[Arthroscopic resection of the cam deformity of femoroacetabular impingement]. / Arthroskopische Behandlung des femoroazetabulären Cam-Impingements der Hüfte.

OBJECTIVE: Resection of the cam deformity of the femoral head-neck junction in order to avoid femoroacetabular impingement and the development of secondary damage to the anterolateral acetabular rim. INDICATIONS: Femoroacetabular cam impingement. Initial femoroacetabular pincer impingement. Advanced femoroacetabular pincer impingement with degenerative tear of the labrum. CONTRAINDICATIONS: Femoroacetabular pincer impingement with significant retroversion and intact acetabular labrum, coxa profunda or circumferential ossification of the labrum. Advanced osteoarthritis. SURGICAL TECHNIQUE: Arthroscopy of the peripheral compartment via three portals with and without traction. The proximal anterolateral portal is used for the arthroscope, instrumentation is done via the anterior and classic anterolateral portal. After resection of the zona orbicularis and the inner parts of the iliofemoral ligament, the anterolateral cam deformity is resected without traction via the anterior portal. After distraction of the head from the acetabulum, the lateral and posterolateral cam deformity is trimmed via the classic anterolateral portal. POSTOPERATIVE MANAGEMENT: Pain-controlled progression to full weight bearing over 1-4 weeks, continuous passive motion therapy and stationary bike for 6 weeks in order to avoid intraarticular adhesions. RESULTS: From 2004 through early 2007, 72 hip arthroscopies were performed for femoroacetabular impingement. So far, 48 patients (25 men, 23 women, mean age 37 years [17-65 years]) were followed up. After a mean follow-up of 18 months, the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) was significantly improved from 65 +/- 21 to 82 +/- 18 and the NAHS (Non Arthritic Hip Score) from 57 +/- 19 to 78 +/- 19. COMPLICATIONS: two persistent branch lesions of the lateral femoral cutaneous nerve. One patient was surgically dislocated after 8 months for the treatment of a significant retroversion of the acetabulum; one patient underwent total hip arthroplasty after 1 year.

Tenodesis of the long head of biceps brachii: cyclic testing of five methods of fixation in a porcine model.

For pathologies of the long head of the biceps brachii, various surgical treatment options have been described, ranging from tenotomy to different open and arthroscopic techniques for tenodesis. We analyzed the biomechanical properties of 5 widely used operative techniques for tenodesis of the long head of the biceps brachii: an interference screw (7 x 23-mm Arthrex BioTenodesis screw), a suture anchor (5 x 15-mm Arthrex BioCorkscrew), a ligament washer, the keyhole technique, and the bone tunnel technique. Ten porcine humeri for each technique were used to evaluate the ultimate failure load and cyclic displacement. Tenodesis with the interference screw showed a significantly greater ultimate failure load compared with every other technique (480.9 +/- 116.5 N, P < .005) and the least displacement after 200 cycles, significantly less in comparison to the keyhole and bone tunnel techniques (4.28 +/- 1.44 mm, P < .05). Interference screw fixation has superior biomechanical properties with respect to cyclic displacement and primary fixation strength.

Isolated avulsion of the biceps femoris insertion-injury patterns and treatment options: a case report and literature review.

Isolated avulsion of the biceps femoris tendon is a relatively rare condition. We report a case of a 43 year-old soccer player with a rupture of the biceps femoris tendon which occurred in a hyperextension of the knee. Based on this case, we discuss the literature referring to injury pattern and treatment.

Arthroscopic treatment of an avulsion fracture of the ligamentum teres of the hip in an 18-year-old horse rider.

We present the case of an 18-year-old horse rider with an avulsion fracture of the ligamentum teres causing persistent hip pain and locking for 2 years. The patient had no history of major trauma; however, repeated minor hyperabduction injuries occurred. We were able to successfully treat this patient by arthroscopic removal of the bony fragments and two loose bodies and partial resection of the ligamentum teres.