Types of treatment of hip labral (labrum) tears

There are 4 main treatment options for the treatment of labral tears. The best way to treat specific patterns of damage has not been fully clarified in publications on hip arthroscopy, but here I present some guidelines:
1. Debridement: This has been historically the main treatment for labral injury. This treatment is performed via hip arthroscopy and essentially consists of removing the damaged tissue with a shaver and/or with an electrocautery device. I perform this technique rarely, as preservation of this tissue when possible is beneficial.
2. Repair: This treatment also is performed via hip arthroscopy and consists of placing suture anchors in the bone and reattaching the labral tissue after it has been prepared. There is increasing evidence that this technique of repair is superior to debridement when possible.
3. Reconstruction: Also performed via hip arthroscopy, this technique may be performed when the labral tissue is too damaged or too small to be repaired. The technique consists of replacing the labrum with new tissue, and may be performed with autograft or allograft tissue.
4. Joint replacement: When the labral damage is associated with significant hip arthritis, the best treatment option is a hip replacement.

All arthroscopic allograft reconstruction of hip labral tear and deficiency

A young active patient who had previously undergone hip arthroscopy and labral debridement was reconstructed with allograft tissue. This was featured in a Channel 10 news story

Instrumentation for hip arthroscopy and hip labral (labrum) tears

How is it possible to reconstruct the hip if it is a deep, ball and socket joint? The answer in part lies in the instrumentation, which includes a number of curved, flexible, and long instruments to do the work. Progress in the area of hip arthroscopy has paralleled progress in instrumentation, which allows for improved access, manipulation, preparation, and refixation of the tissues.

Ankle fracture

Which ankle fractures are treated surgically? When do you treat them? The simple answer is that unstable ankle fractures are treated surgically. If both the medial and lateral sides of the ankle are fractured (called a bimalleolar ankle fracture) or if three sides are fractured (including the posterior malleolus, that is a trimalleolar ankle fracture), then surgical open reduction and internal fixation is recommendable. Fractures of the lateral malleolus alone, when displaced and in combination with a severe injury to the medial, or deltoid ligament, may also be unstable and benefit from surgical fixation. The timing for surgery is dependent on the skin and soft tissues, and is typically done around a week after the injury, to allow the swelling to minimize and thereby decrease risk for wound problems. The ankle fracture may also be treated within a few hours of the injury, before much swelling has developed.

Arthroscopy for ankle fractures?

When is ankle arthroscopy recommendable for ankle fractures? There are two randomized studies published on the use of arthroscopy in ankle fractures. One study demonstrated better results in patients who underwent arthroscopy at the time of open reduction internal fixation and the second study demonstrated equivalent results. Based on this data, I do not perform an ankle arthroscopy on all patients who have had an ankle fracture. With patient specific factors also considered, I tend to perform the arthroscopy on higher energy injuries, such as ankle subluxations or dislocations or syndesmosis injuries. At the time of arthroscopy, Ferkel reported a high rate of damage to the articular surfaces following ankle fractures, and my experience supports this fact. At the time of arthroscopy, loose bodies of cartilage alone or a combination of cartilage and bone can be treated, and the joint is looked at thoroughly to identify and treat any other associated injuries. This damage to the inside of the joint can be a cause of chronic pain if left untreated.

David Beckham torn achilles tendon

A few of my patients today wanted to get my impression of David Beckham's injury. Although I know of no specific details regarding his injury, based on the description in the media he suffered a complete tear. A completely ruptured or torn Achilles tendon is typically repaired surgically, particularly in a competitive athlete who wants to regain near normal strength and function. A complete tear of the Achilles treated non-operatively typically results in a more significant loss of strength with push-off as compared to patients who have a repair. Other tears, such as the peroneals or posterior tibial, typically are incomplete tears and are more chronic and slow in their progression. The main advantage of surgical intervention for a completely torn Achilles is restoration of strength and a decrease in rerupture rate, and the main disadvantage is wound breakdowns. Typically, recovery is at least as quick with surgery as compared to casting. Here in South Florida, the majority of these injuries that I have seen have been from tennis, followed by racquetball and basketball. I treated a patient last week from Miami who jumped off of a palm tree backwards.

Instructions added for recovery after surgery

After undergoing surgery and due to the effects of the medications for the anesthesia and pain control, patients may not remember well all that is discussed in the first hours after surgery. For this reason, I have added the postoperative instructions for foot and ankle onto my website www.hipfootankle.com.

The instructions regarding hip arthroscopy for the treatment of labral (labrum) tears, FAI (femoroacetabular impingement), and other causes of hip pain are provided prior to surgery as part of the hip arthroscopy information packet.

Ankle arthroscopy

What problems can be treated with ankle arthroscopy?

There are a number of different problems which are effectively treated with ankle arthroscopy. These reasons, or indications, are meant to serve as a guideline of the most common indications for ankle arthroscopy. Osteochondral defects or lesions, which are focal areas of articular cartilage damage on either side of the ankle joint (the tibia or more commonly the talus) may be treated with ankle arthroscopy. Anterior impingement, resulting from either excess bone or soft tissue along the front of the ankle joint, is most commonly seen in athletes. Loose bodies, which are loose pieces of bone or cartilage, may be removed. Septic arthritis, or infection of the ankle joint, also may be treated effectively, along with antibiotics afterwards.

New Website

Through the help of Liam Dempsey and lbdesign, we have launched a new website, www.hipfootankle.com.

Through the new website, you will find extensive information about hip, ankle, and foot injuries, as well as possible treatments. It is our hope that this site will serve as a valuable resource to all who are interested in learning more about these injuries.