Dataset Information

Reconstruction of Massive Posterior Nonrepairable Acetabular Labral Tears With Peroneus Brevis Tendon Allograft: Arthroscopy-Assisted Mini-Open Approach.

ABSTRACT: Many of the described labral-reconstruction procedures are purely arthroscopic. This approach only allows segmentary reconstructions. For more extensive reconstructions, surgical dislocation of the hip still represents the more suitable approach. We present an arthroscopy-assisted procedure combined with an anterior mini-open approach, which could be considered for reconstruction of nonrepairable labral lesions located in the posterior aspect of the acetabulum and massive reconstructions in cases of global-pincer femoroacetabular impingement and protrusio acetabuli. Our technique saves the morbidity that might be related to the surgical dislocation of the hip and incorporates a peroneus brevis tendon allograft. This option may restore the anatomy and labral function without morbidity at the donor site, as well as remove graft length restrictions during massive reconstructions.

SUBMITTER: Moya E

PROVIDER: S-EPMC5124060 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Reconstruction of Massive Posterior Nonrepairable Acetabular Labral Tears With Peroneus Brevis Tendon Allograft: Arthroscopy-Assisted Mini-Open Approach.

Moya Esther E Natera Luis Gerardo LG Cardenas Carlomagno C Astarita Emanuele E Bellotti Vittorio V Ribas Manel M

Arthroscopy techniques 20160912 5

Many of the described labral-reconstruction procedures are purely arthroscopic. This approach only allows segmentary reconstructions. For more extensive reconstructions, surgical dislocation of the hip still represents the more suitable approach. We present an arthroscopy-assisted procedure combined with an anterior mini-open approach, which could be considered for reconstruction of nonrepairable labral lesions located in the posterior aspect of the acetabulum and massive reconstructions in case ...[more]

PMID: 27909669

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Project description:PurposeThe purpose of this study was to systematically review the evidence in the literature to ascertain whether acetabular labral repair (ALR) or debridement (ALD) resulted in superior patient outcomes.MethodsThe systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed studies comparing ALR and ALD published in English with full text available were included. Patients undergoing both open and arthroscopic surgery in randomized controlled trials, prospective cohort studies, retrospective cohort studies, and case-control studies were included. Studies were quantified for methodological quality using the MINORS criteria. Clinical outcomes were compared, with qualitative analysis, and quantitative analyses were performed using GraphPad Prism version 7. A P value <.05 was considered to be statistically significant.ResultsThere were 8 studies included (level of evidence [LOE] I = 1; LOE II = 2; LOE III = 5). The 7 studies compared 364 patients (369 hips) with ALR to 318 patients (329 hips) with ALD, with a mean follow-up time ranging between 32-120 months. Five studies found significantly improved patient reported outcomes with ALR (Harris Hip Score, Merle d'Aubigné, Pain, SF-12). Several studies compared the outcomes after ALR and ALD and found statistical significance in all investigated metrics in favor of ALR. One study found a significant improvement in abduction but no other study found any difference in range of motion. No study found any difference in complication rate, revision rate or conversion to total hip arthroplasty. Although, 2 studies found ALR reduced the rate of osteoarthritic progression.ConclusionCurrent literature suggests that acetabular labral repair may result in superior patient reported outcomes. However, there appears to be no significant difference in the rate of progression to total hip arthroplasty at up to 10-year follow-up.Level of evidenceLevel III, systematic review of Level I, II, and III studies.

Project description:ContextSymptomatic femoroacetabular impingement syndrome (FAIS) is a painful condition that leads to decreased function. How walking gait changes over time within the first year after surgery for FAIS and how these changes present in women are currently unknown.ObjectiveTo determine biomechanical gait differences between women with FAIS or labral tears and control individuals preoperatively and at 3 and 6 months postoperatively.DesignCase-control study.SettingLaboratory.Patients or other participantsA total of 18 female participants comprising 9 women in the FAIS group (age = 31.44 ± 7.47 years, height = 1.73 ± 0.08 m, mass = 73.61 ± 14.44 kg) and 9 women in the control group (age = 31.44 ± 6.65 years, height = 1.69 ± 0.06 m, mass = 60.93 ± 5.58 kg).Main outcome measure(s)Between-groups comparisons of the Hip Outcome Score Activities of Daily Living subscale (HOSADL) and gait biomechanics were conducted preoperatively and at the 3- and 6-month postoperative sessions. Statistical parametric mapping was performed on normalized time-series data.ResultsPreoperatively, the FAIS group had poor HOSADL scores (FAIS group = 64.1 ± 15.4 versus control group = 100.0 ± 0, P < .001), walked 15% slower, and exhibited several gait differences compared with the control group. Three months postoperatively, the FAIS group displayed greater vertical ground reaction force (P = .01), ankle-dorsiflexion angle (P = .02), and external dorsiflexion moment (P = .01) in midstance, as well as a greater knee-flexion angle through the second half of stance (P < .001). The FAIS group also demonstrated less hip-extension angle (P = .02) and hip-abduction angle (P = .01) through the second half of stance, which transitioned into less hip extension (P = .040) and hip abduction (P = .03) during the subsequent swing phase. The FAIS group improved their HOSADL to 87.6 ± 7.6 by 6 months postoperatively and had a greater dorsiflexion moment (P = .003) and ankle external rotation during stance (P = .03). In addition, the FAIS group showed a greater external hip external-rotation moment in late stance (P < .001).ConclusionsThe biomechanical differences between groups were most evident at 3 months postoperatively, suggesting that women with FAIS had more postoperative gait compensations in the short term after surgery. By 6 months postoperatively, patient-reported outcomes had markedly improved, and the FAIS group displayed few gait differences compared with the control group.

Project description:To determine if contact forces and electromyography (EMG) muscle amplitudes were altered during the lunge for patients with symptomatic labral tears compared with asymptomatic control subjects.Surface electromyography electrodes were placed over the gluteus medius, gluteus maximus, adductor longus, and rectus femoris muscles of the patients' involved limb and matched limb of asymptomatic controls. Subjects performed 3 trials of the lunge on a clinical force platform. An electrogoniometer tracked knee flexion motion during testing. Average root mean squared EMG muscle amplitudes for each muscle were calculated for the descent and ascent phases of the lunge, represented as a percentage of maximum activity (%MVIC). Peak knee flexion was calculated from the goniometer (°). The dependent variables from the force platform were lunge distance (%height), contact time (seconds), vertical impact force (%BW), and force impulse (%BW*s). Dependent variables were compared between groups using either independent samples t tests or Mann-Whitney U tests. Relations between dependent variables were assessed with Spearman Rho correlation coefficients. The level of significance was set at P ≤ .05.Twenty-one patients with symptomatic unilateral labral tears (14 females, 7 males) and 17 asymptomatic control subjects (11 females, 6 males) participated in this study. Average gluteus maximus EMG muscle amplitudes were reduced for symptomatic labral patients compared with asymptomatic controls during lunge ascent (51.6 ± 31.1 v 71.7 ± 36.3 [mean difference (MD): 20.1% (-2.4%, 42.6%)], P = .042). Average vertical impact force was reduced (21.8 ± 5.5 v 26.8 ± 7.3 [MD: 5.1%BW (0.84%BW, 9.3%BW)], P = .02) and average contact time (1.8 ± 0.4 v 1.5 ± 0.4 [MD: 0.27 seconds (0.006 seconds, 0.54 seconds)], P = .045) and force impulse (188.4 ± 42.4 v 162.6 ± 33.3 [MD: 25.8%BW*s (0.3%BW*s, 51.4%BW*s)], P = .042) were increased for symptomatic labral patients compared with asymptomatic controls. Vertical impact force was inversely correlated with gluteus medius muscle amplitudes during lunge descent for symptomatic labral patients (r = -0.452, P = .045).Our study shows that contact forces and EMG muscle amplitudes are altered during the lunge for patients with symptomatic labral tears. The presence of a relation between muscle amplitudes and contact forces suggests that targeting muscle impairments may restore function in these patients.Level III, case-control study.

Project description:PurposeTo evaluate the 1-year outcomes of a small patient series following open gluteus medius/minimus repair with human dermal allograft incorporated into the repair construct using a double-row repair.MethodsData from consecutive patients undergoing a superior gluteal reconstruction for massive, irreparable abductor tendon tears with severe tendon loss and atrophy by a single fellowship trained surgeon from January 2018 to May 2019 were collected and analyzed. Baseline demographic data and magnetic resonance imaging were collected preoperatively. Clinical outcomes including Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified Harris hip score (mHHS), international Hip Outcome Score-12 (iHOT-12), visual analog scale (VAS) pain, and VAS satisfaction were recorded at 1-year postoperatively.ResultsA total of 8 patients underwent open superior gluteal reconstruction for severe hip abductor deficiency. The mean age and body mass index were 62.6 ± 7.3 years and 29.6 ± 5.3 kg/m2, respectively. The majority of patients were female (N = 7, 87.5%). Three (37.5%) patients had undergone previous endoscopic gluteus medius repair and presented for revision surgery. All patients had full-thickness tears with gluteus medius and gluteus minimus involvement. Patients were evaluated at an average of 11.5 ± 1.7 months from the initial surgical intervention and reported a mean HOS-ADL of 82.9 ± 24.3, HOS-SS of 73.2 ± 37.3, mHHS of 83.6 ± 17.1, iHOT-12 of 63.9 ± 27.4, VAS Pain of 30.0 ± 23.1, and VAS Satisfaction of 87.1 ± 17.0. There was no evidence of retears in this patient cohort as defined by physical examination findings and/or corroborating magnetic resonance imaging.ConclusionsSuperior gluteal reconstruction for massive, irreparable abductor tendon tears with severe tendon loss and atrophy is a technique that demonstrates promising 1-year postoperative outcomes in both primary and revision patients.Level of evidenceLevel IV, therapeutic case series.

Dataset Information

Reconstruction of Massive Posterior Nonrepairable Acetabular Labral Tears With Peroneus Brevis Tendon Allograft: Arthroscopy-Assisted Mini-Open Approach.

Publications

Reconstruction of Massive Posterior Nonrepairable Acetabular Labral Tears With Peroneus Brevis Tendon Allograft: Arthroscopy-Assisted Mini-Open Approach.

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