A Narrow Posterior Joint Space on a False Profile Radiograph Does Not Correlate With Posterior Joint Cartilage Degeneration in Hip Preservation Patients.

PURPOSE: To evaluate whether a narrow posterior joint space (<2 mm) correlated with posterior joint cartilage degeneration in the hip preservation patient population. METHODS: A retrospective chart review of 155 consecutive hip arthroscopy cases by a single surgeon (SKA) from March 2012 to February 2013 was performed. Patients were included in the study if they had an adequate perioperative false profile radiograph and clear intraoperative arthroscopic images of the posterior hip joint. The narrowest posterior joint space (NPJS) width and the directly posterior, posterosuperior, superior, and anterosuperior joint space widths were measured on the false profile radiograph. Femoral and acetabular cartilage of the posterior hip joint were graded according to the International Cartilage Repair Society (ICRS) classification system using arthroscopic images obtained at the time of surgery. The cartilage grades of patients with <2 mm NPJS were compared with cartilage grades of patients with ≥2 mm NPJS. RESULTS: There was no difference in cartilage grading between patients with <2 mm NPJS (19 patients) and those with ≥2 mm NPJS (81 patients) (P = .905). The mean age of patients with NPJS ≥2 mm and <2 mm was 34.0 (median 31.2; interquartile range [IQR] 23.7, 42.9) and 38.7 (median 43.0; IQR 26.1, 50.9) respectively, and was not statistically different (P = .183). No correlation between cartilage grade and NPJS measurement was found (P = .374). CONCLUSION: In this predominantly cam-type femoroacetabular impingement patient cohort, our findings indicate there is no correlation between a <2 mm posterior hip joint narrowing seen on false profile radiographs and posterior hip cartilage degeneration confirmed with arthroscopy. Although posterior arthritis can be visualized on a false profile radiograph, a posterior joint space measurement <2 mm should not be interpreted as isolated posterior joint wear and should not be considered a hip arthroscopy contraindication. LEVEL OF EVIDENCE: Level IV, case series.

Leg dominance as a risk factor for femoroacetabular impingement syndrome.

One etiological factor of femoroacetabular impingement syndrome (FAIS) is high impact athletics involving deep hip flexion, axial loading and jumping during skeletal development. Previous work has established that there is physiologic asymmetry of the lower limbs regarding function, with the dominant limb being primarily responsible for propulsion and kicking while the non-dominant limb is responsible for stability and planting. The authors hypothesize that the dominant limb will be more likely to undergo hip arthroscopy for symptomatic FAIS. Four hundred and sixty-nine patients at a single surgical center who underwent primary or revision hip arthroscopy for cam-type FAIS were identified. Patients were asked to identify their dominant lower extremity, defined as the lower extremity preferred for kicking. Sixty patients who indicated bilateral leg dominance were excluded. It was assumed that with no association between limb dominance and the need for surgery, the dominant side would have surgery 50% of the time. Enrichment for surgery in the dominant limb was tested for using a one-sample test of proportions, determining whether the rate differed from 50%. The enrichment for surgery on the dominant side was 57% (95% confidence interval 52-62%) which was significantly different from the rate expected by chance (50%), P = 0.003. No other significant differences were noted between groups. Limb dominance appears to be an etiological factor in the development of cam-type FAIS. Patients are more likely to undergo arthroscopic treatment of FAIS on their dominant lower extremity, although the non-dominant lower extremity frequently develops FAIS as well.

Extracapsular local infiltration analgesia in hip arthroscopy patients: a randomized, prospective study.

Hip arthroscopy patients can experience significant post-operative pain. Many strategies to combat this pain have been explored including nerve blocks, which can be costly. An alternative option for pain management is local infiltration analgesia (LIA) which has been studied in hip and knee arthroplasty, but its ability to decrease pain in the setting of hip arthroscopy remains uncertain. A prospective randomized controlled trial of 74 patients who underwent hip arthroscopy at a single medical center was performed. Thirty-seven patients received a 20-ml extracapsular injection of 0.25% bupivacaine-epinephrine under direct arthroscopic visualization after capsular closure while 37 from the control group received no injection. Primary outcome measures were both maximum and discharge numeric rating scale (NRS) pain scores while in the post-anesthesia care unit (PACU). The LIA group had a statistically significant decrease in the maximum PACU NRS score (6.16 versus 7.35, P = 0.009), however this did not reach the level of minimal clinically important difference of 1.5. There was an insignificant difference in discharge PACU pain scores. This is the first randomized controlled trial studying extracapsular LIA in hip arthroscopy. While LIA offers an uncomplicated and low-cost approach to post-operative pain management, this specific technique did not reduce pain to a clinically significant level.

Extracapsular local infiltration analgesia in hip arthroscopy: a retrospective study.

Many hip arthroscopy patients experience significant pain in the immediate postoperative period. Although peripheral nerve blocks have demonstrated efficacy in alleviating some of this pain, they come with significant costs. Local infiltration analgesia (LIA) may be a significantly cheaper and efficacious treatment modality. Although LIA has been well studied in hip and knee arthroplasty, its efficacy in hip arthroscopy is unclear. The purpose of this retrospective study is to determine the efficacy of a single extracapsular injection of bupivacaine-epinephrine during hip arthroscopy in reducing the rate of elective postoperative femoral nerve blocks. A retrospective review of 100 consecutive patients who underwent primary hip arthroscopy at a single medical center was performed. The control group consisted of 50 patients before the implementation of the current LIA protocol, whereas another 50 patients received a 20-ml extracapsular injection of 0.25% bupivacaine-epinephrine under direct arthroscopic visualization after capsular closure. In the post-anesthesia care unit (PACU), patients were offered a femoral nerve block for uncontrolled pain. The rate of femoral nerve block, and total opioid consumption, was compared between groups. The proportion of patients receiving elective femoral nerve blocks was significantly less in the LIA group (34%) as compared with the control group (56%; P = 0.027). There was no significant difference in total PACU opioid consumption between groups (P = 0.740). The decreased utilization of postoperative nerve blocks observed in the LIA group suggests that LIA may improve postoperative pain management and should be considered as a potentially cost-effective tool in pain management in hip arthroscopy patients. Level of Evidence: III.

Characterization of plantaris tendon constructs for ankle ligament reconstruction.

BACKGROUND: Many techniques have been described for lateral ligament reconstruction. One frequently overlooked autograft option is the plantaris tendon, potentially due to the paucity of data on its mechanical characteristics. This study examined the structural properties of double and quadruple plantaris tendon constructs. METHODS: Plantaris tendons were harvested from 35 fresh-frozen human cadaver specimens (mean age, 66 years [range, 43-89 years]; 17 female, 13 male). The tendon ends were sutured in a running locking technique and then woven onto a template board to create double or quadruple graft constructs with a 20-mm functional length. If additional tendon length remained, a single 40-mm specimen was isolated to provide tissue material properties. Structural properties were calculated from the results of cyclic and failure uniaxial tensile tests. RESULTS: Quadruple-strand constructs had a tensile strength of 205.8 ± 68.2 N and a stiffness of 133.1 ± 46.3 N/mm. Single strands had a tensile strength of 66.9 ± 26.3 N and a stiffness of 43.8 ± 14.7 N/mm. Material properties were similar to a prior study. CONCLUSIONS: The average maximum tensile strength for the quadrupled plantaris grafts exceeded the strength of the intact anterior talofibular ligament of 139 to 161 N; therefore, the quadruple plantaris construct may be a viable autograft for foot and ankle ligament reconstruction. CLINICAL RELEVANCE: The tensile strength of the plantaris tendon is comparable to, or stronger than, other grafts already in use and offers a donor site that may result in negligible loss of strength.