Femoroacetabular Impingement Negates the Acetabular Labral Seal During Pivoting Maneuvers but Not Gait

Dwyer, Maureen K.; Jones, Hugh L.; Field, Richard E.; McCarthy, Joseph C.; Noble, Philip C.

doi:10.1007/s11999-014-3760-1

Cited by 26 publications

(21 citation statements)

References 21 publications

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“…More commonly, excessive femoral resection has led to disruption of the native labral seal, adversely affecting hip joint biomechanics. 36 Mansor et al 11 reviewed a cohort of 120 patients (130 hips) and divided them into 3 groups (over-resected, under-resected, and neutral resected) who had a mean follow-up from index procedure of 39.6 months. The authors found that overresection greater than 5% of the femoral head diameter correlated with inferior clinical outcomes (modified Harris Hip Score) compared with the under-resected population.…”

Section: Discussionmentioning

confidence: 99%

Achieving a Perfectly Spherical Femoroplasty: Pearls, Pitfalls, and Optimal Surgical Technique

Lall

Annin

Chen

et al. 2020

Arthroscopy Techniques

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Femoroacetabular impingement describes a pathologic interaction between the bony femoral head/neck junction and acetabulum. Cam-type femoroacetabular impingement results from an aspherical femoral head architecture, which increases early contact along the acetabular surface during hip range of motion. Errant arthroscopic femoroplasty recently has been discussed within the literature to describe a preventable etiology of failed hip arthroscopy, most notably cam over-and under-resection. We present an arthroscopic surgical technique for achieving the perfectly spherical femoroplasty, meant to minimize complications and improve postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Achieving a Perfectly Spherical Femoroplasty: Pearls, Pitfalls, and Optimal Surgical Technique

Lall

Annin

Chen

et al. 2020

Arthroscopy Techniques

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“…On the other hand, these same studies have worked on heavily dissected specimen, leaving only bone, capsule and ligaments. Removal of soft tissue surrounding the hip joint, which are key factors in dynamic and passive hip stability in the living individual (Dwyer et al, 2014), may in fact diminish the clinical relevance of these studies by rendering the hip more vulnerable at extreme ranges of motion. Whereas a cadaveric capsular plication model may not represent a perfect clinical application, it represents the first step necessary to demonstrate a change in hip external rotation limitation.…”

Section: Discussionmentioning

confidence: 99%

Capsular plication in the non-deformity hip: impact on post-operative joint stability

et al. 2019

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Purpose and hypothesisThe aim of this study was to evaluate the hip joint range of motion after different capsular plication. The study hypothesis proposed that capsular plication after hip arthroscopy may reduce hip external rotation and thus prevent the hip joint instability created by arthroscopic capsulotomies.MethodsSix fresh frozen human cadavers were studied in the intact state (5 males, 1 females) for a total of 12 non-deformity hips tested. They were fixed to the operating room table using a custom-made apparatus. Three Steinman pins were inserted, the first into ASIS, a parallel pin into the distal femur proximal to inter-epicondylar axis and the third pin into the lateral epicondyle. Simulation of arthroscopic capsulotomies was done progressively with simulation of three capsular plication techniques. The first plication technique consisted of a primary plication shift of the antero-lateral capsule. The distal-medial arm of the iliofemoral ligament was shifted toward the proximal-lateral arm. The second plication technique consisted in adding a longitudinal arm to the capsulotomy, between the lateral arm and the medial arm of the iliofemoral ligament, to create a T-shaped capsulotomy. The resulting two triangular capsular flaps were overlaid onto each other by approximately 5 mm, plicated fully and tighly sutured in a double-breast manner. The third plication technique, called redrapping, consisted in excising the inferior capsular triangular flap (previously made in the second technique), and suturing the latero-anterior superior capsular flap to the medial arm of the iliofemoral ligament, superimposing the capsular edges for closure. External rotation of the hip at 0°, 15° and 30° of flexion were obtained after the capsulotomy and each capsular plication technique to quantify the increase in hip stability after plication. Data were assessed using a two-way repeated measure analysis of variance (ANOVAs) and Student’s T-test when necessary to determine if the change in external rotation was significantly different.ResultsAfter capsulotomy, external rotation averaged 26.3°, 29.1° and 31.1° at 0°, 15° and 30° of flexion. With the primary plication shift, external rotation averaged 24.9°, 30.3° and 34.0°. With the two-triangle technique, external rotation averaged 26.1°, 31.9° and 33.3°. With the re-draping technique, external rotation averaged 25.8°, 30.9° and 32.0°. A significant relationship was found between «Plication Technique» and «Angle of flexion» factors for the measured angle of external rotation (P = 0.04).A decomposition of the interaction showed that external rotation decreased at 0° of hip flexion and increased as the hip flexion angle increased. The only significant difference found corresponded to the two triangles technique at 15° flexion (mean difference compared to the non-repaired state = 2.8° ± 3.8° or 8.8% increase in external rotation; P = 0.03).ConclusionsDifferent techniques of capsular plication result in a non-significant increase in hip external rotation when compared to unrepa...

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“…The aim of labral treatment is to restore the labral seal. 8,[29][30][31][32][33] The options for restoration of the labral seal include debridement, repair, and reconstruction. Stable tears on manual probing are debrided.…”

Section: Discussionmentioning

confidence: 99%

Posterolateral Acetabuloplasty and Distal Femoral Neckplasty, Labral Repair, and Capsular Plication for Hip Reverse Contre-Coupe Lesion

Chandrasekaran

Walsh

Hartigan

et al. 2017

Arthroscopy Techniques

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This article describes the arthroscopic approach and management of a "reverse contre-coup" injury to the hip labrum. The injury occurs in the setting of posterolateral acetabular rim over-coverage impinging on the distal femoral neck in extension causing the femoral head to lever out anteriorly against the labrum. Ligamentous laxity and associated loss of anterior capsular restraint allow increased femoral head translation, adding further insult to the anterior labrum. The arthroscopic approach entails not only a labral repair with correction of the osseous conflict but also restoration of soft-tissue stability to minimize anterior femoral translation.

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Femoroacetabular Impingement Negates the Acetabular Labral Seal During Pivoting Maneuvers but Not Gait

Cited by 26 publications

References 21 publications

Achieving a Perfectly Spherical Femoroplasty: Pearls, Pitfalls, and Optimal Surgical Technique

Achieving a Perfectly Spherical Femoroplasty: Pearls, Pitfalls, and Optimal Surgical Technique

Capsular plication in the non-deformity hip: impact on post-operative joint stability

Posterolateral Acetabuloplasty and Distal Femoral Neckplasty, Labral Repair, and Capsular Plication for Hip Reverse Contre-Coupe Lesion

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