Conclusions

The indications for hip arthroscopy have been well established. The results among athletes appear to be favorable and, in fact, are somewhat better than those reported among a general population.

Intraarticular disorders in athletes may go unrecognized for a protracted period of time, most commonly being diagnosed as a strain. With an increasing awareness of these intraarticular problems and the intensity of services often available to athletes, joint injuries are now being diagnosed earlier. However, this emphasis for earlier diagnosis must be tempered. It is still likely that extraarticular in

FIGURE 13.10. Results based on the onset of symptoms. (From Byrd and Jones,5 with permission of Clin Sports Med.)

juries vastly outnumber injuries within the joint, and thus one should avoid the temptation for an extensive intraarticular workup for every simple muscle strain. Also, it is unknown whether early diagnosis necessitates early intervention. There is much that is not understood regarding the natural history of some of these intraarticular disorders. Thus, while it is difficult to say that a labral lesion identified by MRI will heal, it is uncertain how many of these may become clinically quiescent and asymptomatic or whether some of the signal changes evident on imaging may be caused by remote trauma that had previously become silent.

Nonetheless, arthroscopy has defined various sources of intraarticular hip pathology. In many cases, operative arthroscopy may result in significant symptomatic improvement. For some, arthroscopy offers a distinct advantage over traditional open techniques, but for many, arthroscopy now offers a method of treatment where none existed before.

FIGURE 13.9. Results based on specific diagnoses. (From Byrd and FIGURE 13.11. Results based on level of sport. (From Byrd and

Jones,5 with permission of Clinics in Sports Medicine.) Jones,5 with permission of Clinics in Sports Medicine.)

FIGURE 13.9. Results based on specific diagnoses. (From Byrd and FIGURE 13.11. Results based on level of sport. (From Byrd and

Jones,5 with permission of Clinics in Sports Medicine.) Jones,5 with permission of Clinics in Sports Medicine.)

References

1. Byrd JWT: Hip arthroscopy for post-traumatic loose fragments in the young active adult: three case reports. Clin Sports Med 1996;6:129-134.

2. Villar RN: Arthroscopic debridement of the hip: a minimally invasive approach to osteoarthritis. J Bone Joint Surg 1991;73B: 170-171.

3. Byrd JWT: Indications and contraindications. In: Byrd JWT (ed). Operative Hip Arthroscopy. New York: Thieme, 1998:7-24.

4. Sampson TG, Glick JM: Indications and surgical treatment of hip pathology. In: McGinty J, Caspari R, Jackson R, Poehling G (eds). Operative Arthroscopy, 2nd ed. New York: Raven Press, 1995:1067-1078.

5. Byrd JWT, Jones KS: Hip arthroscopy in athletes. Clin Sports Med 2001;20:749-762.

6. Byrd JWT, Jones KS: Prospective analysis of hip arthroscopy: two year follow-up. Arthroscopy 2000;16:578-587.

7. Byrd JWT: Lateral impact injury: a source of occult hip pathology. Clin Sports Med 2001;20:801-816.

8. Delcamp DD, Klarren HE, VanMeerdervoort HFP: Traumatic avulsion of the ligamentum teres without dislocation of the hip. J Bone Joint Surg 1988;70A:933-935.

9. Barrett IR, Goldberg JA: Avulsion fracture of the ligamentum teres in a child. A case report. J Bone Joint Surg 1989;71A: 438-439.

10. Ebrahim NA, Salvolaine ER, Fenton PJ, Jackson WT: Calcified ligamentum teres mimicking entrapped intraarticular bony fragments in a patient with acetabular fracture. J Orthop Trauma 1991;5:376-378.

11. Kashiwagi N, Suzuki S, Seto Y: Arthroscopic treatment for traumatic hip dislocation with avulsion fracture of the liga-mentum teres. Arthroscopy 2001;17:67-69.

12. Byrd JWT, Jones KS: Traumatic rupture of the ligamentum teres as a source of hip pain. Arthroscopy 2003 (in press).

13. Epstein H: Posterior fracture-dislocations of the hip: comparison of open and closed methods of treatment in certain types. J Bone Joint Surg 1961;43A:1079-1098.

14. Byrd JWT: Investigation of the symptomatic hip: physical examination. In: Byrd JWT (ed). Operative Hip Arthroscopy. New York: Thieme, 1998:25-41.

15. Byrd JWT, Jones KS: Prospective analysis of hip arthroscopy with five year follow up. Presented at AAOS 66 th annual meeting, Dallas, TX, February 14, 2002.

16. McCarthy JC, Noble PC, Schuck MR, Wright J, Lee J: The watershed labral lesion: its relationship to early arthritis of the hip. J Arthroplasty 2001;16(8 suppl 1):81-87.

17. Farjo LA, Glick JM, Sampson TG: Hip arthroscopy for acetabular labrum tears. Arthroscopy 1999;15:132-137.

18. Santori N, Villar RN: Acetabular labral tears: result of arthro-scopic partial limbectomy. Arthroscopy 2000;16:11-15.

19. Byrd JWT, Jones KS: Diagnostic accuracy of clinical assessment, MRI, gadolinium MRI, and intraarticular injection in hip arthroscopy patients. Am J Sports Med, 2004:4.

20. Lecouvet FE, VandeBerg BC, Malghen J, et al: MR imaging of the acetabular labrum: variations in 200 asymptomatic hips. AJR Am J Roentgenol 1996;167:1025-1028.

21. Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr: Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop 2001;382:232-240.

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

Get My Free Ebook


Post a comment