Hip Arthroscopy in the Elite Athlete: Indications and Treatment (SS-27)

Abstract

Introduction Intraarticular hip pathology in the elite athlete is a relatively rare but serious potential consequence of high level competition. The axial and torsional forces going through the hips of elite athletes place them at higher risk for symptoms and further injury from relatively small, inocuous injuries. We undertook this retrospective chart review to further delineate the role of hip arthroscopy in these patients, and to describe the pathologies that were present in them. Materials and Methods A retrospective chart review was completed on all eleven patients who were all elite athletes and fourteen hips which had undergone arthroscopy. Various data was collected included vital statistics, pathologies found, follow-up, treatments, and outcome. Results Of the eleven patients, the average age was twenty-four. Nine patients were male while two were female. There were fourteen hip arthroscopies completed on these eleven patients, two cases were bilateral, while one patient had the same hip operated on during two occasions. Eight of the patients were hockey players, one was a football player, one was a baseball player while one was a golfer. Twelve of fourteen hips had anterior labral tears, while two hips had anterior and posterior labral tears. Two hips had an average of four loose bodies, four had evidence of chondral pathology, while one had an anterior margin acetabular fracture. Ten of eleven patients had successful outcomes while one was considered a surgical failure. There were no surgical complications. Conclusion We believe that hip arthroscopy is a safe and reproducible method to treat the intraarticular hip pathology which is present in some elite athletes. It avoids many of the risks and minimizes the recovery and rehabilitation associated with open hip arthrotomy. Joseph C. McCarthy, M.D. Boston, MA Wael Barsoum, M.D. Boston Lalit Puri, M.D. Boston Stephen Murphy, M.D. Brookline Jo-ann Lee, R.N. Boston Arthroscopic Treatment of the Displaced Volar Lunate Facet of the Radius (SS-28) The treatment of intra-articular fractures of the distal radius has only recently come under the scope of the arthroscopist. Reduction of the displaced volar lunate facet, however, has required open reduction and internal fixation. This study presents the techniques which now facilitate arthroscopic treatment of fractures of the distal radius, which involve a displaced volar lunate facet. Three patients are presented who suffered fractures of the distal radius involving the lunate facet. All fractures were displaced, and all underwent arthroscopically assisted reduction and fixation. Two fractures were Fernandez type III http://www2.us.elsevierhealth.com/inst/serve?art...b&arttype=full&group=Scientific+Program+Abstract (23 of 64) [11/16/2007 9:18:41 AM] Arthroscopy: The Journal of Arthroscopic & Related Surgery Online and one was a shear fracture. Standard wrist arthroscopic portals are used in addition to the described techniques for reduction of the volar fragment. The results reported averaged 20.5 months (range: 11.5 – 37 mo). There were no poor results. The range of motion averaged 68.75 degrees of dorsiflexion (nml 73.75°), 66.25 degrees of palmar flexion (nml 66.25°), 26.75 degrees of radial deviation (nml 29.25°), 31.25 degrees of ulnar deviation (nml 36.25°), 85 degrees pronation (nml 85°), and 85 degrees of supination (nml 85°). Grip strength averaged 73.3 lbs (nml 85 lbs) and pinch averaged 15.75 lbs (nml 17.5 lbs) in key position and 11.75 lbs (nml 18.75 lbs) in the tripod position. Two patients had no complaints of pain and one complained of occasional discomfort with heavy lifting. All returned to full use and activity. All were satisfied with the result. Radiographically, one patient showed a 2 mm. ulna plus deformity. One patient lost volar tilt to a neutral position. There was no loss of radial inclination. All three patients had excellent results when measured by Gartland and Werley evaluation. There were points lost in on patient for ulnar length and one for loss of strength. The displaced lunate facet of a distal radius fracture no longer requires open reduction. These fractures can be arthroscopically visualized, reduced and stabilized. The results in this small series have demonstrated that the necessity of open reduction and internal fixation can be avoided.