PMID- 32898429
OWN - NLM
STAT- MEDLINE
DCOM- 20210114
LR  - 20210114
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 48
IP  - 12
DP  - 2020 Oct
TI  - Arthroscopic Management of Subspinous Impingement in Borderline Hip Dysplasia and 
      Outcomes Compared With a Matched Cohort With Nondysplastic Femoroacetabular 
      Impingement.
PG  - 2919-2926
LID - 10.1177/0363546520951202 [doi]
AB  - BACKGROUND: Arthroscopic management of femoroacetabular impingement (FAI) in the 
      setting of borderline hip dysplasia is controversial. Recently, there has been 
      increased awareness of a prominent anterior inferior iliac spine (AIIS) resulting 
      in subspinous impingement. PURPOSE/HYPOTHESIS: The purpose was to report outcomes 
      of arthroscopic subspinous decompression in patients with symptomatic hip 
      impingement and borderline hip dysplasia compared with a matched cohort with 
      nondysplastic FAI. Addressing a prominent subspinous region and cam/pincer lesion 
      in the borderline dysplastic hip may lead to favorable outcomes comparable with 
      those of patients undergoing arthroscopic management of nondysplastic FAI. STUDY 
      DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients with symptomatic 
      hip impingement, borderline dysplasia (lateral center-edge angle [LCEA], 
      18 degrees -24 degrees ), and prominent AIIS (BDSI group) whose nonoperative management failed 
      and who subsequently underwent arthroscopic subspinous decompression were 
      retrospectively identified. Three-dimensional computed tomography imaging was 
      used to categorize AIIS morphology into type 1, 2, or 3 (Hetsroni 
      classification). Patient-reported outcome (PRO) scores consisting of the modified 
      Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), 
      and Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) were obtained 
      preoperatively and at an average of 44 months postoperatively (range, 23-61 
      months). Exclusion criteria were Tonnis osteoarthritis grade >1 and a history of 
      previous hip procedures. An age-, sex-, and body mass index-matched cohort of 
      patients without dysplasia (LCEA, >25 degrees ) who underwent arthroscopic FAI surgery 
      with a minimum 2-year follow-up were selected to serve as the control group. 
      RESULTS: Eighteen patients, 19 hips (14 women and 4 men; average age, 28 years) 
      were included. Of the 19 hips in the BDSI group, the average LCEA and alpha angle 
      were 21.8 degrees  and 66.2 degrees , respectively; 14 hips were Hestroni type 2, and 5 hips were 
      type 1. There were no postoperative complications or additional procedures 
      performed since the last follow-up. Repeated-measures analysis of variance 
      revealed a significant improvement in all PRO scores from preoperatively to the 
      last follow-up: mHHS, 64.7 to 87.7 (P < .001); HOS-ADL, 62.1 to 92.1 (P < .001); 
      HOS-SSS, 26.5 to 87.1 (P < .001). An analysis of covariance revealed that 
      patients with type 2 AIIS had a significantly higher postoperative mHHS than 
      those with a type 1 morphology (88.3 and 95.6, respectively; P < .01) The BDSI 
      group had a significantly lower preoperative HOS-SSS (26.5; P < .001) in 
      comparison with the control group. However, there was no significant difference 
      in postoperative outcome scores between groups. The BDSI group underwent 
      significantly more microfracture, capsular plication, and ligamentum teres 
      debridement (15.8%; P = .04). CONCLUSION: Arthroscopic AIIS decompression in 
      patients with coexisting borderline dysplasia and subspinous impingement is a 
      safe and effective method of treatment that produces outcomes comparable with 
      those of a cohort with nondysplastic FAI.
FAU - Feghhi, Daniel
AU  - Feghhi D
AD  - Lenox Hill Hospital, New York, New York, USA.
FAU - Shearin, Jonathan
AU  - Shearin J
AD  - Lenox Hill Hospital, New York, New York, USA.
FAU - Bharam, Srino
AU  - Bharam S
AD  - Lenox Hill Hospital, New York, New York, USA.
LA  - eng
PT  - Journal Article
DEP - 20200908
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Activities of Daily Living
MH  - Adult
MH  - *Arthroscopy
MH  - Female
MH  - *Femoracetabular Impingement/surgery
MH  - *Hip Dislocation
MH  - Hip Joint/surgery
MH  - Humans
MH  - Male
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - borderline dysplasia
OT  - femoroacetabular impingement
OT  - hip arthroscopy
OT  - subspinous impingement
EDAT- 2020/09/09 06:00
MHDA- 2021/01/15 06:00
CRDT- 2020/09/08 20:07
PHST- 2020/09/09 06:00 [pubmed]
PHST- 2021/01/15 06:00 [medline]
PHST- 2020/09/08 20:07 [entrez]
AID - 10.1177/0363546520951202 [doi]
PST - ppublish
SO  - Am J Sports Med. 2020 Oct;48(12):2919-2926. doi: 10.1177/0363546520951202. Epub 
      2020 Sep 8.