Hip External Rotation Decreases Ischiofemoral Distance: A Positive Correlation Between Cadaveric and Fluoroscopic Studies.

PURPOSE: To determine the effect of hip external rotation or extension/adduction on minimizing the ischiofemoral distance (IFD) and assess the correlation between cadaveric and fluoroscopic IFD measurements in different hip positions. METHODS: This cadaveric study involved 33 hip joints from 17 embalmed cadavers. IFD, the distance between the lesser trochanter and lateral ischium, was measured in different hip positions: neutral, external rotation at 30°, and external rotation at 60° with the hip in both neutral extension and adduction as well as 10° hip extension and 10° hip adduction. Differences in IFD related to positions and correlation between cadaveric and fluoroscopic measurements were analyzed. RESULTS: IFD measurements showed that the greatest reduction occurred at 60° of external hip rotation, with a significant difference observed only between neutral and 60° external rotation in cadaveric groups (7.60 ± 4.68 vs 5.05 ± 3.48, 95% CI, 0.14-4.96; P = .036). No substantial difference was observed between the extension and adduction positions. Positive correlations were observed between cadaveric and fluoroscopic measurements, especially in the neutral position (r = 0.492, P = .004), external rotation at 30° (r = 0.52, P = .002), external rotation at 60° (r = 0.419, P = .015), and the extension/adduction positions combined with neutral rotation (r = 0.396, P = .023). CONCLUSIONS: The IFD significantly decreased with increasing degrees of hip external rotation, particularly at 60°. No significant reduction was observed in the extension/adduction positions. In addition, positive correlations were observed between cadaveric and fluoroscopic measurements for specific hip positions: neutral rotation, external rotation at 30° and 60°, and extension/adduction at 10° with neutral rotation. CLINICAL RELEVANCE: Surgeons can use this knowledge to improve hip impingement assessment through radiography, focusing on positions in which IFD reduction is most notable. Understanding the relationship between hip positions and IFD can enhance the diagnosis of ischiofemoral impingement syndrome and benefit patient care and outcomes.

Arthroscopic Repair of Acute Traumatic Medial Patellofemoral Ligament Tears at the Patellar Insertion.

After a lateral patellar dislocation or subluxation, injury to the medial patellofemoral ligament (MPFL) is common. The MPFL originates between the medial epicondyle and the adductor tubercle, inserting along the superior one-third border of the medial patella. Operative treatment becomes necessary for patients with intra-articular pathology (such as osteochondral injuries or meniscus tears) or those experiencing recurrent dislocations. Numerous surgical techniques have been proposed for addressing this issue, with MPFL reconstruction being the most frequently performed procedure. Nonetheless, various complications associated with reconstruction have been documented. In recent years, there has been a growing interest in MPFL repair, which has shown acceptable outcomes in the literature. In this study, we introduce an arthroscopic-assisted MPFL repair technique designed for acute traumatic MPFL tears originating from the patellar insertion. This approach offers the advantage of being minimally invasive, straightforward, and reproducible.