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Scope on the hip Labrale letsesl Zeist 24 april 2013 Dr J De Schepper AZ Nikolaas – Sint-Niklaas www.orthopedieregentie.be.

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Presentation on theme: "Scope on the hip Labrale letsesl Zeist 24 april 2013 Dr J De Schepper AZ Nikolaas – Sint-Niklaas www.orthopedieregentie.be."— Presentation transcript:

1 Scope on the hip Labrale letsesl Zeist 24 april 2013 Dr J De Schepper AZ Nikolaas – Sint-Niklaas

2 Groin pain in athletes J Am Acad Orthop Surg Aug;15(8): Sports hernia Imbalance in trunk stabilizers and adductor muscles Soccer, hockey, hurdling, running

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4 Groin pain in athletes Activity related Normal X-rays All investigations negative Long conservative treatment Hernia repair Longterm absence on the field

5 Groin pain in athletes Extra-articular Cause for pain Intra-articular Cause for pain

6 Intra-articular causes for groin pain Acute injury –Torn ligamentum teres –Loose body, cartilage lesion Gradual onset –Concept of impingement

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8 Heup arthroscopie

9 Anatomie Centraal compartiment Perifeer compartiment

10 INDICATIES : LOOSE BODIES Oorzaken: Posttraumatisch Synoviale chondromatose Andere kraakbeenaantastingen Investigaties: CT – Arthro CT Heup arthroscopie

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12 INDICATIES : KRAAKBEENLETSELS Traumatische letsels Impactietrauma

13 Concept of femoro-acetabular impingement FAI dynamic concept Developed by R. Ganz (Bern) 1. cam - impingement 2. pincer - impingement

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16 cam - impingement Probleem situeert zich op de nek, gevolgen acetabulair Anterior offset Notzli’s angle Concept of femoro-acetabular impingement FAI

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18 Notzli’s angle ???? cam - impingement

19 Consequences labral tears wave sign delaminated cartilage early arthritis

20 –Osseous bump “variant” Idiopathic old LCP subclinical slipping –Femoral retroversion –Coxa vara cam - impingement

21 –Bone Marrow Edema –Labral tear –Cartilage lesions –Subchondral cyst formation –(Bump-cyst complex; herniation pit) –Os acetabuli cam - impingement

22 CAM FAI: intact labrum + wave sign cam - impingement

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24 pincer - impingement acetabular retroversion cross-over sign Concept of femoro-acetabular impingement FAI

25 pincer - impingement

26 Pincer FAI – Acetabular origin – Acetabular overcoverage – Coxa profunda – Protrusio acetabuli pincer - impingement

27 Consequences Abutment nek tegen anterior wall Mainly labral tears Contre-coup lesions

28 Often combined impingement

29 Clinical features of FAI Click, locking of the hip Limited internal rotation Pain in ADduction, Flexion and internal rotation Gondolière sign + McCarthy + C-sign + Pain during sport, may aggrevate afterwards

30 Testen –Faber Clinical features of FAI

31 Testen –Mc Carthy Clinical features of FAI

32 Radiological findings of FAI Standard X-ray Arthro MRI 3D CT-scan In doubt : Injection of the joint

33 Standard X-Rays -Comparison of contralateral hip -Leg length -Pelvic rotation -Pelvic tilt -Correct evaluation acetabular retroversion -Coccyx must be centered over the pubic symphysis and should be not separated more than 2 cm Standard radiography: standing AP pelvis

34 Standard X-rays tilt rotatie Value of correct positioning

35 Standard radiography: 3/4 –Lateral neck Standard X-rays

36 Other valuable radiographs –Lequesne (faux profile) Profile of acetabulum: anteversion, retroversion –Dunn view 90° flexion/ abduction 20° Anterior femoral neck Standard X-rays

37 Other valuable radiographs –Lequesne (faux profile) Profile of acetabulum: anteversion, retroversion –Dunn view 90° flexion/ abduction 20° Anterior femoral neck Standard X-rays

38 Pincer FAI – Acetabular origin – Acetabular overcoverage – Coxo profunda – Protrusio acetabuli Standard X-rays

39 MR Imaging –Cor (FS)TSE pd/T2 both hips Evaluation BME/ tumors… –Direct MR arthrography Evaluation labrum, cartilage, hip and actebulum morphology Arthro-MRI findings

40 CAM FAI –Bone Marrow Edema –Labral tear –Cartilage lesions –Subchondral cyst formation –(Bump-cyst complex; herniation pit) Arthro-MRI findings

41 Pincer FAI – Acetabular origin - Acetabular depth Distance of center of the femoral neck to line that connected the anterior and posterior acetabular rim Pfirrmann C. et al. Radiology 2006;240:778. Arthro-MRI findings

42 Behandeling : ARTHROSCOPISCH Philippon, Buly, Dienst Centraal Compartiment : - gevolgen van het impingement - rimtrimming en labrumrefixatie - resectie tot stabiele kraakbeenrand Perifeer Compartiment : - Oorzaak wegnemen Treatment of FAI

43 Resectie door surgical dislocation (Ganz) Treatment of FAI

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46 COMPLICATIES Villar, Clin Orthop, Jan gevallen 1,4 % Neuropraxie, skin necrosis Bloeding portals of hematoomvorming Trochanter bursitis Breuk instrumentarium Infectie Heup arthroscopie

47 Scope on the hip Scope in the hip


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