Assessment of function and muscle strength after endoscopic iliopsoas tenotomy to treat iliopsoas impingement after total hip arthroplasty.

PURPOSE: The objective of this study was to evaluate the functional outcome during follow-up (FU) after endoscopic tenotomy for iliopsoas (IP)-cup impingement and to quantitatively analyze the hip flexion strength. METHODS: This was a monocentric, retrospective cohort study of a single surgeon series. Functional assessment was based on the modified Harris score, the Oxford score and the visual analog scale score. Strength was measured with a handheld dynamometer in the sitting and lying position. RESULTS: Thirty-six IP tenotomies for cup impingement were performed between May 2013 and November 2021. Seven (19%) patients were lost to FU. At the time of tenotomy, the mean (standard deviation) age was 62,6 (12,2) and BMI was 26,5 (4,1). The mean FU time after tenotomy to the last FU was 3,6 (0,8) years. All three outcome scores improved from preoperatively to six months postoperatively (p < 0.001). There were no significant change from six months to last FU. The minimal clinically important difference (MCID) of the modified Harris score was set at 25. 20 (69%) patients had values that exceeded the threshold at one month and six months and neutral 19 (65.5%) had values that exceeded the threshold at the last FU. The limp symmetry index concerning hip flexion strength was 63% at 90° and 40% at 30° at the last FU. CONCLUSION: Most patients significantly improved their outcome scores after endoscopic iliopsoas tenotomy, with results remaining consistently stable over time. Despite a significant loss in hip flexion strength, the majority of patients did not report any impairment of their quality of life. STUDY DESIGN: Level III, Retrospective cohort study.

Repair of radial tears of the lateral meniscus on a stable knee: Results at a minimum follow-up of 2 years.

INTRODUCTION: In younger patients, meniscal repair is recommended for isolated lateral meniscus tears that are most often due to acute trauma. But there is little published data on the outcomes of repairing this specific type of lesion. The goal of this study was to evaluate the clinical outcomes, report the failure rate of repairing radial tears of the lateral meniscus in stable knees and determine the risk factors for failure. MATERIALS AND METHODS: All patients who had a stable knee and underwent arthroscopic repair of a radial lateral meniscus tear between April 2013 and December 2019 were reviewed retrospectively. Failure was defined as revision surgery for recurrence of symptoms (pain, locking) with intraoperative confirmation that the meniscus did not heal. The following data were collected: demographics (age, sex, BMI), time to surgery, clinical outcome scores (Tegner, Lysholm, IKDC), surgical details (repair technique, lesion zone, number of sutures). RESULTS: Thirty patients were included having a mean age of 20.1years (14-31). The follow-up ranged from 24 to 110months (mean 66.8±25.2). An all-inside repair was done in 6 patients (20%); an outside-in technique was done in 17 patients (57%) and a combination of all-inside and outside-in was done in 7 patients (23%). Four patients (13%) had a recurrence of their symptoms later on, while participating in sports. All the recurrences were at the initial tear site. The time to revision surgery was 16, 19, 24 and 37months in these four patients (mean 24±9). All the other patients were able to resume sports at their pre-injury level. Significant improvement in the IKDC, Lysholm and Tegner functional scores were found between the preoperative and postoperative assessments. No statistically significant risk factors for failure were identified. DISCUSSION: The functional healing rate after repair of a radial lateral meniscus tear in a stable knee was 86% at a mean follow-up of 5years, with the surgical technique having no impact on the long-term result. Most of the failures occurred within 2years of the repair procedure. We recommend repairing these tears as they have considerable healing potential. LEVEL OF EVIDENCE: IV; retrospective observational cohort study.

Short-term functional outcomes of Whiteside transfer for massive rupture of gluteus medius tendon in native hips.

PURPOSE: To assess the functional and clinical outcomes of patients who underwent either open or endoscopic Whiteside transfer of gluteus maximus and tensor fascia lata muscles in cases of massive rupture of gluteus medius tendon associated with muscle atrophy on a native hip METHODS: This retrospective, descriptive, single-centre study was conducted by a single operator with a minimum follow-up period of 12 months. All Whiteside palliative transfers performed on patients with Type 5 gluteus medius tendon rupture, according to Lall's classification, resulting in painful and treatment-resistant Trendeleburg gait between 2017 and 2022 were included. Functional evaluation was based on modified Harris Hip Scores (mHHS), iHOT-12, Non-Arthritic Hip Score (NAHS), and the pain on a Visual Analog Scale (VAS). Muscle strength was clinically assessed using the MRC classification. RESULTS: Between January 2017 and January 2022, a total of 15 Whiteside palliative transfers were identified, including nine (60%) open procedures and 6 (40%) endoscopic procedures, performed on 13 patients. One patient was excluded, and none were lost to follow-up. The median follow-up period was 41 (12; 59) months. The median age at the time of surgery was 74 (66; 76) years. The male-to-female sex ratio was 0.27. Functional results demonstrated a significant improvement in all scores: NAHS (45 vs. 72, p = 0.002), mHHS (22 vs. 55, p = 0.002), iHOT-12 (101 vs. 56, p = 0.002), and VAS (8 vs. 3, p = 0.002). Clinical outcomes also showed improvements in muscle strength (p = 0.003), single-leg stance (p = 0.01), and gait (p = 0.02). No significant differences were found in the various scores between the endoscopic and open techniques. CONCLUSION: Whiteside transfer surgery, whether performed through open surgery or endoscopically, is a palliative surgical approach that should be considered for patients with irreparable gluteus medius tendon tears, where the main symptom is trochanteric pain. This procedure yields satisfactory clinical and functional outcomes, although the gains in abduction strength recovery and gait improvement are modest.

Residual acetabular dysplasia in congenital hip dysplasia.

Residual hip dysplasia may exist despite appropriate treatment of congenital hip dysplasia (CHD). The abnormalities chiefly affect the acetabulum and can lead to premature osteoarthritis. Although the main cause is delayed treatment of CHD, primary lesions are also possible and may be worsened by the initial treatment itself. Residual hip dysplasia must be detected during the follow-up of patients with CHD. The antero-posterior radiograph of the pelvis is the main diagnostic tool. However, the importance of non-ossified anatomical structures requires additional investigations such as arthrography and magnetic resonance imaging. The risk of premature osteoarthritis is difficult to predict based only on the imaging-study findings. Hip dysplasia is best treated before 5 years of age. The work-up at this age should allow determination of the best treatment. Surgery is required but should not be performed unnecessarily. The decision rests on the absence of improvement in the radiographic criteria and on the findings from additional imaging studies. The usual treatment is Salter's osteotomy, during which excessive anterior displacement should be avoided. At adolescence, the information provided by radiography in the coronal plane should be completed by a three-dimensional evaluation of the acetabulum and an assessment of the quality of the labrum. The shelf procedure has been proven to relieve pain and to significantly postpone the need for hip arthroplasty, when performed early, before the development of visible osteoarthritis, and on a congruent hip. Chiari's osteotomy has a role to play in complex dysplasia affecting both the acetabulum and the femur. Periacetabular osteotomy is getting more used thanks to cooperation between paediatric and adult orthopaedic surgeons. This osteotomy provides optimal correction in all three dimensions.