Iatrogenic Hip Instability After Hip Arthroscopy: Is There a Role for Open Capsular Reconstruction?

Gehrman, Max D.; Cornell, Max; Seeley, Mark

doi:10.2106/jbjs.cc.18.00091

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…In previous reports, hip dislocation, after a low-energy trauma, occurred between 0 and 4 months postoperatively. These authors described both patient and surgical factors related to instability: female gender (77.8 %), acetabular dysplasia (22.2 %), and generalized ligamentous laxity (11.1 %), unrepaired capsulotomy (77.8 %), iliopsoas release (33.3 %), labrum repair or debridement, and acetabular and femoral remodeling [ 1 , 5 , 6 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Late post-arthroscopy hip instability. Diagnosis, treatment, and 5-year follow-up: A case report

Zárate Leal,

Bautista,

Sánchez-Vergel

2024

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

“…Almost 3 % of patients require additional interventions for its treatment [ 4 ]. Female sex increased femoral anteversion, hip dysplasia, hyperlaxity, and traumatic injuries have been described as predisposing factors for iatrogenic hip instability [ 1 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Late post-arthroscopy hip instability. Diagnosis, treatment, and 5-year follow-up: A case report

Zárate Leal,

Bautista,

Sánchez-Vergel

2024

International Journal of Surgery Case Reports

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“…Iatrogenic hip micro‐instability may be caused by capsular insufficiency secondary to capsular over‐resection, lack of capsular closure or cam over‐resection [1, 5, 8, 27, 43]. Two studies demonstrated significantly improved patient‐reported outcomes with capsular repair or plication for hip micro‐instability at a minimum of two‐year follow‐up [27, 43].…”

Section: Discussionmentioning

confidence: 99%

Hip microinstability diagnosis and management: a systematic review

Cohen

Jean

Patel

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this systematic review is to present the most common causes, diagnostic features, treatment options and outcomes of patients with hip micro‐instability. MethodsThree online databases (MEDLINE, Embase, and PubMed) were searched from database inception March 2022, for literature addressing the diagnosis and management of patients with hip micro‐instability. Given the lack of consistent reporting of patient outcomes across studies, the results are presented in a descriptive summary fashion. ResultsOverall, there were a total of 9 studies including 189 patients (193 hips) included in this review of which 89% were female. All studies were level IV evidence with a mean MINORS score of 12 (range: 10–13). The most commonly used features for diagnosis of micro‐instability on history were anterior pain in 146 (78%) patients and a subjective feeling of instability with gait in 143 (81%) patients, while the most common feature on physical examination was the presence of anterior apprehension with combined hip extension and external rotation in 123 (65%) patients. The most common causes of micro‐instability were iatrogenic instability secondary to either capsular insufficiency or cam over‐resection in 76 (62%) patients and soft tissue laxity in 38 (31%) patients. ConclusionThe most common symptom of micro‐instability on history was anterior hip pain and on physical exam was pain with hip extension and external rotation. There are many treatment options and when managed appropriately based on the precise cause of micro‐instability, patients may demonstrate improved outcomes. Level of evidenceIV.

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“…The subsequent instability in all cases was resolved by the repair of the anterior capsule, suggesting an important stabilizing function of this ligament. 28 , 32 Another important feature of the ILFL is its microscopic composition, as when compared to the distinct characteristics of the LT and the ACL, the IL is a less specialized ligament, showing a lower level of collagen types I, III and IV, confirming its main role as a static stabilizer. 12 Similar results were confirmed by Sato et al, highlighting that the contents of elastic fibres are very rare in the ILFL, suggesting that the elastic fibre content does not relate to the functional significance of the ligament in the hip joint.…”

Section: Discussionmentioning

confidence: 99%

The role of the iliofemoral ligament as a stabilizer of the hip joint

et al. 2021

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The purpose of this systematic literature review is to analyse the role of the iliofemoral ligament (ILFL) as a hip joint stabilizer in the current literature. A total of 26 articles were included in the review. The ILFL is the largest hip ligament consisting of two distinct arms and is highly variable, both in its location and overall size, and plays a primary role in hip stability; in the case of hip dislocation, the iliofemoral ligament tear does not heal, resulting in a persistent anterior capsule defect. Clinically, the ILFL is felt to limit external rotation in flexion and both internal and external rotation in extension. The abduction–hyperextension–external rotation (AB-HEER) test is overall the most accurate test to detect ILFL lesions. Injuries of the ILFL could be iatrogenic or a consequence of traumatic hip instability, and can be accurately studied with magnetic resonance imaging. Different arthroscopic and open techniques have been described in order to preserve the ILFL during surgery and, in case of lesions, several procedures with good to excellent results have been reported in the existing literature. The current systematic review, focusing only on the ILFL of the hip, summarizes the existing knowledge on anatomy, imaging and function and contributes to the further understanding of the ILFL, confirming its key role in anterior hip stability. Future studies will have to develop clinical tests to evaluate the functionality and stability of the ILFL. Cite this article: EFORT Open Rev 2021;6:545-555. DOI: 10.1302/2058-5241.6.200112

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Iatrogenic Hip Instability After Hip Arthroscopy: Is There a Role for Open Capsular Reconstruction?

Abstract: Case: A 23-year-old female athlete presented with postoperative hip pain and laxity following 3 arthroscopic hip procedures. Conclusions: Open reconstruction of the anterior hip capsule with Achilles allograft can correct arthroscopy-induced hip laxity.

Cited by 5 publications

References 29 publications

Late post-arthroscopy hip instability. Diagnosis, treatment, and 5-year follow-up: A case report

Late post-arthroscopy hip instability. Diagnosis, treatment, and 5-year follow-up: A case report

Hip microinstability diagnosis and management: a systematic review

The role of the iliofemoral ligament as a stabilizer of the hip joint

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