Domb, Benjamin G.

Background Ehlers-Danlos syndrome (EDS) is a genetic disorder that affects the structural integrity of collagen within the body. This presents clinically as a connective tissue disorder with increased elasticity of joints, muscles, and ligaments. Multiple joints are affected by hypermobility and joint injury is common in these patients. It is estimated that EDS occurs once in every 5,000 births worldwide. Case review This article focuses on reconstruction of the ligamentum teres (LT) of the hip using a tibialis anterior allograft to treat severe instability and pain in a 43 year-old female with EDS. The LT reconstruction was accompanied by labral repair and capsular plication. The patient was assessed pre- and postoperatively using modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADLS), Hip Outcome Score Sports Specific Subscale (HOS-SSS), Non Arthritic Hip Score (NAHS), Visual Analog Scale (VAS), and satisfaction. One year following surgery the patient has reported positive outcomes in terms of pain and instability. Literature review Ligament reconstruction has been reported in patients with Ehlers-Danlos syndrome for shoulders and knees with positive results and restoration of stability. Currently there is a paucity of literature regarding patients with EDS undergoing hip procedures. In addition, reconstruction of the ligamentum teres for hip instability and pain has rarely been reported in a normal patient cohort. Clinical relevance This is the first study to report ligamentum teres reconstruction of the hip in a patient with Ehlers-Danlos syndrome and hip instability. The patient demonstrated satisfactory results 1 year from surgery.

Abstract Lateral hip pain along with tenderness of the greater trochanter has been associated with greater trochanteric pain syndrome. Radiographically, this has been associated with gluteus medius pathology on magnetic resonance imaging. This has led some surgeons to conclude that abductor pathology is a primary cause of lateral hip pain. Failure of conservative treatment in the setting of gluteus medius pathology may lead to surgical intervention. In some patients a focal tear of the gluteus medius cannot be visualized and likely represents more diffuse tendinopathy. In these patients we propose micropuncture of the greater trochanter. Similar procedures have shown effectiveness in the elbow and shoulder by eliciting a healing response. Our experience suggests that trochanteric micropuncture at the insertion of the gluteus medius tendon can be effectively performed endoscopically for gluteus medius tendinopathy. Technique Video video See video under supplementary data.

Purpose The purpose of this prospective comparative study was to evaluate the effect of intraoperative platelet‐rich plasma (PRP) injection on the outcomes of patients undergoing hip arthroscopy for labral treatment. Methods During the period from November 2010 through March 2012, all patients undergoing hip arthroscopy for labral tears were considered for this study. The study group received intra‐articular PRP at the end of the operation, and the control group received an intra‐articular injection of 0.25% bupivacaine. Selection for the study group was based on the day of the week on which the patient underwent surgery. The protocol included administration of 4 hip‐specific patient‐reported outcome tools. Patients also reported their pain score on a visual analog scale from 0 to 10. Scores were recorded at the preoperative visit and at 3 months and 2 years postoperatively. Results A minimum of 2 years' follow‐up was available for 306 patients. Thirteen patients (4.2%) underwent conversion to total hip arthroplasty and 24 patients (7.8%) underwent revision hip arthroscopy, which left 91 patients in the study group and 180 patients in the control group. The study group had slightly higher pain scores than the control group (3.4 v 2.5) 2 years after surgery ( P = .005). No difference in pain scores was identified at 3 months postoperatively. The 2‐year modified Harris Hip Score was slightly lower in the study group (78.6) than in the control group (82.6) ( P = .049). No significant difference was observed for the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sport‐Specific Subscale, or Non‐Arthritic Hip Score at any time point. There was no significant difference between groups for conversion to total hip arthroplasty or revision surgery. Conclusions On the basis of the results of this study, intraoperative PRP injection does not appear to improve the clinical results of patients undergoing hip arthroscopy for labral treatment. Level of Evidence Level II, prospective comparative study.

Purpose The purpose of this study was to investigate the influence of multiple demographic and radiographic findings on the size of labral tears identified at the time of hip arthroscopy. Methods Data were prospectively collected for patients treated with arthroscopic labral repair or debridement from February 2008 to August 2011. Preoperative radiographic and demographic data were collected for 392 patients during the study period. Exclusion criteria included revision surgery and previous hip conditions. An anteroposterior pelvic view, 45° Dunn view, and false‐profile view were used to measure Tönnis grade, neck‐shaft angle, alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA), acetabular inclination, and the extent of crossover sign when present. At the time of surgery, labral tear size and location were documented for all patients, using traditional acetabular clock face nomenclature for sizing. A multiple linear regression analysis was then performed to assess the correlation of radiographic and demographic findings with the size of the labral tear. Results Regression analysis displayed statistical significance for sex ( P < .0001), age ( P < .0001), and alpha angle ( P = .005) with labral tear size. For female patients, Tönnis grade ( P = .0004) and neck‐shaft angle ( P = .004) correlated with labral tear size. This model accounted for only 26% of variation in labral tear size. Conclusions Preoperative risk factors for the extent of labral tear size are male sex, increasing age, and increasing alpha angle. Labral tears were larger in female patients with higher Tönnis grades and lower neck‐shaft angles. Measurements of acetabular coverage and version showed no correlation with labral tear size. The majority of labral tear size variation was not accounted for in this model. Level of Evidence Level IV, therapeutic case series.