.001). CONCLUSIONS: A higher frequency of achieving SCB for HOSADL was related to lower D% (5% vs. 10.5%, p = 0.04).Cam resection depth affects the frequency of achieving clinically meaningful scores and resection depth less than 6% of the femoral head diameter seems to be appropriate for optimal results. The starting point of resection on head cartilage needs to be <90° when alpha angle is used for reference.

Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression.

PURPOSE: The purposes of this study were to define the anatomy of the anterior inferior iliac spine (AIIS) and its relation to the footprint of the rectus femoris tendon and to evaluate on the clinical outcomes after AIIS/subspine decompression. METHODS: The rectus origin was dissected and detached in 11 male cadaveric hips with a mean age of 54.3 ± 14.3 years (range, 33 to 74 years). The proximal-distal and medial-lateral extent of the footprint and its relation to the AIIS and acetabular rim were evaluated, with the 12-o'clock position defined as directly lateral at the insertion of the indirect head of the rectus tendon and the 1- to 6-o'clock positions defined as anterior acetabular positions. To assess the safety and efficacy of subspine decompression for AIIS deformity, clinical correlation of a series of 163 AIIS decompressions (mean age, 27.8 years; age range, 14 to 52 years) performed from January 2011 to January 2012 was completed, and outcome scores, strength deficits, and ruptures were assessed by manual muscle testing and postoperative radiographs. All patients presented with symptomatic FAI with proximal femoral and/or acetabular deformity and type 2 (131 hips) or type 3 (32 hips) AIIS morphology as defined by Hetsroni et al. RESULTS: The mean proximal-distal and medial-lateral distances for the rectus origin footprint were 2.2 ± 0.1 cm (range, 2.1 to 2.4 cm) and 1.6 ± 0.3 cm (range, 1.2 to 2.3 cm), respectively. There was a characteristic bare area at the anteromedial AIIS. On the clock face, the lateral margin (1-o'clock to 1:30 position) and medial margin (2-o'clock to 2:30 position) of the AIIS and the indirect head of the rectus (12 o'clock) were consistent for all specimens. In the clinical series, 163 AIIS decompressions were performed for symptomatic subspine impingement. The mean modified Harris Hip Score was 63.1 points (range, 21 to 90 points) preoperatively compared with 85.3 points (range, 37 to 100 points) at a mean follow-up of 11.1 ± 4.1 months (range, 6 to 24 months) (P < .01). Short Form 12 scores improved significantly from a mean of 70.4 (range, 34 to 93) preoperatively to a mean of 81.3 (range, 31 to 99) postoperatively (P < .01). The mean pain score on a visual analog scale also improved significantly from a mean of 4.9 (range, 0.1 to 8.6) preoperatively to a mean of 1.9 (range, 0 to 7.8) postoperatively (P < .01). The mean alpha angle improved from 61.5° (range, 35° to 90°) preoperatively to 49° (range, 35° to 63°) postoperatively on anteroposterior radiographs and from 71° (range, 45° to 90°) preoperatively to 44.3° (range, 37° to 60°) postoperatively on lateral radiographs. No short- or long-term hip flexion deficits or rectus femoris avulsions were noted with up to 2 years' follow-up. CONCLUSIONS: The origin of the rectus femoris tendon is broad on the AIIS and protective against direct head detachment with subspine decompression. This broad origin and consistent bare area anteromedially on the AIIS can be readily used by surgeons to perform a safe AIIS resection in cases of symptomatic impingement. Arthroscopic subspine decompression in addition to osteoplasty for symptomatic cam- and/or pincer-type FAI deformities can reliably improve outcome scores without significant hip flexion deficits or AIIS/rectus femoris avulsions. CLINICAL RELEVANCE: The direct head of the rectus tendon has a broad insertion on the AIIS, and an area devoid of tendon provides a "safe zone" for subspine decompression in cases of symptomatic AIIS impingement.