Labral Pathology Research Articles

CORR Insights®: What MRI Findings Predict Failure 10 Years After Surgery for Femoroacetabular Impingement?

CORR Insights®: What MRI Findings Predict Failure 10 Years After Surgery for Femoroacetabular Impingement?

Traumatic, Posterior Pediatric Hip Dislocations With Associated Posterior Labrum Osteochondral Avulsion: Recognizing the Acetabular "Fleck" Sign.

Traumatic dislocation of the hip is uncommon in the pediatric population. Concentric reduction is usually achieved by closed means. Open reduction may be needed if there is femoral head fracture, incarcerated fragment, or incomplete reduction due to soft tissue entrapment. We present a series of 10 patients who sustained a posterior hip dislocation or subluxation with associated osteochondral avulsion of the posterior labrum. During surgery they were noted to have a labral injury pattern not previously recognized. Such treatment was dictated by postreduction advanced imaging, which revealed a consistent acetabular "fleck" sign indicative of this labral injury, which has not been previously described in literature. We performed a retrospective case review of patients with traumatic posterior hip dislocation/subluxation, treated operatively for a suspected associated labral tear and fractures. Ten patients (2 girls and 8 boys) were identified. Average age was 12.7 years. Eight patients had postreduction computed tomography scans, which revealed a posterior acetabular wall "fleck" sign, suggestive of osteochondral injury. The small bony fragment was consistently displaced at least 2 to 3 mm in all patients with majority of the posterior wall remaining intact. Closed reduction was felt to be congruent in 7 of the 10 patients. All patients were treated operatively for exploration and stabilization of the suspected posterior labrum pathology and associated injuries using a surgical hip dislocation. A consistent pattern of labral pathology was seen in all patients, with disruption of the posterior labrum from the superior 12 o'clock attachment to detachment at the inferior 6 o'clock location. Reattachment of the osteochondral labral avulsion was performed with suture anchors along the posterior rim, and the associated femoral head fractures were also addressed with internal fixation. Two patients had inadequate follow-up and were excluded, the average follow-up for the remaining 8 patients was 9.8 months (range, 6 to 26 mo). There were no findings of avascular necrosis in any of the 8 patients. Posterior hip dislocation in children may produce an acetabular "fleck" sign on advanced imaging, which in a stable, concentrically reduced hip has been treated without surgery in the past. Acetabular fleck sign may represent a near-complete avulsion of the posterior labrum as seen in our series. We recommend a high suspicion for this type of labral pathology and surgical repair when acetabular "fleck" sign is identified with hip subluxation or dislocation. Traumatic, posterior hip dislocations in young patients may be associated with significant labral pathology. Acetabular "fleck" sign on advanced imaging may predict such pathology. IV, retrospective study.

Change in Driving Performance following Arthroscopic Shoulder Surgery.

The current study aimed to measure perioperative changes in driving performance following arthroscopic shoulder surgery using a validated driving simulator.21 patients who underwent arthroscopic surgery for rotator cuff or labral pathology were tested on a driving simulator preoperatively, and 6 and 12 weeks postoperatively. An additional 21 subjects were tested to establish driving data in a control cohort. The number of collisions, centerline crossings, and off-road excursions were recorded for each trial. VAS and SPADI scores were obtained at each visit.The mean number of collisions in the study group significantly increased from 2.05 preoperatively to 3.75 at 6 weeks (p<0.001), and significantly decreased to 1.95 at 12 weeks (p<0.001). Centerline crossings and off-road excursions did not significantly change from preoperative through 12 weeks, although centerline crossings were statistically different from the controls at each time point (p<0.001). Surgery on the dominant driving arm resulted in greater collisions at 6 weeks than surgery on the non-dominant driving arm (p<0.001).Preliminary data shows that driving performance is impaired for at least 6 weeks postoperatively, with a return to normal driving by 12 weeks. Driving is more profoundly affected in conditions that require avoiding a collision and when the dominant driving arm is involved.

Modern Radiological Imaging of Osteoarthritis of TheHip Joint With Consideration of Predisposing Conditions.

Osteoarthritis is the most common disease of the hip joint in adults and has a high socioeconomic impact. This review article discusses the value of three imaging modalities in the diagnosis of osteoarthritis of the hip joint: projection radiography, computed tomography, and magnetic resonance imaging (MRI). Besides established imaging diagnostics of osteoarthritis, this review also outlines new MRI techniques that enable the biochemical analysis of hip joint cartilage and discusses predisposing deformities of the hip joint including femoroacetabular impingement (FAI) with labral pathologies, hip joint dysplasia, malrotation, and, finally, femoral head necrosis, for which early detection and an exact description of the extent and localization of the necrotic area are extremely important. Conventional X-rays remain indispensable for the diagnosis of osteoarthritis, while MRI is able to depict additional early symptoms and signs of activity of the disease. With the increasing number of joint-preserving interventions such as surgical hip luxation and hip joint arthroscopy for treating FAI, high-resolution imaging is gaining further importance for both pre- and postoperative diagnostics because it can accurately recognize early stages of joint damage. With high-resolution MR sequences and MR arthrography, the detailed depiction of the thin cartilaginous coating of the hip joint has become quite possible. • Projection radiography is the method of choice for the diagnostic work-up of osteoarthritis of the hip joint.• Using computed tomography, the amount of acetabular bone stock prior to total hip arthroplasty is assessed in selected patients.• Magnetic resonance imaging can substantiate the indication of surgery in case of discrepancy between clinical symptoms and radiological findings of the hip joint.• If distinct and left untreated, predisposing conditions (such as femoroacetabular impingement) may lead to early development of osteoarthritis of the hip joint.• Functional cartilage imaging can verify changes in the biochemical composition of the cartilage before they become morphologically evident. Citation Format: • Weber MA, Merle C, Rehnitz C et al. Modern Radiological Imaging of Osteoarthritis of The Hip Joint With Consideration of Predisposing Conditions. Fortschr Röntgenstr 2016; 188: 635 - 651.

Quantitative magnetic resonance arthrography in patients with femoroacetabular impingement.

Quantitative MRI (QMRI) of the hip with sequences such as T1ρ and T2 mapping has been utilized to detect early changes in cartilage matrix composition. However, QMRI has not been performed in the presence of intra-articular contrast. Thus the purpose of this study was to evaluate the feasibility and use of QMRI during MR-arthrography (MRA) in femoracetabular impingement (FAI) patients. Using a 3 Tesla MR-scanner, 10 FAI patients underwent a unilateral MRA and standard MRI of the hip joint. Global and sub-regional T1ρ and T2 relaxation times of the acetabular and femoral articular cartilage were computed in the MRA and MRI assessments and agreement of these values were assessed using the Krippendorff's alpha (α) coefficient and linear regression (μ). T1ρ and T2 relaxation times between the MRA and MRI were compared using a repeated measures analysis of variance. Both global and sub-regional T1ρ and T2 relaxation times demonstrated strong agreement (α > 0.83; μ > 0.85) independent of intra-articular contrast. Also, global and sub-regional acetabular T1ρ (P = 0.72) and T2 (P = 0.94), as well as femoral T1ρ , relaxation times were similar between MRA and MRI (P = 0.73) yet femoral T2 relaxation times decreased when using intra-articular contrast (P = 0.04). This study demonstrated the feasibility of T1ρ and T2 mapping for use in hip MRA with FAI patients. The inclusion of QMRI in MRA provides a quantitative assessment of the effects of FAI on hip joint articular cartilage while allowing for detailed assessment of labral pathology with the use of intra-articular contrast. J. Magn. Reson. Imaging 2016;44:1539-1545.

Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment.

Athletic groin pain requiring surgery remains a diagnostic and therapeutic challenge. This systematic review aims to identify the most common causes of groin pain in athletes requiring surgery. Additionally, it aims to further characterise their susceptible athlete profiles, common physical examination and imaging techniques, and surgical procedures performed. This will enable the orthopaedic sports medicine clinician/surgeon to best treat these patients. The electronic databases MEDLINE, PubMed and EMBASE were searched from database inception to 13 August 2014 for studies in the English language that addressed athletic groin pain necessitating surgery. The search was updated on 4 August 2015 to find any articles published after the original search. The studies were systematically screened and data were abstracted in duplicate, with descriptive data presented. A total of 73 articles were included within our study, with data from 4655 patients abstracted. Overall, intra-articular and extra-articular causes of groin pain in athletes requiring surgery were equal. The top five causes for pain were: femoroacetabular impingement (FAI) (32%), athletic pubalgia (24%), adductor-related pathology (12%), inguinal pathology (10%) and labral pathology (5%), with 35% of this labral pathology specifically attributed to FAI. Given the complex anatomy, equal intra-articular and extra-articular contribution, and potential for overlap of clinical entities causing groin pain leading to surgery in athletes, further studies are required to ascertain the finer details regarding specific exam manoeuvres, imaging views and surgical outcomes to best treat this patient population.

Intra-articular Diagnostic Injection Exhibits Poor Predictive Value for Outcome After Hip Arthroscopy

To determine whether the amount of pain relief after preoperative intra-articular (IA) anesthetic injection predicts clinical and functional outcomes after hip arthroscopy, especially when controlling for the presence of chondral degeneration. We identified patients who underwent IA injection and subsequent hip arthroscopy for labral pathology between 2007 and 2013 performed by a single surgeon. Inclusion criteria were ultrasound- or fluoroscopic-guided IA anesthetic injection performed at our institution, prospectively documented pre- and postinjection numerical rating scale pain scores, and minimum 1-year follow-up postoperatively. Patients were divided into 2 groups, those who received >50% pain relief from preoperative IA anesthetic injection and those who received ≤50% relief. Preoperative radiographs were reviewed, and degree of osteoarthritis was determined using the Tonnis classification system. Outcomes were assessed with Modified Harris Hip Score and Hip Outcome Score (HOS). Univariate and multivariate models were performed to assess whether percent pain relief correlated with outcome. Of the 319 arthroscopic hip surgeries performed between 2007 and 2013, 115 (37%) patients were lost to follow-up, 16 (5%) patients did not receive an IA injection, 16 (5%) patients had an injection containing gadolinium, and 40 (13%) patients completed injections at an outside institution. Five (2%) patients were excluded for a history of ipsilateral hip surgery, and 3 (1%) for a history of contralateral hip surgery, leaving 96 hips in 96 patients. There were 71 females (74%) and 25 males (26%) with a mean age of 37.6 ± 14.0years. Tonnis was grade 0, 1, and 2 for 26 (27%), 55 (56%), and 16 (17%) patients, respectively. Fifty-one (53%) of the injections contained a corticosteroid. The mean pain relief after IA injection was 73% ± 36% (range, 0% to 100%). Twenty-six hips (26%) had ≤50% pain relief, whereas 70 (73%) had >50% pain relief, and the median time interval from injection to surgery was 3 (range, <1 to 20) months. Outcome scores were obtained at a mean 14.8 (range, 11 to 30) months after arthroscopic surgery. Postoperative mean Modified Harris Hip Score, HOS activities of daily living, and HOS-Sport scores were 79.2 ± 17.3, 82.6 ± 17.3, and 67.4 ± 28.2, respectively. There was no statistical correlation between percent pain relief and outcome. There was no significant difference in outcome scores between those with ≤50% and >50% pain relief. Multivariate regression analysis showed no significant predictors of outcome, including age, gender, Tonnis grade, percent relief with IA injection, or type of surgery. In this study of patients undergoing hip arthroscopy for labral pathology, our data indicate that the amount of pain relief from IA injection may be a poor predictor of short-term outcome, even when adjusting for chondral degeneration. Although anesthetic injections can be an important diagnostic tool in select patients, a combination of the clinical history, physical examination, and imaging findings is fundamental. Level IV, therapeutic case series.

Professional golfers’ hips: prevalence and predictors of hip pain with clinical and MR examinations

AimsThis study aimed to determine the prevalence of hip pain in professional golfers, comparing the lead (left hip in right-handed golfer) and trail hips, and to establish what player characteristics...

Magnetic resonance arthrography and the prevalence of acetabular labral tears in patients 50 years of age and older.

Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with MR arthrography. Our purpose is to assess the frequency of acetabular labral tears in older patients with hip pain and correlate likelihood of labral pathology with severity of osteoarthritis as visualized on conventional radiograph. From 2004 to 2013, 208 hip MRI arthrograms and corresponding radiographs on patients aged 50years and older were identified. Age, gender, grade and location of labral tear, alpha angle, Tönnis grade, and joint space width were documented. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on radiographs. On MR arthrography, true labral tearing was identified in 73% of patients. There was some degree of labral pathology in 93.3% of patients, and this increased to 100% in patients with moderate to severe osteoarthritis, as defined by Tönnis grade 2-3 or joint space width ≤ 2mm. There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool.

Ligamentum Teres Tears and Femoroacetabular Impingement: Prevalence and Preoperative Findings

To determine prevalence of ligamentum teres (LT) injuries identified during hip arthroscopy for treatment of femoroacetabular impingement (FAI) and to identify physical examination findings or radiographic characteristics specific to patients with complete LT tears that could possibly assist in a preoperative diagnosis. Between October 2006 and June 2015, prospective data were collected on consecutive hip arthroscopies. Inclusion criterion was primary hip arthroscopy in patients aged 18years or older. All patients in the study were treated for chondrolabral dysfunction associated with FAI. Patients with prior hip surgery were excluded. A total of 2,213 out of 3,158 hip arthroscopies met the inclusion criterion. Of the 2,213 hips, 233 (11%) had a normal LT, 1,947 (88%) had frayed/partially torn, and 33 (1.5%) had a torn LT. A higher prevalence of torn LT was seen in female subjects. Patients with torn LT had lower body mass index (BMI) (22.5 v 24.7; P < .01) than those with hips with normal LT. On radiographs, patients with torn LTs had a lower center edge angle and had increased odds of having a center edge angle less than 25°. Isolated cam or isolated pincer were seen more often in hips with torn LT than in hips with normal LT. Hips with torn LT were 3.1 times more likely to have a chondral defect on the femoral head than were hips with normal LT (95% confidence interval [CI], 1.2-8.7) and were 3.6 times more likely to have capsular laxity diagnosed at hip arthroscopy than were hips with normal LT (95% CI, 1.4-9.4). Among patients with FAI and labral pathology, complete tears of the LT were rare and were more likely to be seen in women and those with lower BMI and low center edge angles at arthroscopy. LT tears were associated with hip laxity and chondral defects of the femoral head. Level IV, prognostic case series.

Prevalence of acetabular labral tears in asymptomatic children.

PurposeMagnetic resonance imaging (MRI) is a sensitive, non-invasive modality to diagnose acetabular labral pathology, and the normal variants of the acetabular labrum have been characterized in adults. However, the prevalence of labral pathology in the asymptomatic pediatric population is unknown.MethodsAll pelvic MRIs performed at a large tertiary-care children’s hospital were reviewed during one calendar year (2014). Only patients aged between 2 and 18 years were included, and scans were excluded for hip pain/pathology or technical inadequacy. A blinded pediatric musculoskeletal radiologist read all eligible scans for the presence or absence of a labral tear.ResultsThree hundred and ninety-four pelvic MRIs were screened, and patients were excluded for hip pain/pathology (85 subjects), or technical inadequacy (190 subjects). One hundred and eight subjects (216 hips) met the inclusion criteria and were technically adequate for analysis. Labral tears were visualized in three of 216 (1.4 %) hips (two of the 110 subjects; 1.9 %).ConclusionsThere is a low rate of asymptomatic labral pathology by MRI in pediatric patients. The clinical history remains the means of differentiating real labral pathology from spurious imaging findings.Level of evidence IVCase series (prevalence).

New perspectives on femoroacetabular impingement syndrome.

Femoroacetabular impingement (FAI) is characterized by an abnormality in the shape of the femoral head-neck or acetabulum that results in impingement between these two structures. Arthroscopic treatment has become the preferred method of management of FAI owing to its minimally invasive approach. Surgical correction involves resection of impinging osseous structures as well as concurrent management of the associated chondral and labral pathology. Research from the past 5 years has shown that repair of the labrum results in a better anatomic correction and improved outcomes compared with labral debridement. Research is underway to improve cartilage assessment by using innovative imaging techniques and biochemical tests to inform predictions of prognosis. Several ongoing randomized controlled trials, including the Femoroacetabular Impingement Trial (FAIT) and the Femoroacetabular Impingement Randomized Controlled Trial (FIRST), will provide critical information regarding the diagnosis, management and prognosis of patients undergoing arthroscopic management of FAI.

95% prevalence of abnormality on hip MRI in elite academy level rugby union: A clinical and imaging study of hip disorders.

To identify the prevalence of hip disorders in elite level academy rugby union players using clinical and radiological investigation comparing findings to active controls. Cross-sectional, controlled study. Participants were assessed clinically using validated questionnaire (HAGOS) and physical testing procedures. Active ROM of all hip movements were measured using a goniometer and hip-specific clinical tests including the FABER and the Thomas test examined functional hip motion. Physical tests were compared to age, gender and activity matched controls. The rugby-playing participants underwent dedicated non-arthrographic 3T MRI imaging of the hip in axial oblique, sagittal and coronal planes to assess anatomical abnormality. The rugby cohort had significantly reduced ROM of internal/external rotation, extension and FABER scores compared to the controls. Symptoms were reported by 65% of rugby players (HAGOS symptom score <89.3) versus 15% in controls. There was a 95% prevalence of abnormality on MRI (19 of 20 players); 80% of the elite rugby players had labral pathology, 55% had a cam deformity (45% left sided 30% right-sided) and 25% had either unilateral or bilateral chondral wear. The prevalence of abnormality on MRI of the hip is high in rugby players at 95% of study participants. The percentage reporting symptoms was lower at 65% of the cohort although this was significantly higher than (non-rugby) matched controls at 15% of participants. Rugby players demonstrated significantly reduced ROM of the hip compared to controls. Further prospective research is required to investigate the long term sequelae of these findings.

Hip joint pathology: relationship between patient history, physical tests, and arthroscopy findings in clinical practice.

The purpose of this retrospective cohort study was to (a) describe the clinical presentation of femoroacetabular impingement (FAI) and hip labral pathology; (b) describe the accuracy of patient history and physical tests for FAI and labral pathology as confirmed by hip arthroscopy. Patients (18-65years) were included if they were referred to a physical therapist to gather pre-operative data and were then diagnosed during arthroscopy. Results of pre-operative patient history and physical tests were collected and compared to arthroscopy. Data of 77 active patients (mean age: 37years) were included. Groin as main location of pain, the Anterior Impingement test (AIT), Flexion-Abduction-External Rotation (FABER) test, and Fitzgerald test had a high sensitivity (range 0.72-0.91). Sensitivity increased when combining these tests (0.97) as either groin as main location of pain and a positive FABER test or a positive AIT and a positive FABER test were the shortest most sensitive combinations. The results of this study point out that in clinical practice absence of groin as main location of pain combined with a negative FABER test or the combination of a negative AIT and a negative FABER test are suggested to rule out the diagnosis of symptomatic FAI and/or labral pathology.

Arthroscopic Labral Reconstruction of the Hip Using Iliotibial Band Allograft and Front-to-Back Fixation Technique

Labral repair has been shown to be an effective treatment option with excellent early outcomes; however, in cases of severe labral damage or when the labral tissue is too large or diminutive, labral repair may be less effective. The purpose of this article is to present a modified technique for hip labral reconstruction using iliotibial band allograft tissue and a front-to-back fixation technique. The described technique is modified from the original report of a technique for arthroscopic labral reconstruction. The front-to-back technique allows the surgeon to make a graft that is longer than necessary and cut excess graft after front-to-back fixation, resulting in the correct graft size and a reproducible procedure. Allograft tissue offers several advantages, including the ability to control graft thickness and length, as well as the ability to eliminate donor-site morbidity. This procedure adds to the available techniques for treatment of labral pathology by providing a labral reconstruction technique using allograft tissue.

Complications in Hip Arthroscopy

The primary objective of this study was to determine the minor and major complication rate of hip arthroscopy. The secondary objective was to provide strategies for avoiding complications. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and checklist. Therapeutic hip arthroscopy investigations that reported on adverse events or complications were included. Narrative and other systematic reviews, meta-analyses, conference abstracts or proceedings, and level V evidence studies were excluded. No follow-up minimum was imposed. The results yielded 53 studies (8189 hip arthroscopies in 8071 subjects). Most studies were level IV evidence (74%) with a mean of 2.2±2.1 years follow-up. Femoroacetabular impingement (FAI) and labral pathology were the 2 most common indications for surgery, and osteochondroplasty for FAI and labral treatment were the 2 most common procedures performed. The minor and major complication rates were 7.9% and 0.45%, respectively. Iatrogenic chondrolabral damage and temporary nerve injury were the 2 most common minor complications. Extra-articular fluid extravasation was the most common major complication encountered. Minor complications associated with hip arthroscopy are generally technical in nature and may be related to the learning curve associated with hip arthroscopy. As surgeon experience increases and patient selection improves, a corresponding decline should be observed in minor complications. Strategies to prevent complications include careful preoperative planning, appropriate surgical indications, attention to detail in the operating room, and proper postoperative rehabilitation.

Postoperative Rehabilitation After Hip Arthroscopy: A Search for the Evidence.

Hip arthroscopy has become an increasingly popular option for active individuals with recalcitrant hip pain. Conditions that may be addressed through hip arthroscopy include labral pathology, femoral acetabular impingement, capsular hyperlaxity, ligamentum teres tears, and the presence of intra-articular bodies. Although the body of literature examining operative procedures has grown, there is a paucity of evidence specifically on the efficacy of postoperative rehabilitation programs. To date, there are no systematic reviews that have evaluated the available evidence on postoperative rehabilitation. To evaluate the available evidence on postoperative rehabilitation programs after arthroscopy of the hip joint. A search of the PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar databases was conducted in January 2014 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews. Six studies met the inclusion criteria and were either case series or case reports (level 4 evidence) that described a 4- or 5-phase postoperative rehabilitation program. The available evidence supports a postoperative period of restricted weight bearing and mobility; however, the specific interventions in the postoperative phases are variable with no comparison trials. This review identified a paucity of evidence on postoperative rehabilitation after hip arthroscopy. Existing reports are descriptive in nature, so the superiority of a particular approach cannot be determined. One can surmise from existing studies that a 4- to 5-stage program with an initial period of weight-bearing and mobility precautions is efficacious in regard to function, patient satisfaction, and return to competitive-level athletics. Clinicians may consider such a program as a general guideline but should individualize treatment according to the surgical procedure and surgeon guidelines. Future research should focus on comparative trials to determine the effect of specific postoperative rehabilitation designs.

Postoperative Rehabilitation After Hip Arthroscopy: A Search for the Evidence

Context:Hip arthroscopy has become an increasingly popular option for active individuals with recalcitrant hip pain. Conditions that may be addressed through hip arthroscopy include labral pathology, femoral acetabular impingement, capsular hyperlaxity, ligamentum teres tears, and the presence of intra-articular bodies. Although the body of literature examining operative procedures has grown, there is a paucity of evidence specifically on the efficacy of postoperative rehabilitation programs. To date, there are no systematic reviews that have evaluated the available evidence on postoperative rehabilitation.Objective:To evaluate the available evidence on postoperative rehabilitation programs after arthroscopy of the hip joint.Evidence Acquisition:A search of the PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar databases was conducted in January 2014 according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting systematic reviews.Evidence Synthesis:Six studies met the inclusion criteria and were either case series or case reports (level 4 evidence) that described a 4- or 5-phase postoperative rehabilitation program. The available evidence supports a postoperative period of restricted weight bearing and mobility; however, the specific interventions in the postoperative phases are variable with no comparison trials.Conclusion:This review identified a paucity of evidence on postoperative rehabilitation after hip arthroscopy. Existing reports are descriptive in nature, so the superiority of a particular approach cannot be determined. One can surmise from existing studies that a 4- to 5-stage program with an initial period of weight-bearing and mobility precautions is efficacious in regard to function, patient satisfaction, and return to competitive-level athletics. Clinicians may consider such a program as a general guideline but should individualize treatment according to the surgical procedure and surgeon guidelines. Future research should focus on comparative trials to determine the effect of specific postoperative rehabilitation designs.

Outcomes After Labral Repair in Patients With Femoroacetabular Impingement and Borderline Dysplasia

To determine outcomes after labral repair in patients with borderline dysplasia and femoroacetabular impingement (FAI). Patients with dysplasia treated between June 2005 and March 2009 were identified. The study included only patients aged 18 years or older (mean, 35 years; range, 18 to 69 years) whose affected hip had a Wiberg center-edge angle of 20° to 25° and who underwent primary hip arthroscopy performed by the senior author. One hundred two hips (100 patients, comprising 50 women and 50 men) underwent hip arthroscopy with labral repair with correction of FAI and capsular closure. Five hips were converted to total hip arthroplasty, and 7 required revision arthroscopy. Of 95 patients (representing 100 hips, 5 of which underwent total hiparthroplasty), 80 were monitored for a minimum of 2 years. At a mean follow-up point of 40 months, the preoperative modified Harris Hip Score had improved from a mean of 63.5 points (range, 20 to 98 points) to a mean of 84.9 points (range, 45 to 100 points) by the latest follow-up (P < .001). The mean score on the Western Ontario and McMaster Universities Arthritis Index improved from 25.3 (range, 0 to 60) to 9.7 (range, 0 to 59) (P < .001). The 12-Item Short Form Health Survey Physical Component Summary score also significantly improved (from 42.5 to 50.9, P= .001), whereas the 12-Item Short Form Health Survey Mental Health Component Summary score showed an insignificant improvement (from 52.4 to 54.1). This study showed that FAI and labral pathology can be successfully managed using hip arthroscopy, with capsular management, in patients with borderline dysplasia. Patients showed significant improvements in outcomes and high levels of satisfaction after hip arthroscopy. The need for subsequent procedures was similar to that in patients with just FAI and labral repair. Level IV, therapeutic case series.

Arthroscopy provides symptom relief and good functional outcomes in patients with hip synovial chondromatosis.

The purpose of this study was to evaluate clinical presentation, associated pathology and clinical outcomes after arthroscopic treatment of hip synovial chondromatosis (SC). A prospective data registry was queried for patients with SC diagnosis from 2005 to 2012. Surgical indications were intra-articular pain after failure of conservative treatment, labral pathology, chondral damage or loose bodies. All patients had femoroacetabular impingement based on radiographic findings. Patient-centered outcomes were collected before and after surgery. Standard hip arthroscopy techniques were used to address associated pathology. Twenty-three patients met the inclusion criteria. Eleven were males. Mean age was 43.7 years. Mean center-edge angle was 33.7 and alpha angle 73. Radiographs were diagnostic in five patients (23.8%). Magnetic resonance imaging identified loose bodies in 14 (66%). Most patients had an uncountable amount of loose bodies in the central and peripheral compartments. The most common associated pathology was a labral tear (100%) and acetabular cartilage injury (85%). All patients had improvement in range of motion. The average Modified Harris Hip score improved from 62 (pre-op) to 84.8 (post-op). Short-Form 12-PCS improved from 41 to 53. Western Ontario and McMaster Osteoarthritis Index improved from 27.1 to 7.2. Median overall satisfaction was 9.5 (out of 10). Hip arthroscopy with thorough removal of loose bodies and subtotal synovectomy, coupled with an aggressive and early rehabilitation program, was effective in ameliorating symptoms associated with from hip SC, yielding high levels of patient satisfaction and functional outcomes, in a 2.5 year follow-up time. Level of evidence: IV (case series)