Asunto(s)
Artroscopía , Pinzamiento Femoroacetabular , Humanos , Pinzamiento Femoroacetabular/cirugía , Pinzamiento Femoroacetabular/fisiopatología , Artroscopía/métodos , Masculino , Femenino , Resultado del Tratamiento , Articulación de la Cadera/cirugía , Articulación de la Cadera/fisiopatología , Adulto , Conducta Sexual , Recuperación de la FunciónAsunto(s)
Anestésicos Locales , Lidocaína , Luxación del Hombro , Ultrasonografía Intervencional , Humanos , Lidocaína/administración & dosificación , Inyecciones Intraarticulares/métodos , Anestésicos Locales/administración & dosificación , Luxación del Hombro/diagnóstico por imagen , Masculino , Femenino , Adulto , Dimensión del Dolor , Resultado del Tratamiento , Puntos Anatómicos de Referencia , Adulto JovenRESUMEN
Successful arthroscopic hip surgery for patients with generalized ligamentous laxity requires dedicated attention to preoperative patient counseling, including consideration of each patient's functional status and goals, careful evaluation of patient symptomatology, and meticulous capsular management. Maximal preservation of the fibrous capsular ligaments that stabilize the hip is of particular importance. It is incorrect to assume all hip patients with an elevated Beighton score should be categorically treated a certain way. There is a complex interplay of morphologic features, such as acetabular version, femoral orientation, capsular volume, and subspine morphology, that play a role in the symptomatology for every hip patient, hypermobility notwithstanding. Moreover, consideration must be given to the variable degree of phenotypic expression of the hypermobility syndromes.
Asunto(s)
Artroscopía , Articulación de la Cadera , Humanos , Articulación de la Cadera/cirugía , Estudios Retrospectivos , Ligamentos Articulares/cirugía , Atención Dirigida al Paciente , Resultado del TratamientoAsunto(s)
Articulación de la Rodilla , Rodilla , Humanos , Articulación de la Rodilla/cirugía , DolorRESUMEN
Patients with symptomatic femoroacetabular impingement frequently have contralateral symptoms and, thus, alterations to the biomechanics of both hips. It has become increasingly clear that prolonged delays in staging bilateral hip arthroscopic surgery may result in inferior patient outcomes. There is an interchange between primary surgical recovery and altered biomechanics stemming from the untreated hip. At a certain point, the persistence of microinstability and/or femoroacetabular impingement in one hip becomes a limitation to the recovery of the other. Still, individual patient variability remains a critical factor when considering bilateral surgeries. Some patients cannot tolerate 2 surgeries in proximity. The time frame for bilateral surgery should be based on individual patient factors and functional goals.
Asunto(s)
Pinzamiento Femoroacetabular , Humanos , Pinzamiento Femoroacetabular/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Artroscopía , Resultado del Tratamiento , CaderaRESUMEN
BACKGROUND: Bone bruises observed on magnetic resonance imaging (MRI) can provide insight into the mechanisms of noncontact anterior cruciate ligament (ACL) injury. However, it remains unclear whether the position of the knee near the time of injury differs between patients evaluated with different patterns of bone bruising, particularly with regard to valgus angles. HYPOTHESIS: The position of the knee near the time of injury is similar between patients evaluated with 2 commonly occurring patterns of bone bruising. STUDY DESIGN: Descriptive laboratory study. METHODS: Clinical T2- and T1-weighted MRI scans obtained within 6 weeks of noncontact ACL rupture were reviewed. Patients had either 3 (n = 20) or 4 (n = 30) bone bruises. Patients in the 4-bone bruise group had bruising of the medial and lateral compartments of the femur and tibia, whereas patients in the 3-bone bruise group did not have a bruise on the medial femoral condyle. The outer contours of the bones and associated bruises were segmented from the MRI scans and used to create 3-dimensional surface models. For each patient, the position of the knee near the time of injury was predicted by moving the tibial model relative to the femoral model to maximize the overlap of the tibiofemoral bone bruises. Logistic regressions (adjusted for sex, age, and presence of medial collateral ligament injury) were used to assess relationships between predicted injury position (quantified in terms of knee flexion angle, valgus angle, internal rotation angle, and anterior tibial translation) and bone bruise group. RESULTS: The predicted injury position for patients in both groups involved a flexion angle <20°, anterior translation >20 mm, valgus angle <10°, and internal rotation angle <10°. The injury position for the 3-bone bruise group involved less flexion (odds ratio [OR], 0.914; 95% CI, 0.846-0.987; P = .02) and internal rotation (OR, 0.832; 95% CI, 0.739-0.937; P = .002) as compared with patients with 4 bone bruises. CONCLUSION: The predicted position of injury for patients displaying both 3 and 4 bone bruises involved substantial anterior tibial translation (>20 mm), with the knee in a straight position in both the sagittal (<20°) and the coronal (<10°) planes. CLINICAL RELEVANCE: Landing on a straight knee with subsequent anterior tibial translation is a potential mechanism of noncontact ACL injury.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Contusiones , Traumatismos de la Rodilla , Humanos , Lesiones del Ligamento Cruzado Anterior/diagnóstico por imagen , Lesiones del Ligamento Cruzado Anterior/patología , Traumatismos de la Rodilla/diagnóstico por imagen , Traumatismos de la Rodilla/patología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/patología , Tibia/patología , Fémur/patología , Contusiones/diagnóstico por imagen , Contusiones/patología , Epífisis/patología , Imagen por Resonancia Magnética/métodos , Hematoma/patología , Fenómenos BiomecánicosRESUMEN
As hip arthroscopy increases in scope and quantity, treatment options for patients who did not respond to primary surgery expand as well. As our techniques improve and become more nuanced, it is crucial that our understanding of individual patients' root cause pathology keeps pace to ensure that the right patients get the right surgery.