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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

 Arthroscopic view showing the decompression.
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fig7-2325967114561585:  Arthroscopic view showing the decompression.

Mentions: A standard fracture table was used with the patient in a supine position.4 The operative limb was placed with the hip in slight abduction and internal rotation. The contralateral limb was positioned in extension and neutral rotation, with the foot in a support applying a counterbalancing traction. Countertraction, lateralized toward the operative hip, was placed in the perineal region. Two standard portals were used. Using the 70° arthroscope, the anterolateral portal (ALP) was performed. The ALP provides a complete view of the central compartment for the treatment of possible associated intra-articular pathologies. Once inside the hip joint with the camera through the ALP, the midanterior portal was created via direct visualization. An arthroscopic knife (retractable cannulated knife; Arthrex) was introduced to perform an interportal capsulotomy parallel to the labrum. Coagulation of bleeding vessels was achieved with a radiofrequency device (EFLEX Electrothermal Ablator Probe; Smith & Nephew). The central compartment was addressed first. Concomitant lesions (labral tear, chondral lesion, impingement) were evaluated and eventually treated (Table 1). After central compartment examination and treatment was completed, the traction was removed and attention was focused to the calcification of the rectus femoris. A shaver was used to clear all soft tissue from the overhanging acetabulum and to better delimit the plane between the acetabular rim and the calcification. Using an extra-long, 5.5-mm full-radius shaver and a radiofrequency device, complete exposure of the calcification was achieved (Figures 3–6). When possible, care was taken in detaching the minimum amount of fibers of the direct head of the rectus femoris from its insertion site. Using the image intensifier as a guide, the calcification was removed using a 5.5-mm bur (DYONICS Full Radius; Smith & Nephew) (Figure 9). During the entire procedure, both dynamic direct visualization and fluoroscopic evaluation of the amount of resection were performed (Figures 7 and 8). Patients were discharged the day after the procedure. Weightbearing was permitted as tolerated, but extension of the hip was forbidden for 3 weeks to avoid excessive elongation of the rectus femoris tendon. To avoid recurrence, a course of celecoxib was ordered (200 mg/d for 4 weeks).


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)

 Arthroscopic view showing the decompression.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

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

fig7-2325967114561585:  Arthroscopic view showing the decompression.
Mentions: A standard fracture table was used with the patient in a supine position.4 The operative limb was placed with the hip in slight abduction and internal rotation. The contralateral limb was positioned in extension and neutral rotation, with the foot in a support applying a counterbalancing traction. Countertraction, lateralized toward the operative hip, was placed in the perineal region. Two standard portals were used. Using the 70° arthroscope, the anterolateral portal (ALP) was performed. The ALP provides a complete view of the central compartment for the treatment of possible associated intra-articular pathologies. Once inside the hip joint with the camera through the ALP, the midanterior portal was created via direct visualization. An arthroscopic knife (retractable cannulated knife; Arthrex) was introduced to perform an interportal capsulotomy parallel to the labrum. Coagulation of bleeding vessels was achieved with a radiofrequency device (EFLEX Electrothermal Ablator Probe; Smith & Nephew). The central compartment was addressed first. Concomitant lesions (labral tear, chondral lesion, impingement) were evaluated and eventually treated (Table 1). After central compartment examination and treatment was completed, the traction was removed and attention was focused to the calcification of the rectus femoris. A shaver was used to clear all soft tissue from the overhanging acetabulum and to better delimit the plane between the acetabular rim and the calcification. Using an extra-long, 5.5-mm full-radius shaver and a radiofrequency device, complete exposure of the calcification was achieved (Figures 3–6). When possible, care was taken in detaching the minimum amount of fibers of the direct head of the rectus femoris from its insertion site. Using the image intensifier as a guide, the calcification was removed using a 5.5-mm bur (DYONICS Full Radius; Smith & Nephew) (Figure 9). During the entire procedure, both dynamic direct visualization and fluoroscopic evaluation of the amount of resection were performed (Figures 7 and 8). Patients were discharged the day after the procedure. Weightbearing was permitted as tolerated, but extension of the hip was forbidden for 3 weeks to avoid excessive elongation of the rectus femoris tendon. To avoid recurrence, a course of celecoxib was ordered (200 mg/d for 4 weeks).

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