RESUMO
Femoroacetabular impingement (FAI) surgery aims to restore the native anatomical relationships between bones and the soft tissues comprising the hip joint. The goal of this approach is to mimic the natural biomechanical function of the hip joint and translate it into a perfect clinical outcome. In this article, we describe the indications and contraindications for our preferred hip arthroscopic techniques for correcting FAI in both primary and revision cases and discuss the role of postoperative rehabilitation and use of biologics in further improving patient outcomes.
Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Amplitude de Movimento Articular/fisiologia , Fenômenos Biomecânicos/fisiologia , Impacto Femoroacetabular/fisiopatologia , Articulação do Quadril/fisiopatologia , HumanosRESUMO
Anterior hip pain can be difficult to diagnose due to the many pathologies and overlapping pain patterns that exist in the hip region. Clinical findings of pain at the anterior inferior iliac spine with passive hip flexion, proximal quadriceps pain and weakness, and painful impingement tests of the hip may be indicative of subspine hip impingement. This report describes the diagnosis and treatment of anterior hip pain, including subspine impingement and femoroacetabular impingement in an elite weightlifter. This case also describes how with the correct diagnosis and treatment, the athlete returned to play to her previous level of sport 11 months after a complex hip injury.
Assuntos
Artralgia/etiologia , Impacto Femoroacetabular/etiologia , Lesões do Quadril/diagnóstico , Lesões do Quadril/etiologia , Treinamento Resistido/efeitos adversos , Levantamento de Peso/lesões , Artralgia/diagnóstico , Artralgia/prevenção & controle , Terapia Combinada , Feminino , Impacto Femoroacetabular/diagnóstico , Impacto Femoroacetabular/terapia , Lesões do Quadril/terapia , Humanos , Imobilização/métodos , Exame Físico/métodos , Modalidades de Fisioterapia , Radiografia/métodos , Resultado do Tratamento , Adulto JovemRESUMO
The acetabular labrum is a complex fibrocartilaginous structure with unique anatomy. Its unique anatomy imparts biomechanical functions important in hip stability, synovial fluid dynamics, contact pressure dissipation, proprioception, and nociception. Although the importance of labral preservation through surgical repair techniques has been increasingly recognized, situations do occur where the labrum is either absent, deficient, or simply irreparable. In these situations, both open and arthroscopic reconstructive techniques have been described to help restore the function of the native labral tissue. Efforts should be made to maintain or reestablish the native structure and function of the labrum in young patients with at least 2 mm of joint space based on the available biomechanical and clinical evidence. Return to sport, significant improvements in pain and function, high levels of satisfaction, and avoidance of hip arthroplasty have been shown in patients undergoing labral reconstruction. Although short-term results of labral reconstruction are promising, long-term follow-up and comparative studies will be necessary to further define its indications and contraindications.
Assuntos
Artroscopia/métodos , Cartilagem Articular/cirurgia , Impacto Femoroacetabular/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Amplitude de Movimento Articular/fisiologia , Acetábulo/lesões , Acetábulo/cirurgia , Artroscopia/reabilitação , Fenômenos Biomecânicos , Cartilagem Articular/fisiopatologia , Medicina Baseada em Evidências , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Lesões do Quadril/diagnóstico , Lesões do Quadril/cirurgia , Humanos , Instabilidade Articular/prevenção & controle , Masculino , Medição da Dor , Cuidados Pós-Operatórios/métodos , Radiografia , Recuperação de Função Fisiológica , Medição de Risco , Papel (figurativo) , Resultado do TratamentoRESUMO
PURPOSE: Our purpose was to develop an alternative method to divide the acetabulum and femoral head into different zones based on anatomic landmarks clearly visible during arthroscopy to facilitate reporting the geographic location of intra-articular injuries. METHODS: Two vertical lines are positioned across the acetabulum aligned with the anterior and posterior limits of the acetabular notch. A horizontal line is positioned aligned with the superior limit of the notch perpendicular to the previous lines. The lines divide the acetabulum into 6 zones. Numbers are assigned to each zone in consecutive order. Zone 1 is the anterior-inferior acetabulum. The numbers progress around the notch until zone 5 is assigned to the posterior-inferior acetabulum. Zone 6 is the acetabular notch. The same method is applied to the femoral head. Six experienced hip arthroscopists were instructed in the zone and clock-face methods and were asked to identify and describe the geographic locations of lesions at the acetabular rim, acetabular cartilage, and femoral head in the same cadaveric specimen. RESULTS: The zone method was more reproducible than the clock-face method in the geographic description of intra-articular injuries on the acetabulum and the femoral head. CONCLUSIONS: Among a group of expert hip arthroscopists, the zone method was more reproducible than the clock-face method. CLINICAL RELEVANCE: The presented method divides the acetabulum into 6 different zones based on the acetabular notch. The zones are the same for right- and left-side hips. The same method is applied for the femoral head allowing, for the first time, a geographic description of pathology.