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Scope on the hip Labrale letsesl Zeist 24 april 2013

Scope on the hip Labrale letsesl Zeist 24 april 2013. Dr J De Schepper AZ Nikolaas – Sint-Niklaas www.orthopedieregentie.be. Groin pain in athletes. J Am Acad Orthop Surg. 2007 Aug;15(8):507-14 Sports hernia Imbalance in trunk stabilizers and adductor muscles

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Scope on the hip Labrale letsesl Zeist 24 april 2013

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  1. Scope on the hipLabrale letseslZeist 24 april 2013 Dr J De Schepper AZ Nikolaas – Sint-Niklaas www.orthopedieregentie.be

  2. Groin pain in athletes • J Am Acad Orthop Surg. 2007 Aug;15(8):507-14 • Sports hernia • Imbalance in trunk stabilizers and adductor muscles • Soccer, hockey, hurdling, running

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

  4. Groin pain in athletes Intra-articular Cause for pain Extra-articular Cause for pain

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

  6. Heup arthroscopie

  7. Anatomie Centraal compartiment Perifeer compartiment

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

  9. Heup arthroscopie

  10. Heup arthroscopie INDICATIES : KRAAKBEENLETSELS Traumatische letsels Impactietrauma

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

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

  13. cam - impingement Notzli’s angle ????

  14. Consequences • labral tears • wave sign • delaminated cartilage • early arthritis

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

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

  17. cam - impingement CAM FAI: intact labrum + wave sign

  18. cam - impingement

  19. Concept of femoro-acetabular impingementFAI pincer - impingement acetabular retroversion cross-over sign

  20. pincer - impingement

  21. pincer - impingement Pincer FAI • Acetabular origin • Acetabular overcoverage • Coxa profunda • Protrusio acetabuli

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

  23. Often combined impingement

  24. 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

  25. Clinical features of FAI • Testen • Faber

  26. Clinical features of FAI • Testen • Mc Carthy

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

  28. Standard X-Rays Standard radiography: standing AP pelvis • 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

  29. Standard X-rays Value of correct positioning tilt rotatie

  30. Standard X-rays • Standardradiography: 3/4 • Lateral neck

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

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

  33. Standard X-rays Pincer FAI • Acetabular origin • Acetabular overcoverage • Coxo profunda • Protrusio acetabuli

  34. 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

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

  36. Arthro-MRI findings 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.

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

  38. Treatment of FAI Resectie door surgical dislocation (Ganz)

  39. Treatment of FAI

  40. Heup arthroscopie COMPLICATIES Villar, Clin Orthop, Jan 2003 1054 gevallen 1,4 % • Neuropraxie, skin necrosis • Bloeding portals of hematoomvorming • Trochanter bursitis • Breuk instrumentarium • Infectie

  41. Scope on the hip Scope in the hip

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