Operative Techniques in Sports Medicine最新文献

Focal chondral and chondrolabral injuries of the hip have become more commonly recognized lesions of hip joint pathology in the last decade. These injuries are associated with worse clinical outcomes, risk of global degenerative disease, and future conversion to hip arthroplasty. Recent technological advances have expanded the indications and improved outcomes associated with joint preserving hip procedures to address chondral and chondrolabral defects. Options for surgical management include both open and arthroscopic procedures focusing on 3 general treatment goals: chondral flap stabilization, cartilage regeneration, and cartilage restoration. We provide a comprehensive review of these procedures, discuss their outcomes, and provide future directions for research and development.

Symptomatic acetabular impingement represents a distinct subgroup of patients with femoroacetabular impingement syndrome (FAIS). Acetabular-based impingement, or pincer-type FAIS, is characterized by anterior acetabular over-coverage. Pincer subtypes include focal anterior over-coverage, global anterior over-coverage, relative anterior over-coverage (acetabular retroversion), and anterior inferior iliac spine (AIIS) or subspine impingement. These morphological variants can cause abnormal contact between the acetabulum and the femoral head-neck junction during functional hip motion, leading to a variety of labral and chondral injuries. Diagnosis of pincer-type FAIS requires a thorough history and physical exam as well dedicated imaging, and these aspects should all corroborate the symptoms and diagnosis. When symptoms are refractory to conservative management, surgery should be considered with the approach tailored to the individual patient's specific morphology and pathology. Both open and arthroscopic techniques have been shown to be safe and effective in patients with pincer-type FAIS when patients are appropriately indicated and with careful preoperative planning and surgical execution.

When conservative measures have failed, arthroscopic femoroplasty has proven highly efficacious in treating femoroacetabular impingement (FAI) and improving hip joint mechanics. It is best to approach this in a systematic manner with preoperative planning and intraoperative confirmation. Plain radiographs, MRI and/or CT are helpful in the preoperative assessment in identifying the location and shape of the cam deformity. Understanding the extent of the cam lesion prior to surgical intervention will aid in the resection process. The resection can then be confirmed by an intra-operative fluoroscopic exam and arthroscopic dynamic motion evaluation under direct visualization. Using the trough technique, the resection can be marked using the cortical-cancellous border as a depth landmark. When performing the resection, a smooth contour should be performed, with an understanding that both over and under-resection can be problematic. Adequate resection should be ensured by testing range of motion, with fluoroscopic imaging, to obtain a circumferential view of the resected area. It is essential to understand how to position the lower extremity to obtain different fluoroscopic views of the femoral head-neck junction clock-face. Once complete, a thorough irrigation of the joint should be performed to remove bony debris. An ensuing capsular closure should be performed to minimize the risk of iatrogenic hip instability.