clinical outcomes and return to sport in competitive …...clinical outcomes and return to sport in...
TRANSCRIPT
Clinical outcomes and return to sport in competitive athletes undergoing iliopsoas fractional lengthening
as a part of hip arthroscopy – minimum 2 year follow-up
Itay Perets, MD1 , David Hartigan, MD2, Edwin O. Chaharbakhshi, BS1,
Lyall Ashberg, MD3, Mary R. Close, BS1, Benjamin G. Domb, MD1,4
1. American Hip Institute 2. Mayo Clinic Arizona 3. Atlantis Orthopaedics 4. Hinsdale Orthopaedics
Purpose
Conclusions
Background
Methods
Results
• The iliopsoas is a hip flexor and stabilizer that may
be associated with internal snapping.
• Internal snapping is believed to be created by the
motion of the iliopsoas over the iliopectineal
eminence or over the femoral head.
• Treatment options for iliopsoas impingement are
both conservative and surgical.
• First line of treatment: lengthening the tendon and
reduce inflammation through stretching in
physical therapy, non-steroidal anti-inflammatory
drugs, or a direct corticosteroid injection to the
iliopsoas bursa.
• Second line of treatment: if conservative
measures fail to alleviate the pain, a minimally
invasive hip arthroscopic iliopsoas tenotomy or
iliopsoas fractional lengthening (IFL) has shown
to be safe and effective.
• Although flexion and stability are important in
competitive athletes, painful internal snapping may
be debilitating and may necessitate arthroscopic
iliopsoas fractional lengthening (IFL).
To report athletes’ patient-reported outcomes (PROs),
their returns to sports, and competitive abilities after
undergoing IFL as a part of hip arthroscopy at a
minimum of two years postoperatively.
• Data were prospectively collected and retrospectively
reviewed for patients undergoing hip arthroscopy
between November 2009 and April 2014.
• Inclusion criteria: high school, collegiate, or
professional athlete, who underwent arthroscopic IFL,
and agreed to complete preoperative modified Harris
Hip Score (mHHS), Non-Arthritic Athletic Hip Score
(NAHS), Hip Outcome Score – Sports Specific
Subscale (HOS-SSS), and Visual Analog Scale
(VAS).
• Exclusion criteria: patients <16 years old, Tönnis
grade >1, previous hip conditions, and previous
surgical intervention for either hip.
• Indications for an IFL:
• History of painful internal snapping of the hip
• Presence of an iliopsoas impingement lesion
defined as a labral tear at the 3:00 acetabular
clockface position associated with hyperemia at the
capsulolabral or chondrolabral junction (Fig 1)
• 80 athletes were eligible for
inclusion, 64 (80%) of which
had minimum two-year
follow-up.
• All PRO scores demonstrated
significant improvements at
latest follow-up (p < 0.0001).
• mHHS (65.2 – 82.5)
• NAHS (62.8 – 83.1)
• HOS-SSS (43.6 – 73.2)
• VAS (5.7 - 2.6)
• Mean satisfaction was 7.9.
• Painful snapping was
resolved in 49 patients (77%).
• 67.2% return to sport
Figure 1: Iliopsoas impingement lesion. This figure shows a labral tear (LT) and labral
hyperemia (*) at the 3:00 acetabular clockface. This lesion is thought to be a result of
internal snapping of the hip. L – Labrum. A – Acetabulum. FH – Femoral Head. P –
Probe.
Figure 2: Iliopsoas fractional lengthening. 2A) The iliopsoas tendon (IPT) after
performing an interportal capsulotomy to expose the tendon and before the fractional
lengthening. 2B) The IPT is split after cutting through it using a beaver blade (BB).
Medial to the split IPT is the intact iliopsoas muscle (IPM). L – Labrum. C – Capsule.
FH – Femoral Head.
In competitive athletes, IFL during hip arthroscopy is safe and demonstrates favorable improvements in
PROs and VAS, high satisfaction, and high rate of symptom resolution at a minimum of two years
postoperatively. The majority of patients were able to return to sports and maintain or improve their
competitive levels.
1 2A 2B
Strengths:
1.This is the first study examines
arthroscopic IFL in athletes.
2.We utilized three PRO measurements,
VAS, and patient satisfaction and had
an adequately powered study.
Limitations:
1.No control group.
2.Larger studies are warranted to
adequately assess the outcomes of
this procedure based on individual
sports and competitive levels.
Patient RTS and ability
based on preop
competitive level
RTS (n, %)
Ability remained the same
or increased regardless of
RTS (n, %)
Total (n = 64 patients) 43 (67.2%) 43 (67.2%)
High school 21 (58.3%) 24 (66.7%)
Collegiate 13 (72.2%) 14 (77.8%)
Professional 9 (90.0%) 5 (50.0%)
Patient Demographics (n = 64) n (%)/mean ± SD
Age at surgery (years) 19.6 ± 3.9
Gender
Male 13 (20.3%)
Female 51 (79.7%)
Hip laterality
Left 31 (48.4%)
Right 33 (51.6%)
Preoperative competitive sports level
High school 36 (56.3%)
Collegiate 18 (28.1%)
Professional 10 (15.6%)
BMI 22.4 ± 3.9
Follow-up
Time (months) 49.7 ± 19.5
Percentage of eligible patients 80.0%
Future secondary arthroscopy 10 (15.6%)
Time (months) 31.9 ± 27.9
Future total hip replacement 0 (0%)