Background: Anterior inferior iliac spine (AIIS) impingement has been increasingly recognized as a source of extra-articular impingement and hip pain. However, no aggregate data analysis of patient outcomes after AIIS decompression has been performed. Purpose: To evaluate outcomes after arthroscopic AIIS decompression. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for all English-language studies reporting outcomes of arthroscopic AIIS decompression performed in isolation or in conjunction with hip impingement correction surgery. After screening, 10 articles were included. The indications for AIIS decompression were recorded, and weighted mean improvements in patient-reported outcome (PRO) scores, complication rates, and revision rates were calculated. Results: A total of 547 patients (311 women; 57%) were identified, with a total of 620 operative hips. The mean age was 28.42 ± 5.6 years, and the mean follow-up was 25.22 ± 11.1 months. A total of 529 hips (85%) underwent AIIS decompression, 530 hips (85%) underwent femoral osteochondroplasty, and 458 hips (74%) underwent labral repair. Of the patients, 13% underwent bilateral AIIS decompression. The mean modified Harris Hip Score improved from 61.3 ± 6.9 to 88.7 ± 4.7 postoperatively (change, 27.4 ± 5.7 points; P < .001), the Hip Outcome Score–Activities of Daily Living improved from 67.2 ± 10.6 to 91.1 ± 3.2 postoperatively (change, 24.0 ± 8.0 points; P = .001), and the Hip Outcome Score–Sports Specific Subscale improved from 36.8 ± 19.2 to 82.8 ± 3.8 postoperatively (change, 46.0 ± 18.2 points; P = .002). The pooled risk of postoperative complications was 1.1% (95% CI, 0.1%-2.1%), and the pooled risk of needing revision surgery was 1.0% (95% CI, 0.1%-2.0%). No complication was directly attributed to the AIIS decompression portion of the procedure. Conclusion: PROs improved significantly after hip arthroscopy with AIIS decompression, with a low risk of postoperative complications and subsequent revision surgeries. Failure to identify extra-articular sources of hip pain in outcomes of femoroacetabular impingement syndrome, including from the AIIS, could lead to poorer outcomes and future revision surgery.
This report highlights the clinical features seen in duplication of 8q22.1q23.1 inherited from balanced father. It stresses the importance of obtaining a karyotype to identify the location of a large copy number variant for accurate recurrence risk estimation.
Background: Pathologic contact between the femoral neck and anterior inferior iliac spine (AIIS or subspine) often occurs concomitantly with femoroacetabular impingement, contributing to hip pain and dysfunction [1][2][3][4] . We perform arthroscopic AIIS decompression to alleviate this source of extraarticular impingement and eliminate a potential cause of persistent pain following primary hip arthroscopy [5][6][7] . Description: After identifying abnormal AIIS morphology on preoperative false-profile radiographs and/or 3D computed tomography, we utilize a beaver blade to make a small incision in the proximal capsule and rectus femoris tendon. This peri-capsulotomy window grants access to the subspine region. We then shuttle an arthroscopic burr into place within this window and begin debriding the subspine deformity under direct visualization. Fluoroscopy is utilized intraoperatively to ensure adequate resection, using intraoperative false-profile views achieved by canting the C-arm approximately 40°. Resection is considered adequate when the AIIS deformity is no longer readily apparent on false-profile views and when intraoperative range-of-motion testing confirms no further impingement with hip hyperflexion. Alternatives: Femoroacetabular impingement can be treated nonoperatively with use of physical therapy and activity modification 8 ; however, outcomes following nonoperative treatment are inferior to those following hip arthroscopy, according to various studies [9][10][11][12] . There are no known alternative treatments specific to subspine impingement. Rationale: As patients with subspine deformities progress through hip flexion, the femoral neck collides with the AIIS, limiting range of motion. As such, subspine deformities have been shown to be more common in dancers and other high-flexion athletes 13,14 . Additionally, studies have demonstrated that low femoral version of ,5°is associated with increased contact between the distal femoral neck and the AIIS. This pathologic contact can occur even in the absence of an obvious subspine deformity 15 . In both of these patient populations, surgeons should have a high suspicion for subspine impingement, and a subspine decompression should be performed during hip arthroscopy in order to maximize patient outcomes. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A408)
Objectives Significant loss of skeletal muscle mass occurs early after high-energy trauma, leading directly to prolonged functional limitations. As we investigate nutrition interventions to reduce loss of muscle mass, we need to quantify changes in muscle mass after these devastating injuries. The aim of this study was to characterize baseline nutrition and changes in muscle mass after high-energy trauma in a young adult population. Methods We enrolled patients 18–55 years old indicated for operative fixation of either, an open pelvic or extremity fracture, or ≥2 pelvic and/or extremity fractures due to a high-energy mechanism. Baseline assessment of body composition (Lean Body Mass [LBM], Skeletal Muscle Mass [SMM]), was measured within 72 hours of admission using bioelectrical impedance and repeated 6 weeks after injury. Results are reported as median (IQR). Changes in LBM and SMM were evaluated using Wilcoxon Signed Rank tests. Sarcopenia was defined by gender-specific cutoffs for appendicular skeletal mass index. Dietary intake was evaluated using food frequency questionnaires. Inadequate protein intake was classified using the Estimated Average Requirement cut-point method, while inadequate caloric intake was defined as intake below basal metabolic rate. Results Sixteen subjects (14 male) age 38.4 ± 9.6 years were enrolled. At baseline, 3 reported inadequate protein intake and 5 reported inadequate caloric intake. Six weeks after injury participants experienced significant losses in LBM (−4.5kg (−8.8 to −1.4), P = 0.019) and SMM (−3.1kg (−5.6 to −0.3), P = 0.043). The injured extremity had significantly greater loss of LBM compared to the uninjured extremity (−4.0 (−17.1–3.5), P = 0.0495). Five were baseline sarcopenic, with one additional participant meeting the criteria by 6 weeks. Baseline protein and calorie deficiency was not significantly associated with muscle loss. Conclusions This study documented devastating loss of lean body mass and skeletal muscle mass after high-energy trauma in young adults. These losses are likely a combination of immobilization and catabolic response for wound and fracture healing. Understanding loss of muscle mass after injury is important to design impactful rehabilitative and nutrition interventions in this complicated patient population. Funding Sources None.
Objectives: Femoroacetabular impingement (FAI) is a known cause of hip pain and dysfunction in young, active patients and can be successfully managed with hip preservation surgery. For athletes with FAI, however, there is inconsistent data regarding the ability to return to competitive sport after surgery and how performance level is impacted. The purpose of this study is to evaluate patient factors contributing to return to sport after hip preservation surgery. Methods: Study Design: Retrospective cohort We retrospectively reviewed patients aged 14 to 44 who underwent hip preservation surgery between December 2018 and May 2021 and who participated in a competitive or recreational sport pre-operatively. All patients underwent formal return-to-sport (RTS) testing between 4 and 6 months after surgery. Patient-reported outcomes (PROs) were obtained at initial RTS testing using the International Knee (Hip) Documentation Committee (IKDC) questionnaire, Hip Outcome Score – Sports Specific Subscale (HOS-SSS), and Hip Return to Sport After Injury (Hip-RSI) scale. Regression analysis was performed to evaluate the relationship between RTS tests, PRO’s, BMI, pre- and post-operative alpha angles, and degree of correction. Degree of correction was the difference between pre- and post-operative alpha angles measured on Dunn view hip x-rays. Results: We identified 40 patients, 47 operative hips (34 females, 85%). Three patients (4 hips) were excluded for incomplete testing data. Mean age was 17.73 ± 2.7 years. All patients underwent hip arthroscopy for FAI including one case of single-stage bilateral hip arthroscopy. The most common primary sports were dance (7), softball (6), and basketball (5). Mean alpha angles were 67.15 ± 10.9° pre-operatively and 41.37 ± 4.5° post-operatively. Average time from surgery to first RTS testing was 26.79 ± 6.5 weeks (median 25.1 weeks). Mean HOS-SSS score at initial testing was 85.98 ± 11. Posteromedial (PM) and posterolateral (PL) reach on Y-balance test were significantly associated with HOS-SSS score at initial testing (PM: r=0.54, p<0.001; PL: 0.53, p<0.01). Composite Y-balance score was also significantly associated with HOS-SSS score (r=0.6, p<0.01). All other comparisons between PROs and RTS tests were not significantly associated. Similarly, there were no significant associations between time to initial RTS testing and BMI, pre-operative alpha angle, or degree of correction. Conclusions: Higher Y-balance scores at initial RTS testing are associated with improved PROs and perceived readiness to return to sport. This test can be easily incorporated into an assessment for safe return after FAI surgery; further prospective studies are warranted.
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