Arthroscopic Focal Subspinal Decompression and Management of Pincer-Type Femoroacetabular Impingement

Locks, Renato; Utsunomiya, Hidetsuna; Bolia, Ioanna K; Mannava, Sandeep; Chahla, Jorge; Philippon, Marc J.

doi:10.1016/j.eats.2017.03.016

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…Regarding the surgical Fig. 6 Type III anterior inferior iliac spine morphology treatment of this pathology, there are not many reports in the literature, composed mainly of case reports or small series of patients [3,[8][9][10]. We have used like most studies, X-rays (AP, lateral, false profile) [21] and CT, to evaluate AIIS morphology.…”

Section: Discussionmentioning

confidence: 99%

“…The increase in its incidence/diagnosis seems to be due to better knowledge of the anatomical deformity of the AIIS and a better understanding of the kinematics of the hip joint [3][4][5][6][7]. This morphological abnormality of the AIIS can be a subsidiary of surgical treatment by resection to avoid mechanical conflict [3,[8][9][10][11]. Despite the literature, many questions regarding the prevalence, existence, and indications for decompression of AIIS should be considered.…”

Section: Introductionmentioning

confidence: 99%

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Subspine femoroacetabular impingement: retrospective study of a series of patients treated by hip arthroscopic resection

Borrego

Garcia

Barragán

et al. 2023

Arch Orthop Trauma Surg

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Background Femoroacetabular impingement syndrome (FAIS) is a common hip pathology that causes pain and functional limitation in young patients. subspine femoroacetabular impingement (SFAI) is an increasingly diagnosed extra-articular subtype that occurs from mechanical conflict of the anteroinferior iliac spine (AIIS) with the cervico-diaphyseal junction during hip flexion, which is poorly described in the literature. Questions/purposes We aimed to describe the clinical, functional, and radiological results of the arthroscopic treatment of a group of patients with SFAI treated in our Hip Unit. Study design Case series. Methods We present a retrospective study of ten patients with SFAI treated between 2013 and 2020 with arthroscopic resection. Clinical results were assessed with scales such as visual analog scale (VAS); modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). Radiological results were assessed with radiological measurements, magnetic resonance imaging (MRI), and computed tomography (CT) reconstructions. Results Six patients had a Type III AIIS and four of them had Type II. Two patients had previously been surgically treated for FAIS. The range of motion improved in flexion from 107 ± 11 degrees before surgery to 127.5 ± 6 degrees (p = 0.005). MHHS improved from 48.1 (38–75.3) before surgery to 83.1 (57–91) (p = 0.007) and HOOS improved from 65.2 (58–75) to 89 (68.1–100) (p = 0.007). VAS improved from 7.3 (5–9) pre-surgical to 2.5 (0–8) post-surgical (p = 0.005). We did not have significant complications except for an asymptomatic case of heterotopic ossification (Brooker I). Conclusion Arthroscopic decompression of AIIS in SFAI patients is a safe procedure that provides satisfactory short-term functional results, improving clinical symptoms, function, sports performance, and range of motion in our study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Subspine femoroacetabular impingement: retrospective study of a series of patients treated by hip arthroscopic resection

Borrego

Garcia

Barragán

et al. 2023

Arch Orthop Trauma Surg

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“…Actually, SSI was usually identi ed as distal femoral neck contact the AIIS in full hip exion [14,25] . In recent years, Karns et al believed that the possibility of direct impingement may be very small, and the occurrence of SSI was likely due to the reduction or disappearance of the space under the anterior inferior iliac spine [22] , which challenged the diagnostic criteria mentioned above.…”

Section: Discussionmentioning

confidence: 99%

A caparison between ultrasound-guided AIIS injection and radiography in diagnosis of subspine impingement in patients with FAI

Liu

et al. 2022

Preprint

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Background Subspine impingement (SSI) lacks effective diagnostic criteria, especially in patients combined with femoroacetabular impingement (FAI). The classification of AIIS morphology through three-dimensional CT was in doubt. Purpose To propose the method of ultrasound-guided anterior inferior iliac spine (AIIS) injection as a diagnostic idea for SSI and evaluate the accuracy of the radiography method including 3-D CT or MRI as well as intraoperative findings for diagnosis. Methods Patients diagnosed with FAI between September 2020 and December 2021 were evaluated. Those who met the criteria received ultrasound-guided AIIS injection test. It was recorded whether the pain were relieved after injection in the radiology report. Those patients who experienced a significant relief of the anterior groin pain (more than 50%) after AIIS injection were considered as positive responses and received a final diagnosis of SSI. The positive response was compared to the radiography materials including AIIS morphology measured by 3-D CT as well as the superior capsular edema on MRI. It was recorded whether there was congestion or bruise on the capsule side of labrum corresponding to AIIS during hip arthroscopy. Results A total of 73 patients with FAI received ultrasound-guided AIIS injection test. The prevalence of 13.70% (10/73), 58.90% (43/73), 23.29% (17/73) and 4.11% (3/73) were determined for Type I, Type IIA, Type IIB and Type III AIIS respectively. 36 patients had positive responses to injection and 37 patients had negative responses to injection. None patients of Type I AIIS, 23(53.49%) patients of Type IIA, 11(64.71%) patients of Type IIB and 2(66.7%) patients of Type III AIIS had positive responses to injection. A total of 57.14% patients with Type II or Type III AIIS had positive responses to injection. The positive ratio of superior capsular edema on MRI in patients with Type I, Type IIA, Type IIB, Type III was 0%, 30.23%, 29.41% and 0%. In non-type I AIIS patients, patients reported positive responses to injection had a higher incidence of superior capsular edema (38.89% vs 14.81%, P = 0.036), but they had no significant differences in the rate of congestion or bruise of labrum (47.22% vs 37.04%, P = 0.419). The results show that any two methods of ultrasound-guided injection, MRI, and intraoperative findings cannot obtain good consistency (κ = 0.222, κ = 0.098 and κ=-0.116, respectively). Conclusions This study propose to use the method of ultrasound-guided AIIS injection test to help diagnosing SSI. The methods of radiography including 3-D CT and MRI as well as the intraoperative findings of the labrum cannot be considered as accurate and reliable diagnosis and treatment basis for symptomatic SSI. Level of Evidence: IV, case series.

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“…Intraoperative findings on fluoroscopic images obtained during hip flexion and with multiple rotation angles included a prominent base or tip of the AIIS curving toward the femoral neck and signs of impingement on the distal femoral neck, such as cystic changes and sclerosis. SSI was considered present at dynamic fluoroscopic examination when the distal femoral neck would approach and contact the AIIS in full hip flexion (16,17). During arthroscopy, the prominent or low AIIS was assessed by probing the capsule covering the bony protuberance (13).…”

Section: Diagnosis and Treatment Of Ssimentioning

confidence: 99%

MRI Assessment of Subspine Impingement: Features beyond the Anterior Inferior Iliac Spine Morphology

et al. 2019

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Background:The MRI manifestations of subspine impingement (SSI) other than morphologic features of anterior inferior iliac spine (AIIS) have not been extensively explored and validated.Purpose: To determine the MRI findings associated with SSI, including AIIS morphologic features, femoral distal cam, and associated soft-tissue injuries. Materials and Methods:This is a retrospective study of symptomatic patients who underwent arthroscopic treatment for femoroacetabular impingement between December 2014 and March 2017, with preoperative MRI within 6 months before surgery. The SSI group included patients with clinical and intraoperative findings of SSI; the remaining patients comprised the non-SSI group. Preoperative MRI findings were independently assessed by two radiologists who were blinded to clinical information. Interreader agreement was assessed, and multivariable logistic regression was also used.Results: A total of 62 patients (mean age 6 standard deviation, 42.1 years 6 11.9; 38 women) were included. SSI was diagnosed in 20 of the 62 patients (32%) (mean age, 43 years 6 12); 42 patients (68%) did not have SSI (mean age, 41 years 6 10). Reader 1 detected distal cam in 16 of the 20 patients with SSI (80%) and eight of the 42 patients without SSI (19%), and reader 2 detected distal cam in 15 of the 20 patients with SSI (75%) and eight of the 42 patients without SSI (19%) (P , .001 for both). Reader 1 detected signs of impingement on the distal femoral neck (IDFN) in 18 of the 20 patients with SSI (90%) and seven of the 42 patients without SSI (16%), and reader 2 detected signs of IDFN in 13 of the 20 patients with SSI (65%) and nine of the 42 patients without SSI (21%) (P , .001 and P = .001, respectively). Reader 1 detected superior capsular edema in 15 of 20 patients with SSI (75%) and three of 42 patients without SSI (7%), and reader 2 detected superior capsular edema in 17 of 20 patients with SSI (85%) and 22 of 42 patients without SSI (52%) (P , .001 and P = .02, respectively). Distal cam was a predictor of SSI after adjustment for IDFN. Interreader agreement was substantial for distal cam (k = 0.80) and moderate for IDFN (k = 0.50). Conclusion:Soft-tissue injuries and osseous findings other than morphologic features of the anterior inferior iliac spine were associated with subspine impingement.

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Arthroscopic Focal Subspinal Decompression and Management of Pincer-Type Femoroacetabular Impingement

Cited by 8 publications

References 21 publications

Subspine femoroacetabular impingement: retrospective study of a series of patients treated by hip arthroscopic resection

Subspine femoroacetabular impingement: retrospective study of a series of patients treated by hip arthroscopic resection

A caparison between ultrasound-guided AIIS injection and radiography in diagnosis of subspine impingement in patients with FAI

MRI Assessment of Subspine Impingement: Features beyond the Anterior Inferior Iliac Spine Morphology

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