Andrew B. Wolff

Arthroscopic Findings Following Traumatic Hip Dislocation in 14 Professional Athletes

PURPOSE The purpose of this study was to investigate intra-articular hip joint pathologies in professional athletes who sustained dislocation and were treated with hip arthroscopy. METHODS Between August 23, 2000, and September 15, 2006, 14 professional athletes (12 male and 2 female) sustained a nonfracture traumatic hip dislocation during active competition and were treated by a single surgeon. A retrospective chart review of this cohort was done to report the intra-articular hip pathologies identified at the time of arthroscopy. RESULTS The average time from dislocation to relocation was 3.56 hours. The mean time from dislocation to surgery was 125 days (range, 0 to 556 days). The average age at the time of arthroscopy was 30.5 years (range, 16 to 46 years). All patients had labral tears. All patients had chondral defects. Two had isolated femoral head chondral defects, 6 had isolated acetabular chondral defects, and 6 had chondral defects on both surfaces. Eleven patients had loose osteochondral fragments. Eleven patients had partial or complete tears of the ligamentum teres. Nine patients had evidence of femoroacetabular impingement; 4 had isolated cam lesions, 1 had an isolated pincer lesion on the acetabular rim, and 4 patients had mixed type pathology. Two patients had capsulolabral adhesions. Two patients had a capsular tear. Additionally, 3 patients underwent intraoperative evaluation of the lateral epiphyseal vessels with Doppler imaging to confirm good blood flow to the femoral head with consistent pulse. CONCLUSIONS The results of this study show that traumatic dislocation is accompanied by a variety of intra-articular hip joint pathologies, the most common being labral, chondral, intra-articular loose fragments, and disruption of the ligamentum teres.

Partial-thickness rotator cuff tears.

&NA; Partial‐thickness rotator cuff tears are not a single entity; rather, they represent a spectrum of disease states. Although often asymptomatic, they can be significantly disabling. Overhead throwing athletes with partial‐thickness rotator cuff tears differ with respect to etiology, goals, and treatment from older, nonathlete patients with degenerative tears. Pathogenesis of degenerative partial‐thickness tears is multifactorial, with evidence of intrinsic and extrinsic factors playing key roles. Diagnosis of partial‐thickness rotator cuff tears should be based on the patients symptoms together with magnetic resonance imaging studies. Conservative treatment is successful in most patients. Surgery generally is considered for patients with symptoms of sufficient duration and intensity. The role of acromioplasty has not been clearly delineated, but it should be considered when there is evidence of extrinsic causation for the partial‐thickness rotator cuff tear.

Comparison of spin echo T1-weighted sequences versus fast spin-echo proton density-weighted sequences for evaluation of meniscal tears at 1.5 T

PurposeAt our institution, fast spin-echo (FSE) proton density (PD) imaging is used to evaluate articular cartilage, while conventional spin-echo (CSE) T1-weighted sequences have been traditionally used to characterize meniscal pathology. We sought to determine if FSE PD-weighted sequences are equivalent to CSE T1-weighted sequences in the detection of meniscal tears, obviating the need to perform both sequences.Method and materialsWe retrospectively reviewed the records of knee arthroscopies performed by two arthroscopy-focused surgeons from an academic medical center over a 2-year period. The preoperative MRI images were interpreted independently by two fellowship-trained musculoskeletal radiologists who graded the sagittal CSE T1 and FSE PD sequences at different sittings with grades 1–5, where 1 = normal meniscus, 2 = probable normal meniscus, 3 = indeterminate, 4 = probable torn meniscus, and 5 = torn meniscus. Each meniscus was divided into an anterior and posterior half, and these halves were graded separately. Operative findings provided the gold standard. Receiver operating characteristic (ROC) analysis was performed to compare the two sequences.ResultsThere were 131 tears in 504 meniscal halves. Using ROC analysis, the reader 1 area under curve for FSE PD was significantly better than CSE T1 (0.939 vs. 0.902, >95% confidence). For reader 2, the difference met good criteria for statistical non-inferiority but not superiority (0.913 for FSE PD and 0.908 for CSE T1; >95% non-inferiority for difference at most of −0.027).ConclusionFSE PD-weighted sequences, using our institutional protocol, are not inferior to CSE T1-weighted sequences for the detection of meniscal tears and may be superior.

Hip Dysplasia: Prevalence, Associated Findings, and Procedures From Large Multicenter Arthroscopy Study Group

PURPOSE To report observational findings of patients with acetabular dysplasia undergoing hip arthroscopy. METHODS We performed a comparative case series of multicenter registry patients from January 2014 to April 2016 meeting the inclusion criteria of isolated hip arthroscopy, a documented lateral center-edge angle (LCEA), and completion of preoperative patient-reported outcome measures. A retrospective analysis compared range of motion, intra-articular pathology, and procedures of patients with dysplasia (LCEA ≤25°) and patients without dysplasia (LCEA >25°). RESULTS Of 1,053 patients meeting the inclusion criteria, 133 (13%) had dysplasia with a mean LCEA of 22.8° (standard deviation, 2.4°) versus 34.6° (standard deviation, 6.3°) for non-dysplasia patients. There were no statistically significant differences in preoperative modified Harris Hip Score, International Hip Outcome Tool-12 score, or visual analog scale score (pain). Cam deformity occurred in 80% of dysplasia patients. There was a significant difference in internal rotation between the dysplasia (21°) and non-dysplasia groups (16°, P < .001). Mean internal rotation (33.5°; standard deviation, 15.6°) of the dysplastic subjects without cam morphology was greater than that of the dysplastic patients with cam morphology (18.5°; standard deviation, 11.6°; P < .001). Hypertrophic labra were found more commonly in dysplastic (33%) than non-dysplastic hips (11%, P < .001). Labral tears in patients with dysplasia were treated by repair (76%), reconstruction (13%), and selective debridement (11%); labral treatments were not significantly different between cohorts. The most common nonlabral procedures included femoroplasty (76%) and synovectomy (73%). There was no significant difference between the dysplasia and non-dysplasia groups regarding capsulotomy types and capsular closure rates (96% and 92%, respectively). CONCLUSIONS Dysplasia, typically of borderline to mild severity, comprises a significant incidence of surgical cases (13%) by surgeons performing high-volume hip arthroscopy. Despite having similar preoperative pain and functional profiles to patients without dysplasia, dysplasia patients may have increased flexed-hip internal rotation. Commonly associated cam morphology significantly decreases internal rotation. Arthroscopic labral repair, femoroplasty, and closure of interportal capsulotomy are the most commonly performed procedures. LEVEL OF EVIDENCE Level III, therapeutic comparative case series.