Itay Perets, MD Lyall Ashberg, MD Edwin O. Chaharbakhshi, BS, John P. Walsh, MA Mary R. Close, BS Benjamin G. Domb, MD. Hinsdale Orthopaedics

Transcription

1 Clinical utcmes and return t sprt in cmpetitive athletes underging ilipsas fractinal lengthening as a part f hip arthrscpy minimum 2 year fllw-up Itay Perets, MD Lyall Ashberg, MD Edwin O. Chaharbakhshi, BS, Jhn P. Walsh, MA Mary R. Clse, BS Benjamin G. Dmb, MD

2 Backgrund The ilipsas is a hip flexr and stabilizer that may be assciated with internal snapping believed t be created by the mtin f the ilipsas ver the ilipectineal eminence r femral head. First line f treatment includes cnservative measures: Physical therapy NSAIDS Crticsterid injectin t the ilipsas bursa Secnd line f treatment (if cnservative measures fail): Hip arthrscpic ilipsas tentmy r ilipsas fractinal lengthening (IFL) Minimally invasive Shwn t be safe and effective. Althugh flexin and stability are imprtant in cmpetitive athletes, painful internal snapping may be debilitating and may necessitate arthrscpic ilipsas fractinal lengthening (IFL)

3 Purpse T reprt athletes patient-reprted utcmes (PROs), their returns t sprts, and cmpetitive abilities after underging IFL as a part f hip arthrscpy at a minimum f tw years pstperatively.

4 Methds Data were prspectively cllected and retrspectively reviewed fr 1, A patients underging hip arthrscpy between February 2008 and Octber Inclusin criteria: high schl, cllegiate, r prfessinal athlete, wh underwent arthrscpic IFL cmpleted preperative mdified Harris Hip Scre (mhhs), Nn-Arthritic Athletic Hip Scre (NAHS), Hip Outcme Scre Sprts Specific Subscale 2B (HOS-SSS), and Visual Analg Scale (VAS). All patients failed t imprve with at least three mnths f cnservative treatment, including physical therapy, anti-inflammatries, and rest. Exclusin criteria: Patients under 16 years ld Tönnis grade > 1 Previus hip cnditins (Legg-Calve-Perthes disease, hip fractures, slipped capital femral epiphysis, avascular necrsis f the femral head, hip dysplasia) Previus surgical interventin fr either hip.

5 Methds The indicatins fr an IFL included painful internal snapping f the hip in the patient s histry r physical exam and/r the presence f an ilipsas impingement lesin defined as a labral tear at the 3:00 acetabular clckface psitin assciated with hyperemia at the capsullabral r chndrlabral junctin (Figure 1). Figure 1: Ilipsas impingement lesin - labral tear (LT) and labral hyperemia (*) at the 3:00 acetabular clckface. L Labrum. A Acetabulum. FH Femral Head. P Prbe. Figure 2: Ilipsas fractinal lengthening. 2A) The ilipsas tendn (IPT) after interprtal capsultmy t expse the tendn. 2B) The IPT is split after cutting with beaver blade (BB). Medial t the split IPT is the intact ilipsas muscle (IPM). L Labrum. C Capsule. FH Femral Head.

6 Results Fifty athletes were eligible fr inclusin, 44 (88%) f which had minimum tw-year fllw-up. All PRO scres demnstrated significant imprvements at latest fllw-up (p < ). Mean imprvements were as fllws: mhhs (65.1 t 83.7), NAHS (60.7 t 86.2), HOS-SSS (41.5 t 75.4), VAS (5.8 t 2.0). Mean satisfactin was 8.1. Painful snapping was reslved in 41 patients (93%). Six patients (14%) had nn-painful snapping at latest fllw-up.

7 Results Of the 44 athletes: 6 (14%) did nt return t sprt due t their hip symptmatlgy 29 (65.9%) returned t sprts 24 (54.5%) maintained r imprved their cmpetitive abilities. 9 (20.5%) did nt return t sprts fr reasns unrelated t their hip (e.g., lss f interest, aging, etc.). Cmplicatins: 2 (4.6%) superficial wund infectins that reslved with tpical treatment. There were n cmplaints f weakness in hip flexin.

8 Strengths/Limitatins Strengths: This is the first study, t ur knwledge, that examines the utcmes f IFL during hip arthrscpy in a cmpetitive athletic ppulatin. Utilized three PRO measurements (mhhs, NAHS, HOS-SSS), VAS, and patient satisfactin Mean f 38.9 mnths pstperatively. Limitatins: We did nt have a match-pair cntrl grup. The return t sprts rate was affected by many factrs, including aging (e.g. frm high schl t the cllegiate level), lss f interest, ther symptms excluding the hip (e.g. back pain), and ther health cnditins. Larger studies are warranted t adequately assess the utcmes f this prcedure based n individual sprts and cmpetitive levels.

9 Cnclusins In cmpetitive athletes, IFL during hip arthrscpy is safe and demnstrates favrable imprvements in PROs and VAS, high satisfactin, and high rate f symptm reslutin at a minimum f tw years pstperatively. The majrity f patients were able t return t sprts and maintain r imprve their cmpetitive levels.

10 Thank Yu