Postoperative Alpha Angle Is Predictive of Return to Sport in Athletes Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Monahan, Peter F.; Jimenez, Andrew E.; Owens, Jade S.; Lee, Michael S.; Maldonado, David R.; Saks, Benjamin R.; Lall, Ajay C.; Domb, Benjamin G.

doi:10.1016/j.arthro.2021.09.015

Cited by 7 publications

(3 citation statements)

References 64 publications

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“…Recent literature has also indicated a postoperative alpha angle, but not preoperative alpha, to be a strong predictor of RTS in high-level athletes. 38 Conversely, the control group had lower postoperative alpha angles than did the IFL group among athletes who were successfully able to RTS. Despite these differences, both groups demonstrated strong RTS rates and had similar treatments overall.…”

Section: Discussionmentioning

confidence: 88%

Competitive Athletes with Femoroacetabular Impingement and Painful Internal Snapping Treated Arthroscopically with Intrabursal Iliopsoas Fractional Lengthening: High Rate of Return to Sport and Favorable Midterm Functional Outcomes

et al. 2022

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Background: Athletes with femoroacetabular impingement syndrome (FAIS) who undergo hip arthroscopy with iliopsoas fractional lengthening (IFL) in the context of painful internal snapping have demonstrated favorable patient–reported outcomes (PROs), return to sport (RTS), and resolution of internal snapping symptoms at short term follow–up. Midterm outcomes have not been established. Purposes: (1) To report minimum 5–year PROs and RTS rate in competitive athletes who underwent primary hip arthroscopy for FAIS and intra–bursal IFL for painful internal snapping and (2) to compare these clinical results with those of a propensity score–matched control group of competitive athletes who underwent primary hip arthroscopy without painful internal snapping and IFL. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for consecutive surgeries performed by a single surgeon between February 2010 and December 2013. Patients were considered eligible if they were professional, collegiate, or high school athletes and received a primary hip arthroscopy for FAIS and intra–bursal IFL without extended capsulotomy for painful internal snapping. Indications for IFL were painful internal snapping on preoperative physical examination. Inclusion criteria were preoperative and minimum 5–year follow–up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Rates of achieving the minimal clinically important difference were also reported. For comparison, athletes in the IFL group were propensity matched by age, sex, body mass index, lateral and anterior center–edge angles, and sports level to a control group of athletes without internal snapping who underwent primary hip arthroscopy for FAIS without IFL. Results: A total of 105 competitive athletes in the IFL group were included in the study with a follow–up of 66.8 ± 6.9 months (mean ± SD). The IFL cohort showed significant improvement in all recorded PROs at minimum 5–year follow–up ( P < .001). Furthermore, they demonstrated favorable rates of achieving the minimal clinically important difference for the modified Harris Hip Score (82.0%), Nonarthritic Hip Score (85.4%), and Hip Outcome Score–Sport Specific Subscale (82.8%). Further, 89.5% of athletes in the IFL cohort successfully returned to sport. A total of 42 athletes in the IFL group were propensity matched to 54 control athletes. When groups were compared, they demonstrated similar improvement in PROs and rates of RTS, revision arthroscopy, and achieving psychometric thresholds. Conclusion: Competitive athletes undergoing primary hip arthroscopy and intra–bursal IFL in the context of FAIS and painful internal snapping demonstrated favorable PROs and RTS rate at minimum 5–year follow–up. These results were comparable with those of a control group of athletes not requiring IFL.

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Section: Discussionmentioning

confidence: 88%

Competitive Athletes with Femoroacetabular Impingement and Painful Internal Snapping Treated Arthroscopically with Intrabursal Iliopsoas Fractional Lengthening: High Rate of Return to Sport and Favorable Midterm Functional Outcomes

et al. 2022

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“…[10][11][12]27 However, 2 recent studies have reported evidence suggesting an association between postoperative alpha angle change and period of time before returning to sports, and PROs. 25,28 More controversy exists about the magnitude of the depth of resection. Kaplan et al 12 described maximal radial distance (MRD) on 45° Dunn view, which is the distance from the apex of the CAM lesion to the circumference of the best fitting circle incorporating the subspine region and lateral femoral neck base.…”

Section: Discussionmentioning

confidence: 99%

“…10 –12,27 However, 2 recent studies have reported evidence suggesting an association between postoperative alpha angle change and period of time before returning to sports, and PROs. 25,28…”

Section: Discussionmentioning

confidence: 99%

Effect of cam resection depth on clinical outcomes after primary hip arthroscopy

Acar,

Hapa,

Gürsan

et al. 2023

HIP International

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Background: The amount of resection or the starting point of the resection on the femoral head for cam lesions in femoroacetabular impingement (FAI) is controversial. Aim: The purpose of this study was to study the effect of postoperative resection depth, and resection arc ratio of cam lesion on the frequency of achieving substantial clinical benefit (SCB), patient acceptable state (PASS) in modified Harris Hip Score (mHHS) and Hip Outcome Score Activity of Daily Living (HOSADL), 2 years postoperatively. Patients and methods: All patients who underwent first-time hip arthroscopy for FAI with a 2-year follow-up were included in this study. Patient-reported outcomes included the mHHS, HOSADL, and visual analogue scale for pain (Pain VAS). Radiological parameters such as alpha angletraditional (αT), alpha anglecartilage (αC), resection arc ratio (% alpha anglecartilage-alpha angletraditional/360°), resection depth (‘’D’’mm) and resection depth ratio ‘D%’ (D/femoral head diameter %) were measured using the 45° Dunn view. Results: We identified 26 patients (27 hips) with 2-year follow-up. There were 10 female and 16 male patients. The mean age of the patients was 33 ± 12 years. Higher frequency of achieving SCB threshold for mHHS was related to labrum repair (73% vs. debridement ‘27%’ p = 0.03), lower preoperative αT (64° vs. 76°, p = 0.04), lower preoperative mHHS (54 vs. 81, p < 0.001) and higher preoperative VAS scores (8 vs. 7, p = 0.02). Higher frequency of reaching PASS threshold for mHHS was associated with lower αC (82°vs. 92° p:0.02), lower RA (8% vs. 11%, p = 0.03), lower D (2.8 mm vs. 4.5 mm p:0.03), lower D% (4.7% vs. 8.4% p = 0.04) and higher postoperative mHHS (97 vs. 82 p < 0.001). Conclusions: A higher frequency of achieving SCB for HOSADL was related to lower D% (5% vs. 10.5%, p = 0.04). Cam resection depth affects the frequency of achieving clinically meaningful scores and resection depth less than 6% of the femoral head diameter seems to be appropriate for optimal results. The starting point of resection on head cartilage needs to be <90° when alpha angle is used for reference.

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Bedeutung des femoroazetabulären Impingements im Sport

Riedl

Fickert

2022

Arthroskopie

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Postoperative Alpha Angle Is Predictive of Return to Sport in Athletes Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Cited by 7 publications

References 64 publications

Competitive Athletes with Femoroacetabular Impingement and Painful Internal Snapping Treated Arthroscopically with Intrabursal Iliopsoas Fractional Lengthening: High Rate of Return to Sport and Favorable Midterm Functional Outcomes

Competitive Athletes with Femoroacetabular Impingement and Painful Internal Snapping Treated Arthroscopically with Intrabursal Iliopsoas Fractional Lengthening: High Rate of Return to Sport and Favorable Midterm Functional Outcomes

Effect of cam resection depth on clinical outcomes after primary hip arthroscopy

Bedeutung des femoroazetabulären Impingements im Sport

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