Operative Techniques in Sports Medicine最新文献

The supraphysiologic hip in artistic athletes poses a unique challenge to the discerning sports medicine practitioner. Through stretching and repetitive microtraumatic motions, a cascade of soft tissue laxity, increased strain on surrounding soft tissue structures, and microinstability can develop, resulting in both soft tissue and bony injury. In addition, extra-articular pathology can predominantly affect the artistic athlete. Thus, a thorough understanding of the anatomy and pathophysiology as the hip is ranged to the extremes is paramount to establishing an adequate diagnosis and developing a treatment plan. Through a careful history along with a targeted and thorough physical exam in addition to diagnostic imaging, one can accurately identify the sources of pain and dysfunction. Treatment can range from conservative and interventional nonoperative modalities to open and/or arthroscopic hip surgery. Surgical techniques should not only address the identified pathology but also take care to not limit the extremes of hip motion required by the artistic athlete's sport. Despite the high demands of hip motion and function (supraphysiologic motion and function) the artistic athlete can return to high levels of performance if one pays attention to these factors.

Extra-articular impingement (EAI) is an atypical, infrequent source of hip pain. Unlike femoroacetabular impingement (FAI) and acetabular dysplasia (AD), EAI results from abnormal contact of the proximal femur and trochanteric region, and the ischium or subspine areas. Hip pain and potential instability are reported. Causes of EAI include a narrowed ischiofemoral space, coxa valga, femoral torsion abnormalities, avulsion malunions, and more complex deformities resulting from pediatric hip diseases. Unique history and examination findings not commonly seen with standard FAI are noted, including pain with standing and hip extension and imbalanced hip motion with excessive internal rotation and limited external rotation (or vice versa). Surgical indications are yet to be definitively defined, but surgical treatment options include lesser trochanter resection, femoral osteotomy, and surgical hip dislocation. Proper workup and surgical planning have demonstrated good outcomes for treatment of EAI with these techniques, but information to optimally define which patients benefit most from which surgeries is pending.

Hip arthroscopy procedures have become increasingly common in the last few decades for treating both intra and extra-articular hip pathologies. Despite advancements in the field, some patients may not experience improvement and may eventually require revision hip arthroscopy. The multifactorial causes for failure, unknown impacts of the primary procedure and previous iatrogenic considerations can create added complexity for the revision. Given that revision hip arthroscopy has had more variation in patient outcomes and higher rates of subsequent conversion to hip arthroplasty, compared with primary hip arthroscopy, it is imperative to have a good algorithm for patient selection and to understand the various surgical options available to address different pathologies. In this review, we explore the current diagnostic algorithms, etiologies, surgical procedures, outcomes, and provide insights into future directions in the field of revision hip arthroscopy.

Since its inception, there has been considerable advancement made in the field of hip arthroscopy in not only the technological and technical capabilities but our overall understanding of hip biomechanics and pathology. At the center of much of this progress is the surgeon's approach to the acetabular labrum. In this section, we will discuss the treatment considerations regarding the acetabular labrum and the various treatment modalities that have been tried and tested over time. To refer to the various techniques as treatment options would erroneously imply that all treatment modalities are considered equally in the management of each form of labral pathology. We will discuss the variety of techniques as it is presented in the literature, their respective outcomes, as well as our preferred method for each type of acetabular labral pathology.

Proper imaging is essential for treatment planning of athletic hip pathology. Plain radiographs are a valuable imaging modality, as they can provide useful information regarding patient native anatomy and hip pathoanatomy. Both acetabular- and femoral-sided pathology can be examined using a variety of radiographic views including the AP pelvis, cross table lateral, modified Dunn, and false profile views. Computed tomography can be utilized to further characterize the hip in the coronal and sagittal planes with the added information of axial imaging. This can aid in assessment of hip dysplasia and femoroacetabular impingement. Magnetic resonance imaging can be useful in evaluation soft tissue pathology of the hip, as well as in assessment of the cartilage. Ultrasound offers a noninvasive method of imaging the hip and can be useful in dynamic studies.

Pelvic apophyseal avulsion fractures have been occurring more commonly in young athletes in the context of increased intensive year-round training and early specialization in youth sports, and this diagnosis must be considered in the pediatric patient presenting with hip pain. An understanding of the relevant anatomy can guide the history and physical exam to arrive at the diagnosis, which is usually confirmed with plain radiographs. Although nonoperative management remains the mainstay of treatment for these patients, surgery may be warranted for ischial tuberosity fractures displaced > 2 cm and for symptomatic nonunions. The objective of this review is to provide a comprehensive overview of pelvic apophyseal avulsion injuries.

Hip arthroscopy has become the predominant surgical approach for managing femoroacetabular impingement (FAI) and associated intra-articular pathologies, particularly in athletes. Despite advancements in surgical techniques, rehabilitation protocols, especially those governing return to play (RTP), have not kept pace in terms of specificity and objectivity. This article reviews current practices and introduces a comprehensive, multi-factorial continuum for RTP that extends beyond mere time-based criteria to include an athlete's overall readiness, encompassing both physical and psychological aspects. Through a phased rehabilitation strategy beginning in the preoperative phase and extending through to full return to competition, this paper aims to present a more nuanced continuum for RTP that accounts for an athlete's readiness beyond temporal benchmarks. The phases outlined include preoperative preparation, immediate postoperative care, early rehabilitation, reconditioning, performance enhancement, and final return to play, each phase tailored to integrate clinical milestones with biomechanical and psychosocial factors. This approach advocates for a shift towards personalized rehabilitation protocols that align with the biological healing processes and functional milestones essential for a successful return to sports.