Cadera y pelvis

Presentación clinica de pacientes con rotura del borde cartilaginoso acetabular.

"Presentación clinica de pacientes con rotura del borde cartilaginoso del acetábulo."

R. Stephen J. Burnett, MD, FRCS(C)1, Gregory J. Della Rocca, MD, PhD2, Heidi Prather, DO1, Madelyn Curry, RN1, William J. Maloney, MD3 and John C. Clohisy, MD1

1 Suite 11300–West Pavilion, 1 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110. E-mail address for J.C. Clohisy: 2 Department of Orthopaedic Surgery, University of Missouri-Columbia, Mc213 Mchaney Hall, Columbia, MO 65211 3 Stanford Hospital and Clinics, Edwards Building, Room 209, 300 Pasteur Drive, Stanford, CA 94305

Background: The clinical presentation of a labral tear of the acetabulum may be variable, and the diagnosis is often delayed. We sought to define the clinical characteristics associated with symptomatic acetabular labral tears by reviewing a group of patients who had an arthroscopically confirmed diagnosis.

Methods: We retrospectively reviewed the records for sixty-six consecutive patients (sixty-six hips) who had a documented labral tear that had been confirmed with hip arthroscopy. We had prospectively recorded demographic factors, symptoms, physical examination findings, previous treatments, functional limitations, the manner of onset, the duration of symptoms until the diagnosis of the labral tear, other diagnoses offered by health-care providers, and other surgical procedures that these patients had undergone. Radiographic abnormalities and magnetic resonance arthrography findings were also recorded.

Results: The study group included forty-seven female patients (71%) and nineteen male patients (29%) with a mean age of thirty-eight years. The initial presentation was insidious in forty patients, was associated with a low-energy acute injury in twenty, and was associated with major trauma in six. Moderate to severe pain was reported by fifty-seven patients (86%), with groin pain predominating (sixty-one patients; 92%). Sixty patients (91%) had activity-related pain (p < 0.0001), and forty-seven patients (71%) had night pain (p = 0.0006). On examination, twenty-six patients (39%) had a limp, twenty-five (38%) had a positive Trendelenburg sign, and sixty-three (95%) had a positive impingement sign. The mean time from the onset of symptoms to the diagnosis of a labral tear was twenty-one months. A mean of 3.3 health-care providers had been seen by the patients prior to the definitive diagnosis. Surgery on another anatomic site had been recommended for eleven patients (17%), and four had undergone an unsuccessful operative procedure prior to the diagnosis of the labral tear. At an average of 16.4 months after hip arthroscopy, fifty-nine patients (89%) reported clinical improvement in comparison with the preoperative status.

Conclusions: The clinical presentation of a patient who has a labral tear may vary, and the correct diagnosis may not be considered initially. In young, active patients with a predominant complaint of groin pain with or without a history of trauma, the diagnosis of a labral tear should be suspected and investigated as radiographs and the history may be nonspecific for this diagnosis.

The Journal of Bone and Joint Surgery (American). 2006;88:1448-1457.

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