Arthroscopic Repair of Hip Labrum With Suture Anchors

Shenoy, Kartik; Dai, Amos Z.; Mahure, Siddharth A.; Kaplan, Daniel J.; Capogna, Brian; Youm, Thomas

doi:10.1016/j.eats.2017.08.007

Cited by 13 publications

(6 citation statements)

References 12 publications

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“…All hip arthroscopic procedures were performed by the senior surgeon (T.Y.). Surgical techniques were well-described in a technique article by Shenoy et al 23 Patients were placed in the modified supine position on a hip arthroscopy extension traction table with a well-padded perineal post. Antibiotics are typically administered for these procedures immediately before skin incision.…”

Section: Methodsmentioning

confidence: 99%

Does Concomitant Lumbar Spine Disease Adversely Affect the Outcomes of Patients Undergoing Hip Arthroscopy?

Haskel¹,

Baron²,

Zusmanovich³

et al. 2020

Am J Sports Med

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Background: The practice of hip arthroscopy is increasing in popularity, which has highlighted the importance of identifying risk factors that predict hip arthroscopy outcomes. The literature suggests that lumbar spine disease is an independent risk factor for poorer outcomes following total hip arthroplasty; however, the effect of lumbar spine disease on hip arthroscopy outcomes has not been fully investigated. At present, there is a paucity of literature investigating the effect of coexisting hip and lumbar spine disease on outcomes after hip arthroscopy. Purpose: To evaluate the outcomes of hip arthroscopy in patients with concomitant lumbar spine disease compared with those without a history of lumbar spine disease. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a prospectively collected, single-surgeon database was performed to identify patients who underwent hip arthroscopy with subjective and objective evidence of lumbar disease. Patients were included if they were skeletally mature; had hip disease that failed nonoperative treatment; had symptoms of low back pain, lumbar radiculopathy, or lumbar stenosis at the time of surgery; and had advanced imaging of the lumbar spine (computed tomography or magnetic resonance imaging) confirming lumbar spine disease. Patients were excluded if they had any previous hip surgery or evidence of osteoarthritis of Tönnis grade 2 or higher. The hip-spine cohort was matched by age, sex, and body mass index in a 1:3 fashion to a control cohort consisting of patients without symptoms of low back pain, lumbar radiculopathy, or lumbar stenosis at the time of surgery or a history of lumbar spine disease who underwent hip arthroscopy over the same time period. Baseline preoperative modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were compared with scores at 3-, 6-, 12-, and 24-month follow-up, and rates of revision arthroscopy or total hip arthroplasty were assessed. Statistical analysis was performed with the Student t test. Results: A total of 38 patients with radiographically confirmed lumbar disease were matched with 111 control patients. Preoperative mHHS and NAHS were significantly lower in the hip-spine cohort ( P = .01 and P = .02, respectively); however, no significant differences were found in mHHS or NAHS between the cohorts at 3, 6, 12, and 24 months postoperatively. A 89.8% increase in mHHS was found in the hip-spine cohort, compared with a 74.4% increase in the control cohort ( P = .0475). No significant differences in the rates of revision or total hip arthroplasty conversion were identified between the hip-spine and control cohorts (23.7% vs 18.0%, respectively; P = .44). Conclusion: Patients with known lumbar spine disease who underwent hip arthroscopy had a significantly greater percentage improvement at 24-month follow-up compared with those without a history of lumbar spine disease, and outcomes were ultimately not significantly different. No increased risk of reoperation was noted in patients with concomitant lumbar spine disease.

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Section: Methodsmentioning

confidence: 99%

Does Concomitant Lumbar Spine Disease Adversely Affect the Outcomes of Patients Undergoing Hip Arthroscopy?

Haskel¹,

Baron²,

Zusmanovich³

et al. 2020

Am J Sports Med

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“…Fraying lesions were treated by simple debridement. If a labral injury could be repaired, the labrum was sutured with 2.3 mm suture anchors (Smith & Nephew, Andover, MA, USA) using a labral base suture technique [ 10 ]. If the tear had progressed extensively and displaced, a loop-around suture technique was used for stability.…”

Section: Methodsmentioning

confidence: 99%

A novel arthroscopic classification of labral tear in hip dysplasia

et al. 2020

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Background Acetabular labral tears cause of pain in patients with symptomatic hip dysplasia. To date, no structured grading system has been developed to evaluate labral tears in these patients. The present study describes a new system of grading labral tears in patients with acetabular dysplasia. Methods The data of 66 patients who underwent hip arthroscopy for symptomatic hip dysplasia from March 2014 to February 2018 were reviewed. Labral tears were classified into four groups, based on the occurrence of chondrolabral junction (CLJ) disruption, capsulolabral recess (CLR) disruption, and labral displacement. Labral tears without instability were classified as grade 1 or 2. Partial delamination or blistering of the labrum with minimal fraying at the CLJ was classified as grade 1, whereas labral tears with CLJ disruption were classified as grade 2. Unstable labral tears with CLR disruption followed by CLJ disruption, but without labral displacement, were classified as grade 3, whereas unstable labral tears with CLR and CLJ disruption, but with labral displacement, were classified as grade 4. The radiological and clinical characteristics of patients in each grade were determined including by simple radiographs and MRI/MR arthrography, as were concomitant findings, including rupture of the ligamentum teres, articular cartilage damage, and presence of a paralabral cyst. The surgical options selected for each grade and clinical outcomes, including modified Harris hip scores (mHHS) and Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scores, were evaluated. Spearman’s correlation analyses were performed to assess whether labral tear grade correlated with baseline characteristics, the incidence of concomitant injuries, and the severity of osteoarthritis (OA). The Wilcoxon test for paired data was performed to compare treatment results with pain scores. Results The study cohort included six men and 53 women of mean ± SD age 39.9 ± 13.0 years (range, 15–66 years). Of the 66 hips, seven (10.6%), 10 (15.2%), 30 (45.5%), and 19 (28.8%) were classified as grades 1–4, respectively. Symptom duration ( P = 0.017), preoperative Tönnis OA grade ( P < 0.001), cartilage damage ( P < 0.001), and the presence of a paralabral cyst ( P = 0.001) correlated significantly with baseline tear grade. In all groups, mHHS and WOMAC scores improved after surgical treatment. Conclusions Arthroscopic findings of labral tears in patients with hip dysplasia differed from the conventional classification. The classification system proposed in this study will likely be useful for determining the degree of labral tear in patients with hip dysplasia and for predicting treatment outcomes.

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“… 11 , 15 However, these findings do not account for any major deformities or pathologies in the hip, the limited working space of the joint, or the large mass of soft tissue that surrounds it. 16 , 21 , 22 , 23 , 24 Finding a reliable portal that provides safe access into the different compartments of the joint is critical for minimizing iatrogenic damage to the soft or boney tissues of the hip. Although a number of portals have been described previously, no consensus has been reached for either a utilitarian portal for all locations, or specific recommendations for differing portals based on desired rim location.…”

Section: Introductionmentioning

confidence: 99%

Bone Volumes and Trajectory Angles for Acetabular Anchor Placement Can Be Optimized

Loreto

Getgood

Degen

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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The purpose of this study was to determine the optimal anchor placement and trajectory when repairing acetabular labral tears during hip arthroscopy with the primary focus on the 12 to 3 o'clock positions on the acetabular rim. Methods: Three-dimensional computational models of the pelvis were generated from 13 cadaveric specimens using 3D slicer medical imaging software. A set of cones, consistent with the dimensions of a commonly used sutured anchor, were virtually embedded into the models at the 12, 1, 2, and 3 o'clock positions around the acetabulum. Mirror images of the cone were extended toward the superficial aspect of the hip. The volume of bone occupied by the virtual anchor, the trajectory angle, and the volume of overlap between adjacent anchor locations were calculated. Results: Bone volume was significantly greater at the 1 o'clock position (4196.2 [1190.2] mm 3 ) compared with all other positions (P < .001). The 3 o'clock position had the smallest volume (629.2 [180.0] mm 3 ) and was also significantly less than the 12 (P < .001) and 2 o'clock (P ¼ .014) positions). The trajectory angle of 32.04 [5.05] ) at the 1 o'clock position was significantly greater compared with all other positions (P < .001). The least amount of adjacent position overlap occurred between the 2 and 3 o'clock positions (.12 [.42] mm 3 ), and this was statistically smaller than the overlap between cones at the 12 and 1 o'clock positions (214.28 [251.88] mm 3 ; P ¼ .029) and the 1 and 2 o'clock positions (139.51 [177.14] mm 3 ; P ¼ .044). Conclusions: Trajectory angles and the thickness of bone around the acetabulum were the greatest at the 12 to 1 o'clock positions, with the 1 o'clock position identified as that with the largest trajectory angle for safe anchor insertion.

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Arthroscopic Repair of Hip Labrum With Suture Anchors

Cited by 13 publications

References 12 publications

Does Concomitant Lumbar Spine Disease Adversely Affect the Outcomes of Patients Undergoing Hip Arthroscopy?

Does Concomitant Lumbar Spine Disease Adversely Affect the Outcomes of Patients Undergoing Hip Arthroscopy?

A novel arthroscopic classification of labral tear in hip dysplasia

Bone Volumes and Trajectory Angles for Acetabular Anchor Placement Can Be Optimized

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