Arthroscopic Reduction and Internal Fixation in Patients with Acetabular Posterior Wall Fractures.

Background: This study aimed to access the radiologic and clinical outcomes after arthroscopic reduction and internal fixation with screws in patients with posterior wall fractures of the acetabulum. Methods: From May 2013 to December 2019, 13 patients (11 men and 2 women) with posterior wall fractures of the acetabulum were treated with arthroscopic reduction and internal fixation with screws at two medical centers. The mean age at the index operation was 39 years (range, 22-58 years). The mean duration of follow-up was 23 months (range, 12-46 months). Clinical assessment was performed using the modified Merle d'Aubigné and Postel functional scoring system. The maximum displacement of acetabular or femoral head fragments detected on radiographs was used as radiographic results. Secondary osteoarthritis, osteonecrosis, or heterotrophic ossification was assessed at the latest follow-up. Results: Bony union was shown at 12 weeks of follow-up in all patients. The radiologic outcomes showed an anatomical reduction in 11 patients and a satisfactory reduction in 2 patients. The modified Merle d'Aubigné and Postel functional score was excellent in 7 patients, good in 5 patients, and fair in 1 patient. Two patients had transient pudendal nerve palsy after hip arthroscopy. However, no sciatic nerve palsy occurred. At the latest follow-up, there was no heterotopic ossification, osteonecrosis of the femoral head, or posttraumatic osteoarthritis. Conclusions: Arthroscopic reduction and internal fixation with cannulated screws can be good alternative options with good radiographic and clinical outcomes, convenient removal of intra-articular loose body, and low complication rates.

Outcomes in patients with late sequelae (healed stage) of Legg-Calvé-Perthes disease undergoing arthroscopic treatment: retrospective case series.

INTRODUCTION: The residual hip deformities after Legg-Calvé-Perthes disease (LCPD) cause mechanical symptoms and are associated with a pathomechanical environment that can feature femoroacetabular impingement (FAI). The aim of this study is to evaluate the clinical and radiological outcomes in residual or healed LCPD after arthroscopic treatment. PATIENTS AND METHODS: We retrospectively reviewed patients with LCPD amongst patients with FAI who underwent arthroscopic treatment between January 2009 and June 2013. We determined LCPD through 3-dimensional computed tomographic scans and simple radiography of the hip joint. The clinical outcomes were rated using a visual analogue scale pain score (VAS), the modified Harris Hip Score (mHHS) and hip range of motion (ROM) preoperatively and at the 2-year follow-up. All radiographs were assessed using the Tönnis classification system preoperatively and at the final follow-up of each patient. There were 23 patients (14 men, 9 women) with mean age 26.4 (range, 16-49) years undergoing arthroscopic treatment for FAI symptoms because of residual or healed LCPD. RESULTS: At the 2-year follow-up, the mean VAS had improved significantly from 6.7 to 2.1, the mean mHHS had improved significantly from 62.6 to 87.4, and hip flexion and external rotation had improved significantly from 88.7° to 106.5° and from 20.4° to 33.5°, respectively (all p<0.001). The Tönnis osteoarthritis grade had not changed in any patient at the latest follow-up. CONCLUSIONS: Arthroscopic treatment for sequelae of LCPD relieved symptoms and improved range of motion, making arthroscopic treatment a good option for the sequelae of LCPD.

Arthroscopic Treatment of Symptomatic Internal Snapping Hip with Combined Pathologies.

BACKGROUND: Arthroscopic iliopsoas tendon release was introduced in 2000. The purpose of this study was to evaluate clinical outcomes of arthroscopic iliopsoas tendon release for painful internal snapping hip with concomitant hip pathologies. METHODS: Between January 2009 and December 2011, we performed arthroscopic iliopsoas tendon release and related surgeries in 25 patients (20 men and 5 women; mean age, 32 years; range, 17 to 53 years) with combined intraarticular hip pathologies. The patients were followed for a minimum of 2 years postoperatively. Clinical and radiological evaluations were performed. RESULTS: Snapping sounds had disappeared by the 2-year follow-up in 24 of the 25 patients. All patients who had presented with loss of flexion strength postoperatively showed recovery at postoperative week 6 to 10. Harris hip score improved from 65 points (range, 46 to 86 points) preoperatively to 84 points (range, 67 to 98 points) postoperatively (p < 0.001). Seven hips (28%) had an excellent score, 15 hips (60%) a good score, 2 hips (8%) a fair score, and one hip (4%) a poor score (p < 0.001). The Tonnis grade of osteoarthritis did not change in any of the patients at the last follow-up. CONCLUSIONS: Patients with painful internal snapping hip have combined hip pathologies. Therefore, the surgeon should keep in mind that painful internal snapping hips are frequently combined with concomitant intraarticular pathologies.

Arthroscopic Resection of Osteochondroma of Hip Joint Associated with Internal Snapping: A Case Report.

A 16-year old male patient visited the hospital complaining of inguinal pain and internal snapping of right hip joint. In physical examination, the patient was presumed to be diagnosed femoroacetabular impingement (FAI) and acetabular labral tear. In radiologic evaluation, FAI and acetabular labral tear were identified and bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. So arthroscopic labral repair, osteoplasty and resection of bony tumor were performed. The tumor was pathologically diagnosed as osteochondroma through biopsy and all symptoms improved after surgery. There was no recurrence, complication or abnormal finding during 1 year follow up. Osteochondroma located at posteromedial portion of femoral neck can be a cause of internal snapping hip and although technical demands are challenging, arthroscopic resection can be a good treatment option.

Arthroscopic treatment of synovial chondromatosis of the hip.

BACKGROUND: Recently, arthroscopic loose body removal and synovectomy have been performed as treatments for synovial chondromatosis of the hip joint. However, to date, no reports have been published on the outcomes of arthroscopic treatments. HYPOTHESIS: Arthroscopic treatment is effective for synovial chondromatosis of the hip joint and has advantages such as low recurrence rates, faster return to activities of daily life, and few surgical complications. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From June 1996 to July 2008, 24 patients with synovial chondromatosis of the hip who were followed up after arthroscopic removal of loose bodies and synovectomy were evaluated. The common arthroscopic portals were the anterior, anterolateral, and posterolateral portals. In some cases, we applied a medial portal for removal of loose bodies in the posteromedial pouch. Preoperative and postoperative assessments were made through simple radiographs, 3-dimensional computed tomography, magnetic resonance imaging, visual analog scale (VAS) for pain, range of motion of the joint, Harris Hip Score, and Merle D'Aubigné and Postel score. RESULTS: Postoperative mean follow-up period was 41 months. There were no major complications. Patients were able to walk weightbearing on average 2 days after surgery and were discharged in an average of 3.5 days (range, 3-5 days) after surgery. In postoperative radiological imaging, 4 patients showed progression of joint osteoarthritis, and 1 of them underwent total hip arthroplasty. The VAS score before surgery was 8.1 ± 1.3 and after surgery was 3.1 ± 1.4. Range of motion of the hip joint before surgery was increased after surgery, except in 1 patient who required a third operation. Harris Hip Score before surgery was an average of 39 ± 6.9 and improved to an average of 82 ± 10.2 after surgery. Eighteen patients (75%) had good or excellent outcomes. Symptomatic disease recurred in 4 patients (16.7%), and 1 of these 4 patients showed a subsequent recurrence. CONCLUSION: The treatment of synovial chondromatosis of the hip using arthroscopic loose body removal and synovectomy is relatively successful, and rehabilitation of patients is fast, therefore making it an effective treatment with satisfactory postsurgical results. However, a technical limitation of arthroscopy is the difficulty in approaching the posterolateral and posteromedial areas of the peripheral compartment.

Arthroscopic footprint reconstruction of bursal-side delaminated rotator cuff tears using the suture-bridge technique.

For a bursal-side retracted laminated rotator cuff tear, simple repair of the retracted bursal-side rotator cuff might be insufficient because the repaired tendon could remain as an intratendinous tear of the rotator cuff. We present a repair method for intratendinous rotator cuff tears using the suture-bridge technique. We believe that this method helps to preserve the remnant rotator cuff tendon without tissue damage and restores the normal rotator cuff footprint in bursal-side delaminated rotator cuff tears.