MRI is a Reliable Method for Measurement of Critical Shoulder Angle and Acromial Index / A ressonância magnética é um método confiável para medida do ângulo crítico do ombro e do índice acromial

Abstract Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power (p< 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. Level of Evidence II, Diagnostic Study.

Resumo Objetivo Os objetivos deste estudo foram comparar os valores absolutos do índice acromial (IA) e do ângulo crítico do ombro (ACO) obtidos em radiografias e ressonâncias magnéticas (RM) do ombro e comparar a concordância interobservador e intraobservador dos valores de IA e ACO medidos nessas modalidades de imagem. Métodos Pacientes com indicação médica de investigação de doenças dos ombros por meio de radiografias e RM foram incluídos no estudo. As imagens foram levadas para dois cirurgiões de ombro treinados que realizaram medidas de IA e ACO em radiografias e RM. Doze semanas após a primeira avaliação, uma segunda avaliação foi realizada. A confiabilidade inter e intraobservador foi apresentada como coeficiente de correlação intraclasse (CCI) e a concordância foi classificada segundo os critérios de Landis e Koch. As diferenças entre duas medidas foram avaliadas por meio de gráficos de Bland-Altman. Resultados Cento e trinta e quatro ombros de 124 indivíduos foram incluídos no estudo. O CCI intraobservador médio para ACO em radiografias e RM foi 0,936 e 0,940, respectivamente; para IA, foi 0,908 e 0,022. O CCI interobservador médio para ACO foi 0,892 e 0,752 em radiografias e RM, respectivamente; para IA, os valores de CCI foram 0,849 e 0,685. Todas as análises individuais apresentaram poder estatístico (p < 0,001). A diferença média dos valores de IA em radiografias e RM foi 0,01 e 0,03 para os observadores 1 e 2, respectivamente. A diferença média dos valores de ACO em radiografias e RM foi 0,16 e 0,58 para os observadores 1 e 2, respectivamente. Conclusão Tanto a RM quanto as radiografias tiveram alta concordância intra e interobservador para medida de IA e ACO. Os valores absolutos de IA e ACO foram altamente correlacionados em ambas as modalidades de imagem. Esses achados sugerem que a RM é um método adequado para determinação de IA e ACO. Nível de Evidência II, Estudo Diagnóstico.

Progress in diagnosis and hip arthroscopic treatment of borderline developmental dysplasia of hip with Cam-type femoroacetabular impingement / 中国修复重建外科杂志

OBJECTIVE@#To summarize the biomechanical characteristics, diagnosis, and hip arthroscopic treatment of borderline developmental dysplasia of hip (BDDH) with Cam-type femoroacetabular impingement (Cam FAI).@*METHODS@#The literature on BDDH with Cam FAI at home and abroad in recent years was extensively reviewed and analyzed.@*RESULTS@#In patients with BDDH and Cam FAI, the femoral neck anteversion angle and femoral neck shaft angle increase, the pelvis tilts, and the acetabulum rotates, resulting in instability of the hip joint. In order to maintain the stability of the hip joint, the direction of biomechanical action of the hip joint has changed, which further affects the anatomical structures such as the proximal femur and acetabular morphology. BDDH with Cam FAI can be diagnosed clinically by combining lateral center edge angle, anterior center edge angle, and acetabular index. BDDH with Cam FAI can be effectively treated through arthroscopic polishing of the edges of the acetabular proliferative bone, excision of Cam malformations, and minimally invasive repair of the glenoid lip and cartilage of the hip joint.@*CONCLUSION@#Currently, there is no unified standard for the diagnosis and treatment of BDDH with Cam FAI. Minimally invasive treatment of the hip under arthroscopy can achieve good early- and medium-term effectiveness, and has certain advantages in repairing and maintaining the integrity of the glenoid lip and suturing/compression joint capsule. However, the long-term effectiveness needs to be further followed up to determine. The timing of surgery, intraoperative bone edge depth polishing, and joint capsule suturing/compression techniques also need to be further explored.

Relationship between Femoroacetabular Impingement and Pubalgia in Professional Soccer Players / Relação do impacto femoroacetabular e pubalgia em jogadores profissionais de futebol de campo

Abstract Objective To analyze the relationship between pubalgia and femoroacetabular impingement (FAI) in professional athletes of a soccer club, defining the prevalence of these conditions in the sample studied. Methods It is an epidemiological, cross-sectional, and analytical study including 90 professional soccer players active from 2019 to 2021. We accessed the medical records of the subjects to retrieve information from the modified Pre-Competition Medical Assessment (PCMA) protocol, orthopedic physical examination, and anteroposterior pelvic radiographs to assess pubalgia and FAI, respectively. Inclusion criteria were athletes playing in the professional soccer club in the 2019 to 2021 season, who underwent a modified PCMA upon admission, and who signed an informed consent form. Results FAI was highly prevalent (85.6%) in the sample. This prevalence may occur because, in Brazil, people start playing sports early, not always in suitable fields, or with no proper equipment and supervision. In addition, the CAM-type impingement was the most frequent (62.2%). These injuries are related to high-intensity movements, including those associated with soccer. Furthermore, there is no dependency correlation between pubalgia and FAI. FAI was present in only 20% of athletes with pubalgia complaints. Conclusion There was a high prevalence of FAI in professional soccer players in the studied population (85.6%) but with no relationship between FAI and pubalgia.

Resumo Objetivo Analisar a relação entre a pubalgia e o impacto femoroacetabular (IFA) em atletas profissionais de um clube de futebol, definindo a prevalência de pubalgia e de impacto femoroacetabular na casuística estudada. Métodos É um estudo epidemiológico, transversal e analítico. Foram selecionados 90 atletas profissionais de futebol atuantes no período de 2019-2021. Foram acessados os prontuários para obtenção do protocolo PCMA modificado, além de exame físico ortopédico e de radiografias da bacia com incidência anteroposterior para avaliação de pubalgia e IFA, respectivamente. Critérios de Inclusão: Atletas que atuaram no clube de futebol de campo profissional na temporada de 2019 a 2021, que foram submetidos a aplicação do PCMA modificado na admissão e que assinaram o TCLE. Resultados O IFA apresentou elevada prevalência na amostra (85.6%), o que pode ocorrer pois, no Brasil, os jovens iniciam a prática esportiva em idade muito precoce, além do fato de os jogadores nem sempre praticarem o esporte em campos adequados ou com equipamentos e supervisão adequada. Ademais, o impacto tipo CAM foi o mais frequente (62.2%). O surgimento dessas lesões é relacionado a movimentos de alta intensidade, como os vistos no futebol. Outrossim, observou-se que não há correlação de dependência entre a pubalgia e o IFA. Foi visto que o IFA estava presente em apenas 20% dos atletas queixosos de pubalgia. Conclusão Há elevada prevalência de IFA em atletas de futebol profissional na população estudada (85.6%) e não houve relação entre o IFA e a presença de pubalgia.

Parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement / Lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular

Abstract Objective: To describe cases of parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement, correlating the clinical and imaging data. Materials and Methods: This was a retrospective descriptive case series of parafoveal chondral lesion of the femoral head in 21 patients who underwent computed tomography and magnetic resonance arthrography scans of the hip, having then received an imaging-based diagnosis of femoroacetabular impingement. Results: Of the 21 patients evaluated, 15 (71%) had cam-type femoroacetabular impingement, whereas five (24%) had mixed-type impingement, and one (5%) had pincer-type impingement. Twelve patients (57%) had a low frequency of physical activity, which was significantly associated with the presence of cam-type impingement (p = 0.015). Although the extent of the lesion correlated significantly with the acetabular coverage angle (p = 0.04), it did not correlate significantly with the alpha angle or femoral head-neck offset value (p = 0.08 and p = 0.06, respectively). We also found no correlation between the extent of the lesion and the other main parameters that define the femoroacetabular impingement types. Conclusion: This was one of the largest case series of parafoveal chondral lesion of the femoral head in patients with imaging findings of femoroacetabular impingement. The extent of such lesions does not appear to correlate with the parameters of femoroacetabular impingement, with the exception of the acetabular coverage angle.

Resumo Objetivo: Descrever casos de lesão condral parafoveal da cabeça femoral em pacientes com impacto femoroacetabular, correlacionando dados clínicos e de imagem. Materiais e Métodos: Esta foi uma série de casos descritiva retrospectiva de lesão condral parafoveal da cabeça femoral em 21 pacientes submetidos a tomografia computadorizada e artrorressonância magnética do quadril e que receberam diagnóstico por imagem de impacto femoroacetabular. Resultados: Dos 21 pacientes avaliados, 15 (71%) tiveram impacto femoroacetabular do tipo cam, enquanto cinco (24%) tiveram impacto do tipo misto e um (5%) teve impacto do tipo pincer. Doze pacientes (57%) apresentaram baixa frequência de atividade física, sendo esta significativamente associada a impacto do tipo cam (p = 0,015). Houve correlação significativa entre a extensão da lesão e o ângulo de cobertura acetabular (p = 0,04), porém, não se correlacionou significativamente com o ângulo alfa ou com o valor do deslocamento cabeça-colo femoral (p = 0,08 e p = 0,06, respectivamente). Também não encontramos correlação entre a extensão da lesão e os outros principais parâmetros que definem os tipos de impacto femoroacetabular. Conclusão: Esta foi uma das maiores casuísticas de lesão condral parafoveal da cabeça femoral em pacientes com achados de imagem de impacto femoroacetabular. A extensão dessas lesões não parece se correlacionar com os parâmetros do impacto femoroacetabular, com exceção do ângulo de cobertura acetabular.

Effects of tendon-regulating and stretching manipulation combined with JIN's three-needle therapy for the shoulder on pain and shoulder joint function in subacromial impingement syndrome / 针灸推拿医学（英文版）

Objective: To observe the effects of tendon-regulating and stretching manipulation plus JIN's three-needle therapy for the shoulder on pain and shoulder joint function in subacromial impingement syndrome (SIS). Methods: Eighty patients with SIS were recruited and divided into a control group and a treatment group by the random number table method, with 40 cases in each group. The control group was given JIN's three-needle therapy for the shoulder, and the treatment group received additional tendon-regulating and stretching manipulation. The visual analog scale (VAS) score and constant-Murley score (CMS) were observed before and after the intervention, and the total effective rate was also observed. Results: The total effective rate was 92.5％ in the treatment group versus 70.0％ in the control group, and the difference was statistically significant (P<0.05). The VAS score and CMS changed notably after treatment in both groups (P<0.05), and the improvements were markedly greater in the treatment group than in the control group (P<0.05). Conclusion: Tendon-regulating and stretching manipulation plus JIN's three-needle therapy for the shoulder can facilitate the relief of pain and the improvement of shoulder joint function in SIS patients.

Correlation between Intensity of Pain and Disability Due to Intra-articular Lesions in Patients with Femoroacetabular Impingement Syndrome / Correlação entre intensidade da dor e incapacidade com as lesões intra-articulares em pacientes com síndrome do impacto femoroacetabular

Abstract Objective To correlate radiographic alterations and lesions in intra-articular structures of the acetabulum with the intensity of pain and disability of patients diagnosed with femoroacetabular impingement syndrome. Methods A retrospective analysis of the preoperative data of 182 patients (190 hips) was performed. Clinical variables such as age, gender, the practice of physical activity, and radiographic variables, such as the Wiberg and alpha angles, were evaluated. Through an intraoperative video, the extent of the chondral and labial lesions was evaluated considering the clock-face method, the degree of joint involvement by the Outerbridge classification, and the presence of wave lesions. The variables were analyzed by linear regression, with the intensity of the pain assessed by the Visual Analog Scale (VAS), and functional disability measured by the Modified Harris Hip Score (mHHS). Results The mean age of the patients was of 38.5 ± 9.6 years, the mean intensity of the pain was of 7.8 ± 1.6, and the mean mHHS score was of 56.3 ± 12.7. In total, 61% of the sample were classified as Outerbridge III or IV, and 12.6% had wave lesions. There was a correlation between the male gender (r = 0.497) and lower intensity of the pain, and a correlation of age (r = -0.27), the male gender (r = 8.419) and physical activity with higher functional scores on the mHHS (r = 4.729). Conclusion There was no correlation of the radiographic and arthroscopic parameters of the present study and the intensity of pain and the disability of the patients. The male gender is related to lower intensity of pain, and higher functional ability is related to the male gender, lower age, and the practice of physical activity. Level of Evidence IV.

Resumo Objetivo Correlacionar alterações radiográficas e lesões de estruturas intra-articulares do acetábulo com a intensidade da dor e a incapacidade de pacientes com diagnóstico de síndrome do impacto femoroacetabular. Métodos Realiou-se uma análise retrospectiva de dados pré-operatórios de 182 pacientes (190 quadris). Foram avaliadas variáveis clínicas como idade, sexo e prática de atividade física, e variáveis radiográficas, como ângulo de Wiberg e o ângulo alfa. Por meio do vídeo intraoperatório, foi avaliada a extensão das lesões condrais e labiais considerando-se o método clock-face, o grau de comprometimento articular pela classificação de Outerbridge, e a presença de lesão em onda. As variáveis foram analisadas por meio de regressão linear, tendo como variáveis dependentes a intensidade da dor, avaliada pela Escala Visual Analógica (EVA), e a incapacidade funcional, mensurada pelo Harris Hip Score modificado (HHSm). Resultados A média de idade dos pacientes foi de 38,5 ± 9,6 anos, a da intensidade da dor, 7,8 ± 1,6, e a do HHSm, 56,3 ± 12,7. No total, 61% da amostra apresentava Outerbridge III ou IV, e 12,6% apresentava lesão em onda. Observou-se correlação do sexo masculino (r = 0,497) com menor intensidade da dor, e correlação da idade (r = −0,27), do sexo masculino (r = 8,419) e da realização de atividade física com maior escore funcional no HHSm (r = 4,729). Conclusão Não houve correlação dos parâmetros radiográficos e artroscópicos deste estudo com a intensidade da dor e a incapacidade dos pacientes. O sexo masculino está relacionado com menor intensidade da dor, e maior capacidade funcional está relacionada com o sexo masculino, menor idade, e a prática de atividade física. Nível de Evidência IV.

Síndrome del impacto posterior del tobillo secundario a proceso de Stieda / Posterior Ankle Impingement secondary to a Stieda process

Introducción: El síndrome de impacto posterior es una condición que resulta de la compresión de tejidos blandos entre la cara posterior del astrágalo y el área posteroinferior de la tibia durante el movimiento de flexión plantar del tobillo y provoca inflamación de los tejidos blandos circundantes. Objetivo: Presentar un caso de síndrome de impacto posterior secundario a proceso de Stieda. Presentación de caso: Se presenta el caso de un varón de 53 años, cocinero de profesión que se quejaba de dolor en la región posterior del tobillo derecho, que se exacerbaba con la flexión plantar del tobillo sin traumatismo previo. Se descartaron lesiones de tipo tendinosas y ligamentosas al examen físico, por lo que se indica radiografía convencional. A través de la radiografía de tobillo se define proceso de Stieda el cual justifica la clínica. Por esto no se realizaron otros estudios. Conclusiones: La radiografía convencional en el contexto clínico de un síndrome de impacto posterior del tobillo permite establecer el diagnóstico sin requerir estudios de imagen de mayor complejidad(AU)

Introduction: The posterior impingement syndrome is a condition resulted of compressed posterior soft tissues, between the posterior talus and the calcaneus. Classically, this is seen at activities that cause extreme plantar flexion. Objective: To describe a posterior Ankle Impingement case secondary to a Stieda process. Case report: We report a 53 years old male, cook profession, with a chronic pain history within the posterior ankle, previous trauma was denied. At clinical examination tendon and ligament injuries were not found. Initial evaluation with conventional radiography showed the presence of a Stieda's process as cause of clinical manifestations. No further imaging studies were required. Conclusion: Conventional radiograph allows to clarify diagnosis in the posterior impingement syndrome(AU)

The Brazilian version of the Hip Sports Activity Scale: translation and cross-cultural adaptation

Abstract BACKGROUND: The Hip Sports Activity Scale (HSAS) is a reliable and valid tool for determining the levels of sports activities among patients with femoroacetabular impingement (FAI). OBJECTIVE: To translate and cross-culturally adapt the HSAS to the Brazilian Portuguese language. DESIGN AND SETTING: This was a cross-sectional study conducted at the State University of Rio de Janeiro. METHODS: The Brazilian version of the HSAS was developed following a process that comprised six steps: translation, synthesis, back-translation, review by committee, pretesting and submission of documentation to the developers. The translation phase involved three independent bilingual translators whose mother language was Brazilian Portuguese. The back-translation phase involved three independent translators whose mother language was English. In order to verify comprehension of the questionnaire, 30 undergraduate students in physical education (65% men), with mean age 23.2 years (standard deviation = 6.8), participated in the pre-testing phase. RESULTS: During the translation step, some terms and expressions were changed to obtain cultural equivalence to the original HSAS. In the pre-testing phase, each item of the scale showed a comprehension level of 100%. CONCLUSION: The HSAS was translated from English to the Brazilian Portuguese language and adapted to Brazilian culture. The HSAS validation is ongoing.

Correlation between the range of rotation of the hip and the radiographic signs of cam and pincer morphology in femoroacetabular impingement syndrome / Correlação entre amplitude de rotação do quadril e sinais radiográficos came e pincer na síndrome do impacto femoroacetabular

Abstract Objective: To determine whether hip rotation correlates with the radiographic signs of cam or pincer deformity after hip arthroscopy in patients with femoroacetabular impingement syndrome. Materials and Methods: This was a single-center retrospective study of data collected between 2014 and 2017. The study sample included 65 patients between 18 and 55 years of age who underwent hip arthroscopy for the treatment of unilateral femoroacetabular impingement. The following data were collected for the periods prior to and six months after surgery range of medial and lateral rotation of the hip; measures on anteroposterior X-rays of the pelvis obtained in the standing position and on ateral X-rays in the Ducroquet profile view; and score on the 33-item International Hip Outcome Tool. Results: Mean preoperative and postoperative values were as follows: 19.26 ± 10.39° and 30.95 ± 3.52°, respectively, for medial rotation of the hip (p < 0.001); 73.85 ± 6.62° and 68.12 ± 5.04°, respectively, for the anteroposterior alpha angle (p < 0.001); 56.97 ± 6.09° and 50.61 ± 5.39°, respectively, for the lateral alpha angle (p < 0.001); and 0.17 ± 0.11 and 0.07 ± 0.08, respectively, for the acetabular retroversion index (p < 0.001). The crossover sign was identified in 75.4% of the patients before surgery and in 44.6% after (p < 0.001). Although there was an increase in the range of hip rotation and an improvement in radiographic parameters after arthroscopy, we detected no direct correlation between the two. Conclusion: Hip arthroscopy can improve medial rotation of the hip, as well as reducing cam and pincer deformities, in patients with femoroacetabular impingement syndrome. However, those findings do not appear to be directly correlated.

RESUMO Objetivo: Correlacionar rotação medial do quadril com sinais radiográficos came e pincer de pacientes com síndrome do impacto femoroacetabular submetidos a artroscopia. Materiais e Métodos: Estudo retrospectivo com prontuários consecutivos de 2014 a 2017 em único centro. O estudo incluiu 65 pacientes com impacto femoroacetabular unilateral, de ambos os sexos e idade entre 18 e 55 anos, com indicação de artroscopia do quadril. Os dados colhidos no pré-operatório e pós-operatório de seis meses foram: amplitude de rotação medial e rotação lateral do quadril, mensurações de radiografia anteroposterior da pelve em ortostatismo e perfil de Ducroquet, escala visual analógica de dor e questionário de qualidade de vida International Hip Outcome Tool 33. Resultados: A amplitude pré-operatória de rotação medial do quadril foi, em média, 19,26 ± 10,39°, e pós-operatória, 30,95 ± 3,52° (p < 0,001). Para ângulo alfa anteroposterior, o valor médio pré-operatório foi 73,85 ± 6,62°, e após cirurgia, 68,12 ± 5 , 0 4 ° ( p < 0,001). Já o ângulo alfa perfil pré - operatório e pós- operatório foi, respectivamente, 56,97 ± 6,09° e 50,61 ± 5,39° (p < 0,001). O sinal do cruzamento foi presente em 75,40% (pré-cirurgia) e após cirurgia em 44,60% (p < 0,001). O índice de retroversão acetabular pré-operatório, em média, foi 0,17 ± 0,11, e pós-operatório, 0,07 ± 0,08 (p < 0,001). Embora tenham sido observados aumento na amplitude de rotação do quadril e melhora dos parâmetros radiográficos após artroscopia, não houve correlação direta entre as variáveis. Conclusão: A artroscopia do quadril pode promover normalização da amplitude de rotação medial do quadril e redução dos sinais radiográficos came e pincer nos pacientes com síndrome do impacto femoroacetabular, porém, estes achados não possuem correlação direta.

Treatment of Hip Wave Lesion Using Reverse Microfracture: A Retrospective Clinical Study / Tratamento da lesão em onda do quadril através da microfratura reversa: Estudo clínico retrospectivo

Abstract Objective The present study aims to evaluate the treatment of hip wave lesion using reverse microfracture, which is a simple and cheap surgical procedure. Methods We retrospectively analyzed 19 patients with acetabular wave lesion treated with reverse microfracture. The patients were assessed by magnetic nuclear resonance imaging (MRI) at the time of diagnosis and 6 months after the surgery and functionally evaluated using the Harris Hip Score (HHS) and the visual analogue scale (VAS) for pain in the preoperative period, and 3 and 6 months after the surgery. Results The statistical data showed a significant improvement in HHS and VAS 6 months after the surgery. Six months after the surgery, the MRI revealed that the area subjected to reverse microfracture presented cartilage with the same visual characteristics observed in areas with no chondral injury. Conclusion We conclude that the reverse microfracture proved to be an effective, reproducible method for the treatment of wave lesion.

Resumo Objetivo Avaliar o tratamento desta lesão, através da microfratura reversa, que é um procedimento simples e sem aumento de insumos na cirurgia. Métodos Foram analisados retrospectivamente 19 pacientes submetidos a tratamento da lesão em onda no acetábulo, através da microfratura reversa. Utilizamos a ressonância nuclear magnética (RNM) no momento do diagnóstico e 6 meses após a cirurgia, avaliação funcional pelo Harris Hip Score (HHS) e escala visual e analógica (EVA) da dor no pré-operatório, e 3 e 6 meses após a cirurgia. Resultadoos dados estatísticos mostraram melhora significativa do HHS e EVA da dor após 6 meses da cirurgia. A RNM após 6 meses da cirurgia mostrou que na área que foi submetida à microfratura reversa, a cartilagem se apresentou com as mesmas características visuais que nas áreas sem lesão condral. Conclusão Concluímos que a microfratura reversa se mostrou eficaz e reprodutível no tratamento da lesão em onda.

Total ankle arthroscopy for osteogenic posterior ankle impingement syndrome complicated with flexor hallucis longus tenosynovitis / 中华创伤骨科杂志

Objective:To investigate the efficacy of total ankle arthroscopy for resection of the talus os trigonum and debridement of the synovium of flexor hallucis longus (FHL) in the treatment of osteogenic posterior ankle impingement syndrome (PAIS) complicated with flexor hallucis longus tenosynovitis (FHLT).Methods:The 14 patients with osteogenic PAIS and FHLT were retrospectively analyzed who had been treated at Department of Hand-Foot-Ankle Microsurgery, Xuzhou Central Hospital from July 2017 to July 2019. They were 8 men and 6 women, aged from 29 to 53 years (mean, 42.4 years). The talus os trigonum and the giant posterolateral process of the talus were resected under total ankle arthroscopy in the prone position of the posterior ankle while the FHL was released and cleared. The efficacy was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Maryland functional score, and pain visual analog scale (VAS) between preoperation and one year postoperation.Results:All patients were followed up for 12 to 24 months (average, 15 months). For all patients, their plantar flexion and dorsal extension were improved significantly from preoperative 19.2°±4.0° and 14.2°±2.7° to postoperative 42.9°±2.7° and 24.5°±3.2°, their AOFAS score increased significantly from preoperative 42.1±4.2 to 91.6±2.7 at one year postoperation, their Maryland score increased significantly from preoperative 43.9±4.1 to 91.9±3.5 at one year postoperation, and their VAS score decreased significantly from preoperative 6 (6, 7) to 0 (0, 0) at one year postoperation (all P<0.05). Conclusion:In the treatment of osteogenic PAIS complicated with FHLT, total ankle arthroscopy for resection of the talus os trigonum and release of FHL can lead to fine efficacy and limited surgical invasion, resolving the FHL pathological inflammation and PAIS at the same time.

Morphology of dorsal medial talar neck osteophyte and its clinical significance: based on three-dimensional computed tomography / 中华创伤骨科杂志

Objective:To study the morphology of dorsal medial talar neck osteophyte (DMTNO) and its association with anteromedial ankle impingement syndrome (AAIS) using CT 3D reconstruction images.Methods:The present retrospective study included 23 patients with AAIS due to DMTNO (case group) and 23 patients with DMTNO but without AAIS (control group) who had been admitted from February 2019 to June 2021. Multi-slice CT data (DICOM) of DMTNO in both groups were collected and imported into Arigin 3D Pro 3D reconstruction software to reconstruct and observe the 3D morphology of DMTNO. The dorsal convex distance, medial convex distance and anterior convex distance of DMTNO were measured to find their association with AAIS.Results:In the case group, DMTNO clearly showed a flat polyhedral shape with a large base and a small top; in the control group, DMTNO showed various shapes that were different mainly in an irregular top but similar in a large, long and narrow base. The dorsal convex distance [(8.07±2.30) mm] and medial convex distance [(6.70±2.62) mm] in the case group were significantly larger than those in the control group [(3.59±1.10) mm and (1.98±0.93) mm] ( P<0.05), but there was no significant difference between the 2 groups in the anterior convex distance ( P>0.05). Conclusions:The DMTNO leading to AAIS shows a flat polyhedral shape with a large base and a small top. No correlation is found between the anterior convex and AAIS whereas the dorsal convex and medial convex of DMTNO may be closely associated with AAIS.

Comparison of the application value of X-ray and MRI in the diagnosis of subacromial impingement syndrome / 中国医师进修杂志

Objective:To compare and analyze the value of X-ray examination and MRI in the diagnosis of subacromial impingement syndrome.Methods:Sixty patients with shoulder pain and weakness in Beijing Tiantan Hospital, Capital Medical University from January 2019 to May 2021 were selected. All patients underwent X-ray and MRI. Taking clinical diagnosis as the gold standard, the diagnostic efficacy of X-ray and MRI in subacromial impact syndrome was compared and analyzed.Results:The consistency between MRI and gold standard was good ( Kappa = 0.769, P<0.01), and the consistency between X-ray and gold standard was general ( Kappa = 0.464, P<0.01); there was no significant difference between X-ray examination and MRI examination of acromion morphological classification, subacromial space classification ( P>0.05); The sensitivity of MRI was higher than that of X-ray, and the difference was statistically significant ( χ2 = 4.00, P<0.05). There was no difference between MRI and X-ray, and the difference was not statistically significant ( χ2 = 0.25, P>0.05). Conclusions:X-ray and MRI are complementary to each other in the diagnosis of subacromial impingement syndrome. X-ray examination should be carried out first, and MRI should be carried out when necessary.

Arthroscopic treatment for patients with borderline developmental dysplasia of the hip and cam-type femoroacetabular impingement syndrome / 中华骨科杂志

Objective:To evaluate the clinical outcomes of patients with borderline developmental dysplasia of the hip (BDDH) and cam-type femoroacetabular impingement syndrome (FAIS) after hip arthroscopy.Methods:Data were retrospectively reviewed for patients with BDDH and cam-type FAIS who underwent hip arthroscopy surgery from June 2017 to December 2019. A total of 32 patients were enrolled, with a mean age of 36.13±8.67 years (range, 20-50 years), including 15 males and 17 females. The preoperative lateral center-edge angle was 22.3°±1.6° (range 20.1°-24.7°), while the preoperative α angle was 64.1°±4.6° (range, 56.0°-69.8°). All patients were treated with arthroscopic limited acetabular plasty, labral repair, femoral osteoplasty, and capsular plication after excluding from external hip diseases by ultrasound-guided hip blocking test. The visual analogue scale (VAS), modified Harris Hip Scores (mHHS) and International Hip Outcome Tool-12 (iHOT-12) scores were used to evaluate the clinical effects.Results:All patients were followed up, and the mean follow-up time was 2.5±0.8 years (range, 2.0-4.7 years). The VAS score decreased from 6.07±1.56 to 1.96±0.92 at 1 year and to 1.86±1.01 at 2 years after operation ( F=112.64, P<0.001); the mHHS score increased from 53.87±13.04 to 86.12±8.64 at 1 year and to 88.71±8.15 at 2 years after operation ( F=101.70, P<0.001); the iHOT-12 score was improved from 40.00±7.33 to 76.27±9.50 at 1 year and to 78.67±10.31 at 2 years after operation ( F=134.91, P<0.001). The α angle improved to 40.27°±4.52° (range, 34.8°-49.7°) with significant difference ( t=9.24, P<0.001). Conclusion:Hip arthroscopy can achieve satisfied short-term outcomes in treating BDDH and cam-type FAIS with few complications and less trauma.

Diagnostic value and clinical significance of MRI combined with MSCT in ischiofemroal impingement syndrome / 中国医师杂志

Objective:To explore the diagnostic value and clinical significance of total volume of quadratus femoris muscle (TQFMV), ischial angle, femoral neck angle (FNV) measured by magnetic resonance imaging (MRI) combined with eccentric distance and lesser trochanter height measured by multi-slice spiral CT (MSCT) in the diagnosis of ischiofemoral impingement (IFI) syndrome.Methods:A total of 82 patients with IFI in Beijing Huairou Hospital from October 2017 to July 2020 were selected as the observation group. In addition, 82 healthy patients who underwent MRI and MSCT were collected as the control group. The general data, MRI and MSCT parameters of the two groups were compared, and IFI influencing factors were analyzed by logistic regression. The correlation between MRI and MSCT parameters and clinical manifestations and the correlation between MRI and MSCT parameters were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of MRI and MSCT parameters for IFI.Results:There were statistically significant difference between the two groups of gender, age, MRI parameters (TQFMV, ischial angle, FNV), and MSCT parameters (eccentricity, lesser trochanter height) (all P<0.05). Logistic regression analysis showed that gender, age, MRI parameters (TQFMV, ischial angle, FNV), MSCT parameters (eccentricity, lesser trochanter height ) were all influencing factors of IFI (all P<0.05). MRI parameters (TQFMV, ischial angle, FNV), MSCT parameters (eccentricity, lesser trochanter height) were all related to quadratus femoris muscle (QFM) edema, fat infiltration and pain degree in IFI patients (all P<0.05). The MRI parameter TQFMV of IFI patients was positively correlated with the MSCT parameter eccentricity and lesser trochanter height, while the ischial angle and FNV were negatively correlated with the MSCT parameter eccentricity and lesser trochanter height (all P<0.05). The AUC of MRI parameters (TQFMV, ischial angle, FNV) and MSCT parameters (eccentricity, lesser trochanter height) in the diagnosis of IFI were high, especially the highest in combined diagnosis, reaching 0.859. Conclusions:MRI parameters TQFMV, ischial angle, FNV and MSCT parameters, eccentricity and lesser trochanter height are related to the clinical manifestations of IFI patients. Combined detection of them can improve the diagnostic value of IFI and avoid missed diagnosis and misdiagnosis.

La rotación axial de la clavícula que plantea la maniobra de Mulligan ¿produce una reducción de la presión en el espacio subacromial? Un estudio ex vivo exploratorio / Does the axial rotation of the clavicle posed by the Mulligan maneuver produce a pressure reduction in the subacromial space? An exploratory ex vivo study

RESUMEN: El pinzamiento de hombro es la principal causa del hombro doloroso. Dentro de las estrategias terapéuticas propuestas se encuentra la terapia manual. En este contexto, la maniobra de Mulligan, implica una rotación axial en sentido anterior de la clavícula, emulando la acción del músculo subclavio, lo cual hipotéticamente aumentaría el espacio subacromial. Sin embargo, no existen antecedentes que proporcionen sustento experimental a dicha hipótesis. El objetivo del presente estudio fue explorar si la rotación axial de la clavícula, producida por la maniobra de Mulligan, tiene efecto sobre la presión registrada en el espacio subacromial, con el propósito disponer de antecedentes metodológicos que puedan contribuir al diseño de futuros estudios que aborde la problemática expuesta y consideren un mayor tamaño de muestra. Mediante un estudio exploratorio ex-vivo, se evaluaron dos preparados anatómicos que comprendían la escapula, la clavícula y los dos tercios proximales del humero, ambos con indemnidad de la articulación glenohumeral y acromioclavicular. En estos se registraron la presión en el espacio subacromial y la rotación axial de la clavícula, todo durante la realización de una maniobra de rotación axial clavicular en sentido anterior. Se analizaron las diferencias de presión entre una condición basal y durante la maniobra, como también la máxima rotación axial de clavícula. Dichas variables fueron registradas mediante un sensor de presión y un sistema de análisis de movimiento. La presión en el espacio subacromial durante la maniobra, disminuyó en todas las repeticiones en un rango comprendido entre el 21-51 % de la presión basal. La máxima rotación axial registrada estuvo entre los 3.9-10°. Los resultados de este estudio exploratorio, dan pie para hipotetizar que la maniobra de rotación axial anterior de la clavícula produce una disminución de la presión subacromial, en el área comprendida inmediatamente bajo el acromion.

SUMMARY: Shoulder impingement is the main cause of shoulder pain. Manual therapy is one of the proposed therapeutic strategies. In this context, the Mulligan maneuver implies anterior axial rotation of the clavicle, emulating the action of the subclavius muscle, which hypothetically would increase the subacromial space. However, there are no antecedents that provide experimental support for this hypothesis. The objective of the present study was to explore whether the axial rotation of the clavicle, produced by the Mulligan maneuver, has an effect on the pressure registered in the subacromial space, with the purpose of having methodological antecedents that can contribute to the design of future studies that address the problem exposed and consider a larger sample size. Through an ex-vivo exploratory study, two anatomical preparations comprising the scapula, clavicle, and proximal two-thirds of the humerus, both with glenohumeral and acromioclavicular joint sparing, were evaluated. In these, the pressure in the subacromial space and the axial rotation of the clavicle were recorded, all during the performance of an anterior clavicular axial rotation maneuver. Pressure differences between a basal condition and during the maneuver were analyzed, as well as the maximum axial rotation of the clavicle. These variables were recorded using a pressure sensor and a movement analysis system. The pressure in the subacromial space during the maneuver decreased in all repetitions in a range between 21-51% of the basal pressure. The maximum axial rotation recorded was between 3.9-10°. The results of this exploratory study give rise to the hypothesis that the anterior axial rotation maneuver of the clavicle produces a decrease in subacromial pressure, in the area immediately below the acromion.

Osteotomy at the base of femoral neck and osteoplasty for the treament of scfe / Osteotomia na base do colo femoral e osteoplastia para o tratamento da epifisiolistese

ABSTRACT Objective: To compare the clinical outcomes between patients with moderate and severe slipped capital femoral epiphysis (SCFE) treated with osteotomy at the base of neck and osteoplasty and with healthy individuals. Methods: Comparative cohort with 12 patients (14 hips) with moderate and severe SCFE who underwent osteotomy at the base of neck and osteoplasty between 2007 and 2014. The mean age at surgery was 13.3 ± 2.5 years and the mean follow-up was 3.8 ± 2.2 years. We assessed the level of hip pain by the visual analog scale (VAS) and anterior impingement test (AIT); the level of function using the Harris Hip Score (HHS) and 12-Item Short Form Health Survey (SF-12), the range of motion (ROM) by goniometry and Drehmann sign, and the hip muscular strength by isokinetic and Trendelenburg sign. Results: The level of pain was slightly higher in the SCFE cohort compared with healthy hips (VAS, 0.8 ± 1.4 vs 0 ± 0, 0.007; AIT, 14% vs 0%, p = 0.06; respectively). No differences were observed between the SCFE and control cohort for the functional scores (HHS, 94 ± 7 vs 100 ± 1, p = 0.135); except for ROM, with increased internal rotation (37.3º ± 9.4º vs 28.7º ± 8.2º, p < 0.001), and strength, with decreased abduction torque (75.5 ± 36.9 Nm/Kg vs 88.5 ± 27.6 Nm/Kg, p = 0.045) in the SCFE cohort. Conclusion: The osteotomy at the base of neck and the osteoplasty restored the hip motion and muscle strength, except for the abductor strength, to near normal levels, representing a viable option for the treatment of moderate and severe SCFE. Level of Evidence III, Ambidirectional Cohort Study.

RESUMO Objetivo: Comparar resultados clínicos de pacientes com escorregamento epifisário proximal do fêmur (EEPF) moderado e grave tratados com osteotomia basocervical e cervicoplastia com indivíduos saudáveis. Métodos: Coorte comparativa com 12 voluntários saudáveis e 12 pacientes (14 quadris) com EEPF moderado e grave submetidos à osteotomia basocervical e cervicoplastia entre 2007 e 2014. A média de idade na cirurgia foi de 13,3 ± 2,5 anos e o seguimento médio de 3,8 ± 2,2 anos. Avaliou-se nível de dor no quadril utilizando a escala visual analógica (EVA) e o teste de impacto anterior (TIA); nível de função usando o Harris Hip Score (HHS) e o 12-Item Short Form Health Survey (SF-12); amplitude de movimento (ADM) com goniometria e sinal de Drehmann; e força muscular do quadril com dinamômetro isocinético e sinal de Trendelenburg. Resultados: O nível de dor foi ligeiramente maior na coorte de EEPF comparado a quadris saudáveis (EVA, 0,8 ± 1,4 vs 0 ± 0, 0,007; TIA, 14% vs 0%, p = 0,06; respectivamente). Não foram observadas diferenças entre os grupos EEPF e controle para os escores funcionais (HHS, 94 ± 7 vs 100 ± 1, p = 0,135), exceto para ADM, com aumento da rotação interna (37,3º ± 9,4º vs 28,7º ± 8,2º, p < 0,001), e força, com diminuição do torque de abdução (75,5 ± 36,9 Nm/Kg vs 88,5 ± 27,6 Nm/Kg, p = 0,045), para o grupo EEPF. Conclusão: A osteotomia basocervical e a cervicoplastia restauraram o movimento do quadril e a força muscular, com exceção da força abdutora, a níveis próximos do normal, representando uma opção viável para o tratamento de EEPF moderado e grave. Nível de Evidência III, Estudo de Coorte Ambidirecional.

Distal femoral fractures from high-energy trauma: a retrospective review of complication rate and risk factors / Fraturas distais do fêmur por trauma de alta energia: uma revisão retrospectiva da taxa de complicações e fatores de risco

ABSTRACT Objective Determine complications' incidence and risk factors in high-energy distal femur fractures fixed with a lateral locked plate. Methods Forty-seven patients were included; 87.2% were male, and the average age was 38.9. The main radiographic parameters collected were distal lateral femoral angle (DFA), distal posterior femoral angle (DPLF), comminution length, plate length, screw working length, bone loss, and medial contact after reduction and plate-bone contact, location of callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection. Results Complex C2 and C3 fractures accounted for 85.1% of cases. Open fractures accounted for 63.8% of cases. The mean AFDL and AFDP were 79.8 4.0 and 79.3 6.0, respectively. The average total proximal and distal working lengths were 133.3 42.7, 60.4 33.4, and 29.5 21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p = 0.005). The nonunion rate was 19.1%, with longer working length (p = 0.035) and higher PDFA (p = 0.001) as risk factors. The site of callus formation also influenced pseudoarthrosis (p = 0.034). Conclusion High-energy distal femoral fractures have a higher incidence of pseudoarthrosis and infection. Nonunion has greater working length, greater AFDL, and absence of callus formation on the medial and posterior sides as risk factors. The risk factor for infection was an open fracture. Level of Evidence III; Retrospective Cohort Study.

RESUMO Objetivos Determinar a incidência e os fatores de risco de complicações nas fraturas de alta energia das fraturas distais do fêmur fixadas com placa bloqueada lateral. Métodos Foram incluídos 47 pacientes, sendo 87,2% homens e idade média de 38,9 anos. Os principais parâmetros radiográficos coletados foram o ângulo femoral distal lateral (AFDL), ângulo femoral distal posterior (AFDP), comprimento da cominuição, comprimento da placa, comprimento de trabalho dos parafusos, perda óssea, contato medial após a redução e contato placa-osso, localização da formação do calo e falha do implante. As complicações registradas foram não união, falha do implante e infecção. Resultados Fraturas complexas C2 e C3 representaram 85,1% dos casos. As fraturas expostas corresponderam a 63,8% dos casos. O AFDL e AFDP médios foram 79,8° ± 4,0° e 79,3°± 6,0°, respectivamente. Os comprimentos de trabalho total, proximal e distal médios foram 133,3 ± 42,7, 60,4 ± 33,4 e 29,5 ± 21,8 mm, respectivamente. A taxa de infecção foi de 29,8% e o único fator de risco foi a fratura exposta (p = 0,005). A taxa de não união foi de 19,1%, com maior comprimento de trabalho (p = 0,035) e maior PDFA (p = 0,001) como fatores de risco. O local de formação do calo também influenciou na pseudoartrose (p = 0,034). Conclusões Fraturas distais do fêmur de alta energia apresentam maior incidência de pseudoartrose e infecção. A não união tem como fatores de risco maior comprimento de trabalho, maior AFDL e ausência de formação de calo nos lados medial e posterior. O fator de risco para infecção foi a fratura exposta. Nível de evidência III; Estudo de Coorte Retrospectivo.

Reliability of Bigliani’s Classification using Magnetic Resonance Imaging for Determination of Acromial Morphology

@#Introduction: Bigliani classification is used for determination of acromial morphology, but poor interobserver reliability has been reported on conventional radiographs. This study aims to assess inter- and intraobserver reliability using magnetic resonance imaging (MRI). Materials and methods: Forty consecutive patients diagnosed with subacromial impingement syndrome were included to study. All subjects underwent standard shoulder MRI scan and acromial shape was evaluated by nine observers of different level of expertise (three attending surgeons, three senior orthopaedic residents and three radiologists). A second set of evaluation was performed in order to assess intra-observer reproducibility. Kappa (κ) coefficient analyses both for interobserver reliability and intra-observer reproducibility were then performed. Results: Overall inter-observer agreement among nine observers was fair (κ=0.323). κ values for all 4 individual types ranged from 0.234 to 0.720 with highest agreement for type 4 and lowest agreement for type 3. Second evaluation did not result with an increase of inter-observer agreement (κ=0.338, fair). The κ coefficients for intra-observer reproducibility of nine observers ranged from 0.496 to 0.867. Overall intra-observer reproducibility was substantial. Comparison of inter- and intra-observer reliability among three groups showed no significant difference (p=0.92 and 0.22, respectively). Conclusion: Results showed that MRI did not show superior reliability compared to conventional radiographs. Moreover, inter- and intra-observer agreement did not differ between observers of different level of expertise. Findings of present study suggest that despite a sophisticated imaging modality like MRI, Bigliani’s classification apparently lacks accuracy and additional criteria, or different assessment methods are required to assess acromial morphology for clinical guidance.

Effect of neuromuscular training on femoroacetabular impingement / 中国康复理论与实践

ObjectiveTo observe the effect of neuromuscular training on femoroacetabular impingement. MethodsFrom January, 2017 to November, 2021, 27 patients with femoroacetabular impingement in Beijing Rehabilitation Hospital were randomly divided into control group (n = 13) and observation group (n = 14). The control group accepted routine rehabilitation training, and the observation group accpeted neuromuscular training in addition. They were assessed with Visual Analogue Scale (VAS) for pain, peak torque (PT) of hip flexion and extension, Y-balance test (YBT) and simplified International Hip Outcome Tool (iHOT-12) before and after treatment. ResultsThe VAS score, PT, YBT score and iHOT-12 score improved in the observation group after treatment (|t| > 3.628, P < 0.01), while the VAS score and PT improved in the control group (|t| > 3.409, P < 0.01). After treatment, the VAS score, PT, YBT score and iHOT-12 score were better in the observation group than in the control group (|t| > 2.067, P < 0.05). ConclusionNeuromuscular training can relieve the pain of patients with femoroacetabular impingement, and improve the muscle strength and function of hip joint.