Arthroscopy

Internal snapping hip

Cause

 

Movement of iliopsoas tendon over femoral head / iliofemoral ridge / iliofemoral ligament

 

Can be seen following THA with cup impingement

 

Symptoms

 

Audible or palpable snap in the groin

 

Hip moves

- from flexed / abducted / externally rotated position

- to extended / internally rotated position

 

Incidence

 

10% of the population - usually painless

PVNS

Definition

 

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

 

Epidemiology

 

Age: 20 - 50

Sex: M > F

 

Types

 

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully

 

Background

Intact PCL

Anatomy

 

Size

 

2 x as strong as ACL

About the same length as ACL 38 mm

 

Cross sectional area 150% of ACL

13 mm diameter (thicker) 

 

2 Bundles

 

1.  Anterolateral

- most important

- double the size of the posteromedial

- tight in flexion

- try to reconstruct this bundle

External snapping hip

Causes

 

Most common

- fascia lata on greater trochanter

- iliopsoas on lesser trochanter

 

1.  Intra-articular structures

- labrum

- ligamentum Teres

- loose bodies

- synovial chondromatosis

- osteochondoma

 

2.  Extra-articular structures

- fascia lata on greater trochanter (common) 

Management

Management Summary

 

Stage 0

 

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

 

Stage 1 / Normal X-ray, abnormal MRI

 

Forage: 80% G/E

Bisphosphonates

 

Stage 2 / Abnormal X-ray with cysts and sclerosis

 

A:  As for Stage I