Search

Background: Posterolateral synovial fold syndrome is a rare entity on elbow pathology. Careful evaluation of clinical presentation and radiological imaging is essential to obtain the diagnosis. Treatment is usually resection of the synovial fold with arthroscopy. Objective: To retrospectively evaluate and review the functional outcomes, findings and results after arthroscopic surgery in a case series of patients with posterolateral synovial fold syndrome treated with a modified arthroscopic technique. Methods: Between 2010 and 2020, 6 patients diagnosed with posterolateral synovial fold syndrome were treated with average of 12 months follow-up (SD ± 17.3) they were evaluated for clinical symptoms, radiological signs and arthroscopic findings. Patient outcome was assessed pre- and postoperatively by the Mayo Elbow Performance Index (MEPI), which assesses pain, ROM, stability and function. Statistical analysis was performed with the student’s t-test. P=0.05 were considered statistically significant. The study was approved by ethics committee of Hospital Clinica Mompia, Santander, Spain. Results: In all cases the synovial fold was swollen and thickened with some synovitis adjacent to the fold on the radio capitellar joint. Mild chondromalacia was observed on the capitellum and the posterolateral zone of the radial head. No pathology was observed at the anterior compartment of the elbow. All patients showed up a clinical improvement with the disappearance of pain and snapping and returned to physical activities. No loss of motion was observed. No complication or recurrence of the symptoms appeared during the 12month of follow-up. The preoperative MEPI score of 64.1 points (SD ± 5.8) had significant improvement to 92.5 (SD ± 8.2) on postoperative at 12 months of follow up. Conclusion: Management of a symptomatic posterolateral synovial fold is successful and effective with our proposed arthroscopic technique.

Hip preservation surgery is now an established part of orthopedic surgery and sports medicine. This report describes the key findings of the 11th Annual Scientific Meeting of International Society for Hip Arthroscopy—the International Hip Preservation Society—in Madrid, Spain from 16 to 19 October 2019. Lectures, seminars and debates explored the most up-to-date and expert views on a wide variety of subjects, including: diagnostic problems in groin pain, buttock pain and low back pain; surgical techniques in acetabular dysplasia, hip instability, femoroacetabular impingement syndrome, labral repair and reconstruction, cartilage defects, adolescent hips and gluteus medius and hamstring tears; and new ideas about femoral torsion, hip–spine syndrome, hip capsule surgery, impact of particular sports on hip injuries, registries, robotics and training for hip preservation specialists. Surgeons, sports physicians, radiologists and physiotherapists looking after young people with hip problems have an increasingly sophisticated armoury of ideas and techniques with which to help their patients. The concept of hip preservation has developed incredibly fast over the last decade; now it is clear that the best results can only be achieved by a multidisciplinary team working together. The 2020s will be the decade of ‘Teamwork in Hip Preservation’.

Deep gluteal syndrome (DGS) is defined as the presence of pain in the subgluteal space caused from non-discogenic and extra-pelvic entrapment of the sciatic nerve in which piriformis syndrome is the most common cause. The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique, allowing the treatment of the diverse causes of sciatic nerve entrapment. Ischiofemoral impingement is a rare cause of posterior hip pain featured by the contact between the lesser trochanter and the ischium. If conservative treatment fails to relieve symptoms, endoscopic lesser trochanter osteoplasty can be considered. Hamstring injuries affect both athletes and middle-aged individuals and may cause significant impairment. The spectrum of hamstring injuries ranges from muscle strains to avulsion injuries. Non-operative management has been proposed for muscle strains and low-grade partial tears of the hamstring origin, whereas surgery is recommended in the setting of more refractory cases of proximal avulsions, with open surgical repair with suture anchors being the gold standard. With the advent of hip arthroscopy and refinement of endoscopic techniques, endoscopic hamstring repair has come to be considered as an effective and safe alternative to open repair. In this chapter, the endoscopic techniques are outlined.

This chapter updates main topics in hip arthroscopy. Since chondrolabral injury has been proposed the beginning of hip osteoarthritis, other new entities play a role in the painful hip. Actually, if we want to improve long-term clinical results, we should establish better indications for surgical treatment rather than surgical technical modifications. Different options to manage chondrolabral lesions are described in this chapter, and labral reconstruction is a very popular option nowadays. Capsular management is also a hot topic that will be discussed, and its relationship with hip instability is an interesting debate. The importance of cam deformity resection and modern therapies to treat cartilage defects are other problems directly related to osteoarthritis progression in the hip.

ResumenObjetivoLa anatomía de la cadera presenta una serie de peculiaridades que condicionan el tratamiento artroscópico de su patología. El objetivo de la presente publicación es describir los hallazgos anatómicos y biomecánicos más destacados para la aplicación clínica y terapéutica.MétodoDividiremos el capítulo en biomecánica de la cadera con aplicación clínica y las estructuras anatómicas según estén en el compartimento central o en periférico.ResultadosLa necesidad de tracción para poder acceder a la articulación y la dificultad de movilidad dentro de la misma, nos obliga a conocer la anatomía normal y sus variantes. En el compartimento central describiremos estructuras como el labrum, cartílago acetabular, ligamento redondo, fosita semilunar y cartílago de carga de la cabeza femoral. En el compartimento periférico se observará el cartílago de la cabeza, cara no articular del labrum, cápsula y diferentes plicas sinoviales.ConclusionesConocer la anatomía artroscópica y sus variantes, junto con nociones básicas de biomecánica de la cadera, nos permiten mejorar nuestra orientación en una articulación de difícil acceso.Relevancia clínicaEl conocimiento de la anatomía artroscópica y la biomecánica aplicada de la cadera nos permite acortar nuestra curva de aprendizaje quirúrgico en artroscopia de cadera.Nivel de evidenciaOpinión de expertos Nivel IV.AbstractObjectiveHip joint anatomy has a number of peculiarities that determine the arthroscopic treatment. The aim of this article is to describe the most significant anatomical and biomechanical findings for clinical and therapeutic applications.MethodWe divide the chapter into hip biomechanics with clinical application and anatomical structures of the central or peripheral compartment.ResultsAccess and mobility into the hip joint is difficult, and requires understanding the normal anatomy and its variants. In the central compartment, we describe important structures such as the labrum, acetabular cartilage, round ligament, acetabular cartilage, and cartilage of the femoral head. In the peripheral compartment, femoral head cartilage, non-articular labrum, capsule and synovial folds are described.ConclusionsUnderstanding hip arthroscopic anatomy and its variants, along with the basics of hip biomechanics, allow us to improve our orientation in a joint with a difficult access.Clinical relevanceThe knowledge of applied anatomy and arthroscopic hip biomechanics allows us to reduce our surgical learning curve in hip arthroscopy technique.Level of evidenceLevel IV Expert opinion.

The os acetabuli is thought to arise from unfused secondary ossification centers or as rim fractures in the setting of dysplastic hips or hips with femoroacetabular impingement. Resection of a large os acetabuli can lead to structural instability of the joint, and in these cases, osteoplasty of the impingement, reduction and internal fixation of the osseous fragment, and labral repair have been described in the literature. Anchor fixation for labral repair in the surrounding zone of the osteosynthesis might bring some technical problems. We aim to describe a technical modification improving labral lesion treatment while addressing the rim fracture. The addition of a suture to the screw addresses both lesions because it simultaneously has the function of a screw and an anchor. A suture-on-screw technique for os acetabuli fixation helps surgeons to gain versatility and is more cost-effective for the patients and health services.

Hip arthroscopy is an evolving surgical technique that has recently increased in popularity.Although femoroacetabular impingement was an important launch pad for this technique, extra-articular pathology has been described through hip endoscopy.Good clinical results in the medium term will allow improvements in this technique and increase its indications. Cite this article: EFORT Open Rev 2017;2:58-65. DOI: 10.1302/2058-5241.2.150041. info:eu-repo/semantics/publishedVersion

Background Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included "piriformis syndrome", a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. Methods This article describes the subgluteal space anatomy, reviews known and new etiologies of DGS, and assesses the role of the radiologist and orthopaedic surgeons in the diagnosis, treatment and postoperative evaluation of sciatic nerve entrapments. Conclusion DGS is an under-recognized and multifactorial pathology. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification. The whole sciatic nerve trajectory in the deep gluteal space can be addressed by an endoscopic surgical technique. Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapments, but requires significant experience and familiarity with the gross and endoscopic anatomy. Level of evidence IV.

To retrospectively evaluate the diagnostic accuracy of magnetic resonance (MR) arthrography of the hip with leg traction in the evaluation of ligamentum teres lesions and to evaluate whether there is increased articular distraction, possibly indicating secondary instability, in hips with ligamentum teres injuries. Institutional review board approval and informed consent were obtained for this retrospective study. MR arthrograms of the hip with leg traction of 184 consecutive patients, including 108 men (mean age, 32.6 years; range, 19–53 years) and 76 women (mean age, 38.5 years; range, 18–56 years), who underwent hip arthroscopy were assessed for the presence of ligamentum teres lesions. The MR arthrographic findings were independently assessed by two radiologists who were blinded to the arthroscopic results. The inclusion criteria stipulated no previous surgery, arthroscopy within 1 month after MR arthrography, and availability of a detailed surgical report with ligamentum teres findings. The arthroscopy findings served as the reference standard. Sensitivity, specificity, accuracy, and K statistics for interobserver and intraobserver agreement were calculated. At arthroscopy, 32 ligamentum teres injuries were found. The ligamentum teres was normal in 152 (82.6 %) patients and had suffered low-grade partial tears in 15 (8.1 %) patients, high-grade partial tears in 10 (5.4 %) patients, and complete ruptures in 7 (3.8 %) patients. MR arthrography with axial traction demonstrated moderate sensitivity and high specificity for both low-grade (62/93 %) and high-grade (66/96 %) partial tears. Grouping low- and high-grade partial tears increased the diagnostic performance of MR arthrography, yielding a sensitivity of 87 % and a specificity of 95 %. For complete ligamentum teres tears, MR arthrography with leg traction demonstrated high sensitivity (92 %) and specificity (98 %). Articular distraction was significantly increased in patients with complete ruptures of the ligamentum teres (p = 0.001). MR arthrography with leg traction offers accurate diagnosis of ligamentum teres injuries. Patients with complete tears of the ligamentum teres exhibit increased articular distraction that may indicate secondary hip instability.

Freiberg disease is a disorder that has a predilection for the second metatarsal head. Keller excision of the base of the proximal phalanx is a procedure described for the treatment of late-stage Freiberg disease. We describe a case of a 60-year-old man, with a stage IV lesion according to Smillie's classification, treated by debridement, removal of the free body, and arthroscopic Keller excision. Arthroscopic treatment allows the patient to begin and maintain an aggressive postoperative physical therapy program immediately after surgery, thus decreasing the risk of scarring and contracture. At last evaluation, 2 years postoperatively, he is symptom-free. A suggested pattern of minimally invasive surgery management of this disease is proposed.

The scaphotrapeziotrapezoidal (STT) joint is a complex joint in which the arthroscope and instruments can be used through the radial midcarpal and STT-ulnar portals. This report describes a new arthroscopic portal at the STT joint to complete and improve the evaluation and treatment of this joint by arthroscopy: The STT-radial (STT-R) portal is situated immediately radial to the abductor pollicis longus at the STT level. Five cadaveric wrist specimens were dissected immediately after the portal was established, and photographed to determine the proximity of neurovascular structures. Magnetic resonance imaging evaluation of 15 hands was performed to measure the proximity of the radial artery. A cadaveric distal scaphoid excision was also created arthroscopically to show the real usefulness of this portal. Results of the anatomic study showed that no lesions of nerves or vessels were seen at this portal. Magnetic resonance imaging showed that the radial artery was located at a safe distance from the portal. The distal scaphoid excision was performed 15 minutes after the STT portals were established. Our results suggest that this new portal is safe and effective.

Even though arthroscopy of the hip was first performed as early as 1931, its clinical application has developed rather slowly. However, recent advances in arthroscopic techniques and equipment have revolutionized the diagnosis and treatment of hip injuries. Currently, there is unprecedented enthusiasm for hip arthroscopy. Clinical assessment of the hip is improving and arthroscopic indications are therefore increasing. As hip arthroscopy becomes more common, it is vital that accurate knowledge of the anatomy of the hip and how to establish the common portals is combined with correct patient selection, sound preoperative planning, and consistent arthroscopic technique in order to maximize clinical outcomes. This chapter discusses the relevant arthroscopic anatomy of the hip and anatomic variations that are commonly encountered during this procedure.

Arthroscopic subtalar arthrodesis, as reported by Tasto, is done in the lateral decubitus position, and the portal sites are lateral. This report describes a new alternative method in which the patient is in the prone position and a posterior 2-portal approach is used, as described by van Dijk et al. The initial debridement and synovectomy are performed with 4- and 5-mm resectors. Debridement and decortication are done posterior to the interosseous ligament because only the posterior facet is fused. Denudation of the articular surfaces is performed with curettes, as well as 4.5- and 5.5-mm burs, to remove 2 mm of subchondral bone. Stabilization in 5 degrees of hindfoot valgus is accomplished with 2 percutaneous cannulated headless screws from the non-weight-bearing portion of the calcaneal tuberosity directed to a point 5 to 10 mm posterior to the anterior margin of the posterior facet. The advantages of this alternative treatment are better intra-articular visualization, more thorough preparation of the fusion site, and minimal bone removal of the lateral side with better control of the arthrodesis position and with less chance of malunion, as well as the possibility to perform a concomitant surgical fusion or debridement of the ankle joint during the same operative procedure with no need for additional portals or orientation.

Thumb arthroscopy and arthroscopically assisted treatment of the thumb are safe and effective techniques. This report describes technical innovations particularly useful in the surgical performance of arthroscopically assisted treatment of basal joint arthritis. (1) With adduction and hyperextension of the thumb, the bony landmarks are easier to palpate and a volar radial soft spot is clearly defined between the trapezium and metacarpal (i.e., the adduction-hyperextension maneuver). (2) After the distension of the joint with saline solution, the thumb automatically abducts and flexes if the capsule has been distended successfully (i.e., the flexion-abduction sign). (3) The radial and ulnar borders of the proximal phalanx and the local tendons can serve as external landmarks if fluid extravasation occurred. (4) Finally, the simultaneous use of the 3 portals described in the first carpometacarpal joint is very effective for better visualization and performance of the procedures in this joint (i.e., the 3-portal technique). We propose a new description of the portals for carpometacarpal arthroscopy as follows: (1) volar portal, which is just distal to the oblique ridge of the trapezium following a line referencing the radial edge of the flexor carpi radialis; (2) ulnar portal, which is just ulnar to the extensor pollicis brevis; and (3) radial portal, which is just radial to the abductor pollicis longus.