Absorbable suture anchors for treating femoroacetabular impingement syndrome combined with acetabular labral tears / 中国组织工程研究

BACKGROUND: Metal anchors are not easily accepted by patients as permanent foreign bodies, so bioabsorbable anchors have been gradually applied in orthopedics in recent years. OBJECTIVE: To evaluate the effectiveness of absorbable suture anchors for repairing femoroacetabular impingement syndrome combined with acetabular labral tears. METHODS: Eighty patients with femoroacetabular impingement syndrome combined with acetabular labral tears admitted in Beijing Shijitan Hospital Affiliated to Capital Medical University from February 2014 to February 2016 were selected, and all were treated by absorbable suture anchors under arthroscopy. The Harris hip score, and the Visual Analogue Scale score at baseline, postoperative 1 and 3 months were recorded and compared to assess the effectiveness. The complications and material-host reaction were recorded. The treatment satisfaction was evaluated. The study was approved by the Ethical Committee of Beijing Shijitan Hospital and all patients and their families signed the informed consents. RESULTS AND CONCLUSION: (1) The Harris hip scores at 1 and 3 years postoperatively in 80 patients with femoroacetabular impingement syndrome combined with acetabular labral tears were significantly higher than those at baseline, and the Visual Analogue Scale scores were significantly lower than those at baseline (P 0. 05). (3) None appeared with anchor drop off, cartilage injury or material-host reaction. In summary, the method of absorbable suture anchors under arthroscopy has the advantages of minimal invasion, reliable fixation, simple operation, no metal implants, and significant clinical effect to treat femoroacetabular impingement syndrome combined with acetabular labral tears.

Preservación articular post-artroscopía de cadera a 5 años mínimo de seguimiento / Joint preservation treated with hip arthroscopy. Minimum follow-up of 5 years

Introducción: El objetivo de este trabajo fue evaluar los resultados clinicos y la tasa de preservacion articular en pacientes a los que se le realizo una artroscopia de cadera por sindrome de friccion femoroacetabular (SFFA) con seguimiento minimo 5 anos. Se analizaron los factores predictivos de requerimiento para un reemplazo total de cadera (RTC). Materiales y métodos: Se evaluaron 42 pacientes consecutivos (15 mujeres, 27 hombres, edad promedio 38 anos) con SFFA. A todos se les realizo una artroscopia de cadera para estabilizar el dano articular (lesiones labrales y/o condrolabrales) y correccion de deformidades oseas asociadas (CAM y/o PINCER). Se realizo un seguimiento clinico. Ningun paciente fue perdido en el seguimiento. Se analizaron los factores predictivos de probabilidad de RTC. Resultados: A un seguimiento minimo de 5 anos la tasa de preservacion articular fue del 88,1 % (IC95 % 74,54 %-95,27 %). La probabilidad de evolucionar a una RTC en pacientes con escala radiografica Tonnis preoperatoria 0 y I fue del 0% (IC95 % 0%-14,76 %). La probabilidad de evolucionar a una RTC en pacientes con estadios Tonnis II y III fue del 33,3 % (IC95 %, 14,96 %-58,5 %). La diferencia entre ambos grupos fue significativa p= 0.003. La edad mayor o igual a 45 anos al momento de la artroscopia resulto ser un factor de riesgo significativo para evolucionar a una RTC (p=0.005). Conclusión: El tratamiento artroscopico del SFFA presenta resultados favorables a 5 anos en terminos de preservacion articular. Pacientes con artrosis preoperatoria avanzada y mayores de 45 anos tienen mayor riesgo de requerir una artroplastia de cadera en dicho lapso. Nivel de evidencia: IV. Tipo de estudio: Serie de casos...

Introduction: Purpose of this work is to evaluate the clinical results and the rate of joint preservation in a series of patients with Femoroacetabular Impingement (FAI) treated with hip arthroscopy at a minimum follow up of 5 years. The predictive factors for total hip arthroplasty (THA) requirement were analyzed. Material and methods: Between February 2008 and February 2009, 42 consecutive patients treated with a hip arthroscopy due to FAI syndrome were included. There were 15 women and 27 men with an average age of 38 years (range 23 to 56 years). The surgery involved joint damage stabilization (labral tears and/or condrolabral injuries) and correction of associated bony deformities (CAM and/or PINCER lesions). A prospective clinical follow up was made with no patient lost. We specifically addressed the need for THA. Predictive factors for THA were also analyzed. Results: At a minimum follow up of 5 years the rate joint preservation was 88.1% (CI95% 74,54%-95,27%). The probability of evolving to a THA in patients with radiographic preoperative Tonnis grades 0 and I was of 0% (CI95% 0%-14,76%). The probability of evolving to a THA in patients with preoperative Tonnis grades II and III was 33, 3% (CI95%14.96%-58.5%). Statistical significant difference was present between both groups (p= 0.003). Patients with an age of 45 years or more at the time of hip arthroscopy were at significant risk to evolve to THA (p=0.005). Conclusions: Hip arthroscopy for the treatment of patients with FAI syndrome presents favorable results regarding joint preservation at a minimum follow up of 5 years. Patients with advanced preoperative radiographic signs of osteoarthritis and those older than 45 years at the time of surgery have greater risk for requiring THA. Level of evidence: IV. Type of study: Case Series...

Current application of hip arthroscopy / 中国矫形外科杂志

Diagnosis and management of hip injuries has advanced significantly in the past few years with the improvement of arthroscopic techniques of the hip. Many of pathologic conditions previously unrecognized and untreated have been diagnosed and treated correctly under hip arthroscopy . Current application for hip arthroscopy include management of labral tears,osteoplasty for femoroacetabular impingement, thermal capsulorrhaphy and capsular plication for subtle rotational instability and capsular laxity, lateral impact injury and chondral lesions, osteochondritis dissecans, ligamentum teres injuries, internal and external snapping hip, removal of loose bodies, synovial biopsy, subtotal synovectomy, synovial chondromatosis, infection, and certain cases of mild to moderate osteoarthritis with associated mechanical symptoms. In addition,patients with long-standing, unresolved hip joint pain may benefit from arthroscopy. Patients with reproducible symptoms and physical findings that reveal limited functioning, and who have failed an adequate trial of conservative treatment will have the greatest likelihood of success after arthroscopic intervention. Prescise attention to thorough physical examination, detailed imaging,and adherence to safe and reproducible surgical techniques are essential for the success of this procedure.

Tratamiento artroscópico de las lesiones del labrum acetabular / Arthroscopic treatment of acetabular labral tears

Purpose: Acetabular labral tears are a frecuent cause of hip pain in nonarthritic young patients. We present our experience in the arthroscopic treatment of acetabular labral tears. Material and Methods: This is a retrospective study of45 patients operated by hip arthroscopy between December 2002 and March 2006. We analized the etiology and the location of the labral tears, the presence of associated chondral lesions and clinical short term results. In all the patients we perform the resection of the damaged part of the labrum, in 13 of this cases we perform a resection off the underlying bone deformity. Results: The most frecuent etiology was the femoroacetabular impingement (28 patients), less frecuent are traumatic, displastic and degenerative causes. In 36 patients the lesion was located anterosuperior, in 35 cases chondral lesions of the articular surface were present. The clinical result were excellent and good in 39, poor or fair in 6 patients. Conclusion: In our group the labral tear was the most frecuent cause of hip arthroscopy. Associated chondral lesions are highly frecuent. The main etiology is the femoroacetabular impingement which must be treated simultaneously. With a selective patient selection and an accurate surgical technique good clinical results can be achieved.

La lesión del labrum acetabular es causa frecuente de coxalgia en pacientes jóvenes sin artrosis. En este trabajo se presenta el análisis de sus causas y nuestra experiencia en el tratamiento artroscópico. Material y Métodos: Se analizan retrospectivamente 45 pacientes operados entre Diciembre 2002 y Marzo 2006. Se analiza la etiología, localización de las lesiones, presencia de lesiones condrales asociadas y la evolución clínica. En todos se efectuó la resección parcial del labrum dañado, en 13 se efectuó además la resección artroscópica de la deformidad ósea subyacente. Resultados: La etiología más frecuente fue un pellizcamiento femoroacetabular (28 pacientes), menos frecuente la causa degenerativa, displasia o traumática. En 36 pacientes la lesión del labrum era anterosuperior, 35 presentaban lesiones condrales asociadas. En 13 casos de pellizcamiento se efectuó la resección de la deformidad ósea. Los resultados clínicos fueron excelentes y buenos en 39 pacientes, regulares y malos en 6. Conclusiones: La lesión del labrum es la indicación más frecuente de artroscopia de cadera. Son muy frecuentes las lesiones condrales asociadas. La principal etiología fue el pellizcamiento femoroacetabular el cual idealmente debe ser tratado en forma simultánea. Con una indicación selectiva y adecuada técnica quirúrgica se obtienen resultados clínicos satisfactorios.