Nontraumatic glenohumeral instability and coracoacromial impingement in swimmers

Competitive swimming is one of the most demanding and time-consuming sports. Swimmers at elite level practice 20–30 h per week. During 1 year's practice, the average top level swimmer performs more than 500,000 stroke revolutions per arm. These innumerable repetitions over many years of hard training together with an increasing muscular imbalance around the shoulder girdle seem to be the main etiological factors in the development of the overuse syndrome swimmer's shoulder. Shoulder pain in swimmers has in general been regarded as synonymous with coracoacromial impingement, i.e. anterior shoulder pain due to rotator cuff tendinitis, but new knowledge suggests that a concomitant glenohumeral instability plays an additional role. The diagnostic complexity of the problem is as challenging as the search for the gold standard of treatment. The condition should ideally be diagnosed as early as possible, and intensive functional rehabilitation of the shoulder girdle including the scapular muscles should be started in order to restore muscle balance. The surgical possibilities include subacromial decompression in cases of purely mechanical impingement. If a painful glenohumeral instability persists after intensive functional rehabilitation, anterior capsulolabral reconstruction can be performed. Still, however, short- and long-term results show that surgery is less successful in elite athletes involved in overhead sports. Prevention protocols include education of coaches in primary injury prophylaxis and the institution of resistance strength training in prepubescent swimmers. Emphasis should be made to improve muscular balance around the glenohumeral and scapulothoracic joints.     

Avoiding complications in arthroscopic subacromial space and instability surgery

Arthroscopic shoulder surgery has become a safe tool for evaluation and treatment of a wide range of shoulder problems with few complications. With ever-improving technology (and commitment to motor skill development among arthroscopists), we can expect to maintain this low rate despite increasing procedure complexity. Avoiding complications in arthroscopic shoulder surgery requires careful preoperative planning, judicious patient selection, a thorough understanding of arthroscopic anatomy, and facility with arthroscopic techniques.     

Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression

Femoroacetabular impingement (FAI) occurs when an osseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. Although the precise etiology of FAI is not well understood, both types of FAI are common in athletes presenting with hip pain, loss of range-of-motion, and disability in athletics. An open surgical approach to decompressing FAI has shown good clinical outcomes; however, this highly invasive approach inherently may delay or preclude a high level athlete’s return to play. The purpose of this study was to define associated pathologies and determine if an arthroscopic approach to treating FAI can allow professional athletes to return to high-level sport. Hip arthroscopy for the treatment of FAI allows professional athletes to return to professional sport. Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.     

超声介入治疗肩峰下撞击综合征疗效对比分析

目的 研究超声介入治疗肩峰下撞击综合征(SIS)患者的疗效及复发危险因素。 方法 回顾性分析92例SIS患者的临床资料,根据其超声表现进行分型,并分别采用超声引导肩峰下滑囊注射(单纯注射组)以及超声引导肩袖肌腱松解术联合肩峰下滑囊注射(联合治疗组),比较两组术后1周及1,3,6月的疗效差别。 结果两组患者术后1周及1,3,6月的VAS,CMS和OSS评分较术前均有不同程度改善,但术后6月均有复发病例,单纯注射组及联合治疗组的晚期复发率分别为34.9%及10.2%,两组差别有统计学意义(P<0.05)。 结论 对于SIS的患者,采用超声引导下介入治疗有确切的临床疗效; 但对于超声诊断为SIS 2型的患者,应采用超声引导肩袖肌腱松解术联合肩峰下滑囊注射,以降低晚期复发风险。     

膝骨关节病性髁间窝撞击症的镜下诊断与治疗

目的 探讨膝骨性关节炎合并股骨髁间窝撞击症的诊断和治疗方法.方法 关节镜下确诊合并股骨髁间窝撞击症的膝骨性关节炎患者37例43膝.采用镜下清理骨赘、股骨髁间窝扩大成形术治疗.结果 43膝均获随访,时间6～24个月.术前Lysholm评分平均61分(41～80分) ,术后平均85分(75～100分),关节功能均获明显改善(P＜0.05).结论 关节镜检查及镜下微创手术对膝骨关节病性髁间窝撞击症的诊断和治疗有着重要的价值,镜下股骨髁间窝扩大成形术是治疗该病的有效方法.     

局麻关节镜下清理术治疗踝关节大骨节病的疗效分析

目的分析关节镜清理治疗踝关节大骨节病的近期疗效。方法 2000年7月至2012年3月关节镜治疗踝关节大骨节病共44例(48踝),包括左踝18例,右踝22例,双侧4例。男性26例,女性18例,平均年龄36(23~57)岁。采用美国足踝外科协会(AOFAS)踝-后足评分系统、疼痛视觉模评分(VAS)、踝关节背伸活动度(ROM)对术前和术后3、6、12、24个月进行随访时的功能状态进行评价。结果 VAS评分术前(6.8±0.9)分,术后3、6、12、24个月时分别为(1.9±0.7)、(2.2±0.9)、(2.9±1.2)、(4.8±2.1)分,手术前后差异有统计学意义(P<0.05);AOFAS评分术前(53.6±7.4)分,术后各时间点分别为(86.6±4.9)、(83.4±6.4)、(77.0±4.7)、(67.0±5.3)分,手术前后差异有统计学意义(P<0.05);术后踝关节背伸及下蹲显著改善,关节绞锁症状消失,疼痛得到缓解,6踝术后负重行走疼痛无改善。结论局麻关节镜下清理治疗踝关节大骨节病可显著缓解踝关节疼痛,改善行走功能,延缓疾病进展,提高患者生活质量。     

Femoroacetabular impingement

Femoroacetabular impingement (FAI) is a pathomechanical concept describing the early and painful contact of morphological changes of the hip joint, both on the acetabular, and femoral head sides. These can lead clinically to symptoms of hip and groin pain, and a limited range of motion with labral, chondral and bony lesions.     

Experimentally induced cam impingement in the sheep hip

Sheep hips have a natural non‐spherical femoral head similar to a cam‐type deformity in human beings. By performing an intertrochanteric varus osteotomy, cam‐type femoro‐acetabular impingement (FAI) during flexion can be created. We tested the hypotheses that macroscopic lesions of the articular cartilage and an increased Mankin score (MS) can be reproduced by an experimentally induced cam‐type FAI in this ovine in vivo model. Furthermore, we hypothesized that the MS increases with longer ambulatory periods. Sixteen sheep underwent unilateral intertrochanteric varus osteotomy of the hip with the non‐operated hip as a control. Four sheep were sacrificed after 14, 22, 30, and 38‐weeks postoperatively. We evaluated macroscopic chondrolabral alterations, and recorded the MS, based on histochemical staining, for each ambulatory period. A significantly higher prevalence of macroscopic chondrolabral lesions was found in the impingement zone of the operated hips. The MS was significantly higher in the acetabular/femoral cartilage of the operated hips. Furthermore, these scores increased as the length of the ambulatory period increased. Cam‐type FAI can be induced in an ovine in vivo model. Localized chondrolabral degeneration of the hip, similar to that seen in humans (Tannast et al., Clin Orthop Relat Res 2008; 466: 273–280; Beck et al., J Bone Joint Surg Br 2005; 87: 1012–1018), can be reproduced. This experimental sheep model can be used to study cam‐type FAI. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 580–587, 2013     

Impingement and stability of total hip arthroplasty versus femoral head resurfacing using a cadaveric robotics model

We identified and compared the impingent‐free range of motion (ROM) and subluxation potential for native hip, femoral head resurfacing (FHR), and total hip arthroplasty (THA). These constructs were also compared both with and without soft tissue to elucidate the role of the soft tissue. Five fresh‐frozen bilateral hip specimens were mounted to a six‐degree of freedom robotic manipulator. Under load‐control parameters, in vivo mechanics were recreated to evaluate impingement free ROM, and the subluxation potential in two “at risk” positions for native hip, FHR, and THA. Impingement‐free ROM of the skeletonized THA was greater than FHR for the anterior subluxation position. For skeletonized posterior subluxations, stability for THA and FHR constructs were similar, while a different pattern was observed for specimens with soft tissues intact. FHR constructs were more stable than THA constructs for both anterior and posterior subluxations. When the femoral neck is intact the joint has an earlier impingement profile placing the hip at risk for subluxation. However, FHR design was shown to be more stable than THA only when soft tissues were intact. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1108–1115, 2013