Surgical Technique: Arthroscopic Osteoplasty of Anterior Inferior Iliac Spine for Femoroacetabular Impingement

Sharfman, Zachary T.; Grundshtein, Alon; Paret, Matan; Amit, Leah; Amar, Eyal; Rath, Ehud

doi:10.1016/j.eats.2016.02.032

Cited by 8 publications

(11 citation statements)

References 10 publications

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“…One of the most important factors demonstrating poor clinical outcomes is hip instability, a characteristic associated with developmental dysplasia of the hip (DDH). 8,22,24 DDH is a musculoskeletal condition in newborns and is considered a precursor to osteoarthritis (OA). 21 This condition is characterized by a shallow or an abnormally vertical acetabulum that may result in hip joint instability, unexplained hip dysfunction, pain in young patients, and possible tearing of the labrum.…”

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confidence: 99%

Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis

Murata

Fukase

Dornan

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Based on previous studies, it is difficult to discern whether patients who have femoroacetabular impingement (FAI) with borderline developmental dysplasia of the hip (BDDH) would benefit from arthroscopy when compared with patients without BDDH. Purpose: To evaluate the existing comparative literature on arthroscopic findings, procedures, patient-reported outcomes (PROs), and failures in patients who have FAI with BDDH compared with those without BDDH. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed, Embase, and Ovid databases were searched for studies published up to August 31, 2019, that reported outcomes after arthroscopy to treat patients who had FAI with BDDH. Included studies were required to have patients diagnosed with FAI and BDDH who were treated arthroscopically and compared with control patients (FAI without BDDH). Arthroscopic findings, PROs, and revision or total hip arthroplasty (THA) conversion rates were compared between groups. Results: Included in the review were 4 articles (933 patients). Patients who had FAI with BDDH were defined as having a lateral center-edge angle (LCEA) of either 18° to 25° or 20° to 25°; for control patients, the maximum LCEA was 40°. Across the studies, there were 224 patients who had FAI with BDDH compared with 709 control patients; the mean follow-up time ranged from 21.6 to 31.3 months among the groups. Improvements were shown across all PROs in each study. Random-effects meta-analysis indicated no statistically significant differences in postoperative PROs, the risk for revision surgery, or conversion to THA between the patients who had FAI with versus without BDDH. Conclusion: The results of the current review indicated that hip arthroscopy produced similar short-term outcomes between patients who had FAI with versus without BDDH.

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confidence: 99%

Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis

Murata

Fukase

Dornan

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Sharfman et al. 15 described a technique for AIIS decompression. In their technique, a capsular stripping of the anterior acetabular rim was essential for AIIS exposure, and they pointed out wide capsulotomy as one of the pitfalls.…”

Section: Discussionmentioning

confidence: 99%

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

Locks

Utsunomiya

Bolia

et al. 2017

Arthroscopy Techniques

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Femoroacetabular impingement syndrome is a common hip pathology significantly affecting not only the intra- and extra-articular structures but also the biomechanical function of the joint. Cam and pincer bony lesions have been extensively studied. However, during recent years, other types of extra-articular impingement between the pelvic and femoral bone have been investigated. When a prominent or morphologically abnormal anterior-inferior iliac spine (AIIS) impinges repetitively on the femoral side during motion, the subspinal acetabular region becomes prominent and extends toward the intra-articular part of the joint. This results in restriction of the range of motion of the hip and pain, especially with flexion. Therefore, during hip arthroscopy, it is necessary to evaluate the subspinal region (triangular area located at 1:30 to 2:30 o'clock using the acetabular clock face system). For the correction of the acetabular bone pathology to be complete, the surgeon should focus both on the pincer and subspinal impingement lesions. This article describes our preferred technique to successfully address subspinal and pincer acetabular impingement during hip arthroscopy. The pearls and pitfalls of this technique are discussed.

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“…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). The morphologic features of the subspine region and AIIS base were assessed arthroscopically by using a capsular-preserving technique or interportal capsulotomy and were classified into four previously described types (18,19).…”

Section: Diagnosis and Treatment Of Ssimentioning

confidence: 99%

“…There have been intraoperative descriptions of soft-tissue abnormalities related to SSI, such as rectus femoris tendon edema and capsule and labral impingement (5,13). However, to our knowledge, no published study has investigated imaging manifestations of SSI other than pathomorphologic features of AIIS.…”

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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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Surgical Technique: Arthroscopic Osteoplasty of Anterior Inferior Iliac Spine for Femoroacetabular Impingement

Cited by 8 publications

References 10 publications

Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis

Arthroscopic Treatment of Femoroacetabular Impingement in Patients With and Without Borderline Developmental Dysplasia of the Hip: A Systematic Review and Meta-analysis

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

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

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