The Modified Resisted Internal Rotation Test for Detection of Gluteal Tendon Tears

Greater trochanteric pain syndrome (GTPS) has received increasing attention in recent years. Most patients with GTPS present with trochanteric bursitis and respond to nonoperative treatment. However, a subset of patients may have persistent lateral hip pain or recalcitrant GTPS resulting from an undiagnosed gluteal tendon tear. Recalcitrant GTPS may be a debilitating condition in this patient subset. There is a need for an accurate and evidence-based physical examination maneuver to aid in earlier diagnosis of gluteal tendon tears and timely intervention in these patients. Most studies evaluating gluteal tendinopathy fail to assess surgical indications and instead focus on identifying trochanteric bursitis, which may or may not require surgical treatment. The modified resisted internal rotation test has been used in our practice to detect gluteus medius tendon tears in the recalcitrant GTPS patient population. Fundamental anatomic, biomechanical, electromyographic, and clinical data have been reviewed to make this an evidence-based clinical test for early detection of this pathology

Fresh Femoral Head Osteochondral Allograft Transplantation for Treating Osteochondritis Dissecans of the Femoral Head

Treatment options for the management of osteochondritis dissecans (OCD) lesions of the femoral head are limited. Although arthroscopic surgery of the hip can treat a variety of intra- and extra-articular pathologies, an OCD lesion located at the superior and medial zone of the femoral head is often difficult to access and cannot be adequately treated arthroscopically. The use of fresh-stored osteochondral allograft allows surgeons to both avoid donor-site morbidity and treat lesions of a larger surface area. We present our technique for surgical treatment of a femoral head OCD lesion with open surgical dislocation of the hip through stepped trochanteric osteotomy and osteochondral transplantation of fresh-stored femoral head allograft

The “Bird's Eye” and “Upper Deck” Views in Hip Arthroscopy: Powerful Arthroscopic Perspectives for Acetabuloplasty

Arthroscopic acetabuloplasty involves trimming of bone from the acetabular rim. Although early techniques often involved detachment of the labrum prior to bone resection, recent studies have reported on acetabuloplasty without labral detachment. This method has the benefit of preserving the labro-osseous junction, but visualization of the acetabular rim may be more difficult. Compromised visualization can lead to incomplete resection and residual impingement. We describe an arthroscopic perspective called the “bird's eye” and “upper deck” views that facilitates optimal visualization of the acetabuloplasty without labral detachment

Arthroscopic-Assisted Intraosseous Bioplasty of the Acetabulum

Intraosseous bioplasty (IOBP), has been previously described for arthroscopic-assisted treatment of subchondral bone cysts in the proximal tibia associated with early stages of knee osteoarthritis (OA). This technique entails combining bone marrow aspirate concentrate or concentrated platelet-rich plasma with demineralized bone matrix as a bone substitute before injecting into a subchondral bone defect under fluoroscopic guidance. The principles of IOBP as a procedure that combines core decompression with biologic bone substitute augmentation can be extended to treat subchondral bone marrow lesions such as acetabular and femoral cysts in degenerative hip OA. Intraosseous bioplasty of the hip, in particular the acetabulum, when done using this technique, is a useful alternative that can be beneficial in treating young patients with early hip arthritis to achieve successful outcomes while delaying more invasive procedures. The Technical Note described here presents a step-by-step approach, including tips and pearls for arthroscopic-assisted IOBP with decompression of the subchondral cyst in the acetabulum followed by bone substitute injection under fluoroscopic guidance. We believe this method is a safe and reproducible way to treat subchondral defects in young patients with signs of early osteoarthritis of the hip joint