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Rectus Femoris Tendon Calcification: Arthroscopic Excision in 6 Top Amateur Athletes.

Zini R, Panascì M, Papalia R, Franceschi F, Vasta S, Denaro V - Orthop J Sports Med (2014)

Bottom Line: To assess whether arthroscopic excision of calcification of the proximal rectus is a safe and effective treatment.Statistical analysis showed significant improvement of the Oxford Hip Score, the Modified Harris Hip Score, and all 3 VAS subscales (pain, SAL, and ADL) from pre- to latest postoperative assessment (P < .05).The recent improvements in hip arthroscopy give the opportunity to address an increasing number of hip conditions effectively and safely, with rapid recovery for the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic and Trauma Surgery, Gvm Care and Research Hospital and Clinics, Ravenna, Italy.

ABSTRACT

Background: Since it was developed, hip arthroscopy has become the favored treatment for femoroacetabular impingement. Due to recent considerable improvements, the indications for this technique have been widely extended. Injuries of the rectus femoris tendon origin, after an acute phase, could result in a chronic tendinopathy with calcium hydroxyapatite crystal deposition, leading to pain and loss of function. Traditionally, this condition is addressed by local injection of anesthetic and corticosteroids or, when conservative measures fail, by open excision of the calcific lesion by an anterior approach.

Purpose: To assess whether arthroscopic excision of calcification of the proximal rectus is a safe and effective treatment.

Study design: Case series; Level of evidence, 4.

Methods: Outcomes were studied from 6 top amateur athletes (age range, 30-43 years; mean, 32.6 years) affected by calcification of the proximal rectus who underwent arthroscopic excision of the calcification. Patients were preoperatively assessed radiographically, and diagnosis was confirmed by a 3-dimensional computed tomography scan. To evaluate the outcome, standardized hip rating scores were used pre- and postoperatively (at 6 and 12 months): the Hip disability and Osteoarthritis Outcome Score, Oxford Hip Score, and Modified Harris Hip Score. Moreover, visual analog scales (VAS) for pain, sport activity level (SAL), and activities of daily living (ADL) were also used.

Results: One year after surgery, all patients reported satisfactory outcomes, with 3 of 6 rating their return-to-sport level as high as preinjury level, and the remaining 3 with a percentage higher than 80%. Five patients ranked their ability to carry on daily activities at 100%. Statistical analysis showed significant improvement of the Oxford Hip Score, the Modified Harris Hip Score, and all 3 VAS subscales (pain, SAL, and ADL) from pre- to latest postoperative assessment (P < .05).

Conclusion: Arthroscopic excision of rectus femoris tendon calcification yields satisfying results with few risks to the patient as well as rapid recovery.

Clinical relevance: The recent improvements in hip arthroscopy give the opportunity to address an increasing number of hip conditions effectively and safely, with rapid recovery for the patient. Arthroscopic excision of rectus femoris tendon calcification can be considered a feasible option, with few risks to the patient, rapid recovery, and satisfying outcomes.

No MeSH data available.


Related in: MedlinePlus

Axial radiographic view of a right hip. The tendon appears calcified in its proximal insertion.
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fig2-2325967114561585: Axial radiographic view of a right hip. The tendon appears calcified in its proximal insertion.

Mentions: Six consecutive male patients presented to Gvm Care and Research Hospital and Clinics (Ravenna, Italy) between September 2009 and July 2012 for chronic (>6 months) pain and impaired function of the hip, unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs). All patients were top amateur athletes (soccer players, 2-3 games per week). None had a history of previous hip issues or any other injury of note. Patients complained of pain at the anterolateral aspect of the hip, difficulty with weightbearing, and limited hip extension, preferring to hold the affected hip with 10° to 30° of flexion. A standard radiograph showed an HC close to the superior aspect of the acetabulum (Figures 1 and 2). To exclude other pathologies, sedimentation rates, C-reactive protein, rheumatoid latex test, serum uric acid level, white blood cell count, and blood chemistry were all investigated. A computed tomography scan was performed in all patients. Blood tests showed values within normal limits, except for C-reactive protein levels, which showed slightly higher values than normal (mean, 2.01 mg/dL; range, 0.85-2.56 mg/dL). Computed tomography scans confirmed the presence of a calcification of the direct head of the rectus femoris. Patients were therefore indicated for arthroscopic excision of the HC. Concomitant pathologies and relative treatment procedures are reported in Table 1.


Rectus Femoris Tendon Calcification: Arthroscopic Excision in 6 Top Amateur Athletes.

Zini R, Panascì M, Papalia R, Franceschi F, Vasta S, Denaro V - Orthop J Sports Med (2014)

Axial radiographic view of a right hip. The tendon appears calcified in its proximal insertion.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555532&req=5

fig2-2325967114561585: Axial radiographic view of a right hip. The tendon appears calcified in its proximal insertion.
Mentions: Six consecutive male patients presented to Gvm Care and Research Hospital and Clinics (Ravenna, Italy) between September 2009 and July 2012 for chronic (>6 months) pain and impaired function of the hip, unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs). All patients were top amateur athletes (soccer players, 2-3 games per week). None had a history of previous hip issues or any other injury of note. Patients complained of pain at the anterolateral aspect of the hip, difficulty with weightbearing, and limited hip extension, preferring to hold the affected hip with 10° to 30° of flexion. A standard radiograph showed an HC close to the superior aspect of the acetabulum (Figures 1 and 2). To exclude other pathologies, sedimentation rates, C-reactive protein, rheumatoid latex test, serum uric acid level, white blood cell count, and blood chemistry were all investigated. A computed tomography scan was performed in all patients. Blood tests showed values within normal limits, except for C-reactive protein levels, which showed slightly higher values than normal (mean, 2.01 mg/dL; range, 0.85-2.56 mg/dL). Computed tomography scans confirmed the presence of a calcification of the direct head of the rectus femoris. Patients were therefore indicated for arthroscopic excision of the HC. Concomitant pathologies and relative treatment procedures are reported in Table 1.

Bottom Line: To assess whether arthroscopic excision of calcification of the proximal rectus is a safe and effective treatment.Statistical analysis showed significant improvement of the Oxford Hip Score, the Modified Harris Hip Score, and all 3 VAS subscales (pain, SAL, and ADL) from pre- to latest postoperative assessment (P < .05).The recent improvements in hip arthroscopy give the opportunity to address an increasing number of hip conditions effectively and safely, with rapid recovery for the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic and Trauma Surgery, Gvm Care and Research Hospital and Clinics, Ravenna, Italy.

ABSTRACT

Background: Since it was developed, hip arthroscopy has become the favored treatment for femoroacetabular impingement. Due to recent considerable improvements, the indications for this technique have been widely extended. Injuries of the rectus femoris tendon origin, after an acute phase, could result in a chronic tendinopathy with calcium hydroxyapatite crystal deposition, leading to pain and loss of function. Traditionally, this condition is addressed by local injection of anesthetic and corticosteroids or, when conservative measures fail, by open excision of the calcific lesion by an anterior approach.

Purpose: To assess whether arthroscopic excision of calcification of the proximal rectus is a safe and effective treatment.

Study design: Case series; Level of evidence, 4.

Methods: Outcomes were studied from 6 top amateur athletes (age range, 30-43 years; mean, 32.6 years) affected by calcification of the proximal rectus who underwent arthroscopic excision of the calcification. Patients were preoperatively assessed radiographically, and diagnosis was confirmed by a 3-dimensional computed tomography scan. To evaluate the outcome, standardized hip rating scores were used pre- and postoperatively (at 6 and 12 months): the Hip disability and Osteoarthritis Outcome Score, Oxford Hip Score, and Modified Harris Hip Score. Moreover, visual analog scales (VAS) for pain, sport activity level (SAL), and activities of daily living (ADL) were also used.

Results: One year after surgery, all patients reported satisfactory outcomes, with 3 of 6 rating their return-to-sport level as high as preinjury level, and the remaining 3 with a percentage higher than 80%. Five patients ranked their ability to carry on daily activities at 100%. Statistical analysis showed significant improvement of the Oxford Hip Score, the Modified Harris Hip Score, and all 3 VAS subscales (pain, SAL, and ADL) from pre- to latest postoperative assessment (P < .05).

Conclusion: Arthroscopic excision of rectus femoris tendon calcification yields satisfying results with few risks to the patient as well as rapid recovery.

Clinical relevance: The recent improvements in hip arthroscopy give the opportunity to address an increasing number of hip conditions effectively and safely, with rapid recovery for the patient. Arthroscopic excision of rectus femoris tendon calcification can be considered a feasible option, with few risks to the patient, rapid recovery, and satisfying outcomes.

No MeSH data available.


Related in: MedlinePlus