Abstract
Purpose
This study was designed to (1) evaluate the clinical outcomes after arthroscopic subspinal decompression in patients with hip impingement symptoms and low AIIS, and to (2) assess the presence of low anterior inferior iliac spine on the pre-operative radiographs of patients with established subspinal impingement diagnosed intra-operatively.
Methods
Retrospective analysis of patients who underwent arthroscopic subspinal decompression has been performed. The indications for surgery were femoroacetabular impingement (FAI), or subspinal impingement. Pre-operative radiographs were assessed for anterior inferior iliac spine type. Intra-operative diagnosis of low anterior inferior iliac spine was based on the level of anterior inferior iliac spine extension relative to the acetabulum and the presence of reciprocal labral and chondral lesions. In patients where low anterior inferior iliac spine was not diagnosed on pre-operative radiographs, the pre-operative radiographs were re-read retrospectively to assess missed signs of low anterior inferior iliac spine.
Results
Thirty-four patients underwent arthroscopic subspinal decompression between 2012 and 2015. The patients were followed for a median of 25 months (13–37 months). Intra-operatively, grade 2 anterior inferior iliac spine was found in 27 patients and grade 3 anterior inferior iliac spine was found in 7 patients. MHHS, HOS, and HOSS scores increased from median (range) pre-operative scores of 55 (11–90), 48 (20–91) and 20 (0–80) to 95 (27–100), 94 (30–100) and 91 (5–100), respectively (p < 0.0001, p = 0.001, p < 0.0001, respectively). Pre-operative diagnosis of low AIIS was made in 6/34 patients via AP radiographs. On retrospective analysis of pre-operative radiographs, signs of low AIIS were still not observed in 21/34 (61.8%) patients.
Conclusions
Arthroscopic subspinal decompression of low AIIS yielded significantly improved outcome measures and high patient satisfaction at a minimum of 13 months follow-up. Low AIIS is often under-diagnosed on AP pelvis and lateral frog radiographs and if left untreated, may result in unresolved symptoms and failed procedure.
Level of evidence
IV.
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References
Amar E, Druckmann I, Flusser G, Safran MR, Salai M, Rath E (2013) The anterior inferior iliac spine: size, position, and location. An anthropometric and sex survey. Arthroscopy 29:874–881
Amar E, Warschawski Y, Sharfman ZT, Martin HD, Safran MR, Rath E (2016) Pathological findings in patients with low anterior inferior iliac spine impingement. Surg Radiol Anat 38:569–575
Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R (2004) Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 418:67–73
Byrd JW (2007) Evaluation of the hip: history and physical examination. N Am J Sports Phys Ther 2:231–240
Hapa O, Bedi A, Gursan O, Akar MS, Guvencer M, Havitcioglu H et al (2013) Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression. Arthroscopy 29:1932–1940
Hetsroni I, Larson CM, Dela Torre K, Zbeda RM, Magennis E, Kelly BT (2012) Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy 28:1644–1653
Hetsroni I, Poultsides L, Bedi A, Larson CM, Kelly BT (2013) Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res 471:2497–2503
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Larson CM, Kelly BT, Stone RM (2011) Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy 27:1732–1737
Mai C, Michel A, Claikens B, Van Wettere P (2013) Avulsion fracture of the anterior inferior iliac spine. JBR-BTR 96:240–241
Matsuda DK, Calipusan CP (2012) Adolescent femoroacetabular impingement from malunion of the anteroinferior iliac spine apophysis treated with arthroscopic spinoplasty. Orthopedics 35:e460-463
Morales-Avalos R, Leyva-Villegas JI, Sánchez-Mejorada G, Méndez-Aguirre O, Galindo-Aguilar OU, Quiroga-Garza A et al (2015) A new morphological classification of the anterior inferior iliac spine: relevance in subspine hip impingement. Int J Morphol 33:626–631
Pan H, Kawanabe K, Akiyama H, Goto K, Onishi E, Nakamura T (2008) Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine. J Bone Joint Surg Br 90:677–679
Philippon MJ, Michalski MP, Campbell KJ, Goldsmith MT, Devitt BM, Wijdicks CA et al (2014) An anatomical study of the acetabulum with clinical applications to hip arthroscopy. J Bone Joint Surg Am 96:1673–1682
Rajasekhar C, Kumar KS, Bhamra MS (2001) Avulsion fractures of the anterior inferior iliac spine: the case for surgical intervention. Int Orthop 24:364–365
Ross JR, Bedi A, Clohisy JC, Gagnier JJ, Group AS, Larson CM (2016) Surgeon willingness to participate in randomized controlled trials for the treatment of femoroacetabular impingement. Arthroscopy 32:20e23–24e23
Rossi F, Dragoni S (2001) Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skelet Radiol 30:127–131
Schindler BR, Venderley MB, Mikula JD, Chahla J, Dornan GJ, Turnbull TL et al (2017) Comparison of radiographs and computed tomography for the screening of anterior inferior iliac spine impingement. Arthroscopy 33:766–772
Sharfman ZT, Grundshtein A, Paret M, Amit L, Amar E, Rath E (2016) Surgical technique: arthroscopic osteoplasty of anterior inferior iliac spine for femoroacetabular impingement. Arthrosc Tech 5:e601–606
Tonnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81:1747–1770
Zaltz I, Kelly BT, Hetsroni I, Bedi A (2013) The crossover sign overestimates acetabular retroversion. Clin Orthop Relat Res 471:2463–2470
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MF participated in acquisition of data, analysis and interpretation of data, and wrote the manuscript. EA is an equal contributor to this paper. He participated in the design of the study and performed the statistical analysis, and helped with writing the manuscript. RA participated in acquisition of data, analysis and interpretation of data. ZS participated in acquisition of data, analysis and interpretation of data, and helped with writing the manuscript. BH participated in acquisition of data, analysis and interpretation of data. GE participated in acquisition of data, analysis and interpretation of data. ER conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
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All procedures performed in the study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.
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Informed consent was obtained from all individual participants included in the study.
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Michal, F., Amar, E., Atzmon, R. et al. Subspinal impingement: clinical outcomes of arthroscopic decompression with one year minimum follow up. Knee Surg Sports Traumatol Arthrosc 28, 2756–2762 (2020). https://doi.org/10.1007/s00167-018-4923-5
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DOI: https://doi.org/10.1007/s00167-018-4923-5