The predominant insertion of the ischiofemoral ligament is a merging to the iliofemoral ligament as demonstrated on magnetic resonance arthrogram studies.

Background: The capsular ligaments at the hip joint work in synchrony with the acetabulum and femoral head for articular stability. There is a lack of understanding about ischiofemoral ligament (ISFL) anatomy and function.

Purpose: To assess the insertion of the ISFL in non-arthritic adult hips.

Imaging changes following surgery for ischiofemoral impingement.

Partial resection of the lesser trochanter (LT plasty) has been increasingly recommended to treat ischiofemoral impingement. However, there is a lack of studies on the imaging findings following LT plasty. The purpose of this study was to assess magnetic resonance imaging (MRI) changes on the lesser trochanter and surrounding musculotendinous structures following LT plasty to treat ischiofemoral impingement.

Anterior Electronic Hip Pain Drawings Are Helpful for Diagnosis of Intra-articular Sources of Pain: Lateral or Posterior Drawings Are Unreliable.

Purpose: The purpose of this study was to determine the accuracy of electronic hip pain drawing to diagnose intra-articular source of pain in nonarthritic hips, defined by response to an intra-articular injection.

Methods: A retrospective assessment was performed in consecutive patients who had an intra-articular injection completed within a 1-year period. Patients were classified as responders or nonresponders to intra-articular hip injection.

Hip physical examination extension loss and radiographic osseous findings in patients with low back pain and nonarthritic hips.

The association between hip and spine abnormalities is frequent, and limitation in hip extension has been linked with low back pain. The purpose of this study was to assess the radiographic osseous findings in nonarthritic hips of patients with hip pain, low back pain, and limited hip extension. Ninety patients (92 hips) were included in this study.

Usefulness of magnetic resonance imaging to diagnose greater trochanteric-ischial impingement.

Extra-articular impingement between the femur and ischium is increasingly recognized as a cause of hip pain. The purpose of this study was to assess the diagnostic parameters for greater trochanteric-ischial impingement (GTI) in magnetic resonance imaging (MRI) studies. Seven patients (seven hips) diagnosed with GTI were retrospectively identified.

Iliopsoas Muscle/Tendon Proportions at Three Levels of Described Arthroscopic Tenotomy: An Anatomic Study in Fresh Cadaveric Specimens.

Purpose: To calculate the iliopsoas muscle/tendon ratio at 3 levels of arthroscopic iliopsoas tenotomy sites in fresh cadaveric specimens.

Methods: An anatomic study design was performed using 16 iliopsoas musculotendinous units from the level of the hip joint to their insertion on the lesser trochanter. All specimens came from 16 fresh cadaveric specimens (10 male, 6 female), with a median age of 41 years (range 31-55.

A biomechanical analysis of ischiofemoral impingement in a cadaver model.

Ischiofemoral impingement (IFI) occurs due to the diminishing of space between the ischium and lesser trochanter. During a robotic hip study, one hip presented with indications of IFI, an opportunity to explore the pathophysiology and treatment strategies for this unusual condition. This specimen underwent kinematic tests in two states: (i) native lesser trochanter and (ii) resected lesser trochanter.

Pain management practice patterns after hip arthroscopy: an international survey.

Several post-operative pain control methods have been described for hip arthroscopy including systemic medications, intra-articular or peri-portal injection of local anesthetics and peripheral nerve blocks. The diversity of modalities used may reflect a lack of consensus regarding an optimal approach. The purpose of this investigation was to conduct an international survey to assess pain management patterns after hip arthroscopy.

Hip-spine syndrome: rationale for ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion leading to low back pain.

The term 'hip-spine syndrome' was introduced in recognition of the frequent occurrence of concomitant symptoms at the hip and lumbar spine. Limitations in hip range of motion can result in abnormal lumbopelvic mechanics. Ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion are increasingly linked to abnormal hip and spinopelvic biomechanics.

Frequency of ischiofemoral space discrepancy when comparing magnetic resonance images of distinct institutions for the same patient.

Inaccuracy of ischiofemoral space (IFS) measurement may result in radiographic misdiagnosis of ischiofemoral impingement, as well as insufficient or excessive osseous resection when surgery is indicated. This study compared the IFS measured in magnetic resonance imaging (MRI) performed in distinct health services for the same patient. Sixty-five patients (95 hips) who had hip MRI performed at an outside institution (noncontrolled MRI) followed by a hip MRI with lower extremity positioning reproducing the standing position (controlled MRI) were studied.

Low Back Pain Improves After Surgery for Lesser Trochanteric-Ischial Impingement.

Purpose: To assess the effects of surgery for lesser trochanteric-ischial impingement (LTI) on low back pain.

Methods: The records of patients with LTI who underwent endoscopic partial resection of the lesser trochanter (LT) between May of 2017 and February of 2019 were reviewed. Inclusion criteria were the presence of low back pain in association with hip pain, diagnosis of LTI, and partial resection of the LT to treat LTI.

Anteroinferior Hip Instability in Flexion During Dynamic Arthroscopic Examination Is Associated With Abnormal Anterior Acetabular Horn.

Background: The stabilization of the femoral head is provided by the distal acetabulum when the hip is in a flexed position. However, the osseous parameters for the diagnosis of hip instability in flexion are not defined.

Purpose/hypothesis: To determine whether the osseous parameters of the distal acetabulum are different in hips demonstrating anteroinferior subluxation in flexion under dynamic arthroscopic examination, compared with individuals without hip symptoms.

Spinopelvic Parameters Do Not Predict the Sagittal Orientation of the Acetabulum.

Background: The orientation of the acetabulum has a fundamental role in impingement and instability of the hip, and the spinopelvic parameters are thought to predict the sagittal orientation of the acetabulum (SOA). However, similar to the acetabular version (axial orientation) and inclination (coronal orientation), the cephalic or caudal orientation of the acetabulum in the sagittal plane, or SOA, may primarily be an intrinsic feature of the acetabulum itself.

Purpose: To determine whether the spinopelvic parameters predict the sagittal orientation of the acetabulum in individuals without lumbar deformity.

Carbon dioxide gas endoscopy of the deep gluteal space.

The treatment of hip and pelvic pain associated with abnormalities of the deep gluteal space has evolved and increasingly involves endoscopic techniques with a saline expansion medium. This investigation presents a surgical technique utilizing carbon dioxide as the insufflation medium for deep gluteal space endoscopy in 17 cadaveric hips. This technique was successful in 94% (16/17) of the hips, allowing for visualization of the sciatic nerve, posterior femoral cutaneous nerve, pudendal nerve, branch of the inferior gluteal artery crossing the sciatic nerve, piriformis muscle, hamstring tendon origin, and lesser trochanter.

Postoperative Deep Gluteal Syndrome After Hip Arthroscopic Surgery.

Background: Deep gluteal syndrome (DGS) is an uncommon source of buttock and groin pain, resulting from entrapment of the sciatic nerve in the deep gluteal space. The incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery are currently unknown.

Purpose: To investigate the incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery.

Preemptive analgesia in hip arthroscopy: intra-articular bupivacaine does not improve pain control after preoperative peri-acetabular blockade.

Introduction: Literature addressing postoperative pain management after hip arthroscopy is relatively scarce. This study aimed to assess if there was added analgesic benefit associated with postoperative intra-articular bupivacaine blockade for patients who received preoperative peri-acetabular blockade for hip arthroscopy procedures.

Methods: 52 patients were included in this comparative cohort study.

Femoral Derotation Osteotomy Improves Hip and Spine Function in Patients With Increased or Decreased Femoral Torsion.

Purpose: To evaluate the outcomes of proximal femoral derotation osteotomy (PFDO) on the hip and spine function of patients with abnormal femoral torsion.

Methods: This retrospective study included patients who underwent PFDO to treat increased or decreased femoral torsion between July 2014 and February 2019. The exclusion criteria were: previous fracture, fixation of slipped capital femoral epiphysis or osteotomy in the ipsilateral femur; PFDO associated to varus or valgus osteotomy; Tönnis grade 2 or 3 osteoarthritis; and PFDO performed to treat knee abnormalities.

Snapping of the Sciatic Nerve and Sciatica Provoked by Impingement Between the Greater Trochanter and Ischium: A Case Report.

Case: A 64-year-old woman developed worsening sciatica associated with snapping at the hip over a period of 4 years. The physical examination and dynamic ultrasound revealed the snapping of the sciatic nerve (SN) provoked by impingement between the greater trochanter (GT) and the ischium. Additional imaging studies demonstrated hyperintense signal in the SN at the hip, sagittal imbalance, decreased ischiofemoral space, and increased femoral torsion.

Proximal iliotibial band thickness as a cause for recalcitrant greater trochanteric pain syndrome.

To investigate iliotibial band (ITB) diameter thickness at the greater trochanter in patients requiring iliotibial band release who have failed conservative modalities, in comparison to an asymptomatic patient population. A total of 68 subjects were selected to be reviewed using T2 axial plane MRI. The ITB diameter thickness was measured in 34 subjects who underwent surgical ITB release, and compared with a match-paired asymptomatic hip cohort consisting of 34 subjects.

A MECHANISM FOR LIGAMENTUM TERES INJURIES IN FEMOROACETABULAR IMPINGEMENT: AN ANATOMICAL STUDY.

Background: Femoroacetabular impingement can produce abnormal biomechanics that lead to compensatory injuries around the hip and pelvis. Ligamentum teres pathologies are commonly associated with these bony deformities but a mechanism for injury has not been described in the literature.

Purpose: The purpose of this study was to describe a potential mechanism behind ligamentum teres injury and impingement between the femoral neck and acetabulum.

Current Concepts Review: Evaluation and Management of Posterior Hip Pain.

Understanding the etiology of and evolving research on intra- and extra-articular hip complaints requires comprehensive diagnosis and management of the spectrum of posterior hip diseases. Interest in posterior hip disorders has increased in recent years as new studies and theories have emerged regarding the disease process. Although most of the differential diagnoses around the posterior hip have traditionally been considered uncommon, recent reports suggest that these complaints have instead been commonly overlooked.

Editorial Commentary: Hip Labral Revision Reconstruction in a Fellowship Training Center: A Report From the Mountains.

Hip labral reconstruction has proven to be a successful technique in restoring normal labrum function. However, sometimes revision surgery is required. A recent, well-designed prospective study provides significant support for revision labral reconstruction, showing how it leads to improved hip mechanics and reduction in pain.

Incorporating Hip Arthroscopy Into A Practice.

Hip arthroscopy is one of the most rapidly growing areas in orthopaedic surgery because of increased awareness of nonarthritic hip pathologies, advanced imaging modalities, and advanced techniques to reproducibly manage nonarthritic hip pathologies within a deep soft-tissue envelope and a constrained joint. In addition, more academic medical centers are providing residents with education on hip arthroscopy, and many hip preservation fellowships and courses are helping increase awareness of nonarthritic hip pathologies. Nonarthritic hip pathologies currently managed via hip arthroscopy include nonrepairable labral lesions, femoroacetabular impingement, hip instability, and hip fractures.