e196 2013 ISHA ABSTRACTS

Conclusions: Four distinct patterns of sub-spine mor-phology were observed in this cohort of patients and wereconsidered abnormal in over half of cases studied, raisingthe possibility of bony and/or soft tissue impingement inthis region. Arthroscopic signs of labral bruising and rimfractures were strongly associated with abnormal sub-spine morphology and should alert the surgeon to thepotential presence of sub-spine impingement. Re-con-touring of the sub-spine region may be necessary as partof the management of the acetabular rim in patients withFAI, having the potential for reducing bony impingementand increasing the space available for soft tissues in thisregion.

Long-Term Outcomes of Arthroscopic IliopsoasJAMES KEENE, USABRAIN LUDWIG, USA

Objectives: Short-term (one-year) results of arthroscopiciliopsoas tenotomies have documented that the procedurewill prevent recurrent, painful snapping of the tendon [1][2] [3] [4]. To date, however, the long-term results (> 3years) have not been reported. This study presents theresults of 60 consecutive patients who were evaluatedthree or more years after their iliopsoas tenotomy.

Methods: Between January 2008 and June 2009, 200patients with painful snapping hips were evaluated withMR arthrograms that included injection of the hip withbupivicaine, Omnipaque, and gadolinium. The 60 patientsreported here had minimal relief of their hip pain after theinjection and thus had an ultrasound evaluation of theirpsoas tendons that included real-time imaging and ananesthetic injections into the psoas bursa. In all 60 patients,the bursa injection relieved their pain, and in 36, ultra-sound demonstrated snapping of the tendon. All 60patients had an arthroscopic release of the tendon at thelesser trochanter.

Fluoroscopic and arthroscopic views of the thermal probeduring release of the iliopsoas tendon from the lessertrochanter.All hips were assessed with Byrd’s 100-point modifiedHarris hip scoring system prior to the release, and at 6, 12,24, and 36 months after surgery.Results: Average age of the 60 patients was 35 years, andtheir preoperative scores averaged 42 points. After surgery,patients had hip flexor weakness, used crutches for 2 to 4weeks, and had 6-week scores that averaged 68 points.Their scores continued to improve, and at 6 months aver-aged 88 points, and at 12 months averaged 90 points(range, 45-100 points). The patient with 45 points hada total hip replacement 14 months after the release due toincreasing hip pain from his DJD. At 24 months, the scoresof the remaining 59 patients averaged 90 points (range,59-100 points). Three patients had a second arthroscopiciliopsoas tenotomy performed 15, 18, and 25 months afterthe first release to treat recurrent snapping of the tendon.The scores of these three patients one year after the secondrelease were 81, 84, and 96 points, respectively, and theyhad not experienced any further snapping of the tendon.At a minimum follow-up of 36 months, the scores of the 56patients that had not had a second surgery averaged 91points (range, 65-100 points).Conclusions: An arthroscopic release of the iliopsoastendon from the lesser trochanter is a safe, outpatientprocedure that will provide long-term (> 3 years) relieffrom painful snapping of the tendon. In 3 cases (5%),painful snapping of the tendon recurred, and a secondarthroscopic lesser trochanteric tenotomy was required topermanently relieve the snapping and pain. There were nocases of post-tenotomy heterotopic ossification in this seriesof patients.

Pelvic Incidence and Femoroacetabular Impinge-ment - A Novel Relationship MICHAEL HELLMAN, USABRYAN HAUGHOM, USANICHOLAS BROWN, USAYALE FILLINGHAM, USAMICHAEL SALATA, USASHANE NHO, USA

Objectives: Pelvic Incidence (PI) is a fixed anatomicparameter that plays an integral role in the sagittal balanceof the spine and in maintaining stable posture whileexpending a minimum of energy - conus of economy.While PI has been studied in relation to the spine, PI hasyet to be studied as it relates to disorders of the hip. Wepropose that abnormal PI is associated with femo-roacetabular impingement (FAI).Methods: We performed a retrospective analysis of 50consecutive patients (60 hips) who underwent hiparthroscopy for labral tears secondary to FAI. There were31 women and 19 men. The average age was 33.1�8.7. Allpatient’s underwent hip CT evaluation as well as plainradiographs. PI, acetabular version (AV) at a 3-o’clockposition, alpha- angle, center-edge angle (CEA) andacetabular index (AI) were all measured. The PI wasmeasured using scout lateral radiographs from the CT scan.Cam Impingement was defined as a bump on the head