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CASE CORNER

Case Presenter: Case Response:

Omer Mei-Dan, MD Rodrigo Mardones Petermann
USA
Santiago, CHILE

I will offer this patient an immediate surgical treatment.
However I recommend to somebody that is not an

expert on Hip scope to wait until capsule has healing
so avoid extravasation (4–6 weeks). It is important to

perform the full procedure in less then 2 hours and be
very careful with the water flow. Main complication to

avoid is peritoneal fluid extravasation.
I will perform all at the same time:

Treatment of his minimal FAI (may have small
retroversion since the AP pelvis looks little bit hipo

lordotic/outlet plus had a plane anterior offset mainly
reactive typically seen in a pincer type plus reactive

cam).

Labral repair if there is some anterior damage. For
sure posterior bone labral repair for the posterior wall. 20 y.o. active male with no previous complaints was
Sunday, June 9, 13
If it is too small to repair I will debride it and repair the
snowboard jumping and went out of control. Upon
labrum over the new bone edge. For small fragment landing on his knees he remembers feeling his right
like this I will pass throughout the fragment with my
hip dislocating with, what seemed to be, immediate
anchors (drill trough) and will suture the fragment spontaneous reduction. He states that he rested for
with the labrum against the defect (some support 30 minutes before resuming snowboarding for one

by the anchor and some by the suture). Our group more run. Pain limited him from continuing and he
actually has perform this twice with very good results. stopped activity. He has been limping since injury,

If the fragment is bigger (not in this case) would two weeks ago, and though has crutches, has not
use small cannulated screws, arthroscopicaly. More been using them and has been weight-bearing.

than 1/3 of the wall I will probably proceed with an The hip would wake him at night due to discomfort
open procedure.
more than pain and would click and catch on him.

Will not suture the capsule.
Sitting has not been especially difficult for him and he
I will protect with partial weight bearing for 4 – 6 has continued to drive since the accident.

weeks after surgery
Physical exam: 5 feet 11 inches tall, 165 lbs male.

Will use CPM for the hospital stay but if the patient Currently, he walks with a guarded, limping gait.
can rent, it will prescribe for 4 weeks. Otherwise will He has no leg length discrepancy and present with
no signs of joint laxity. He is fit looking. NV exam is
use stationery bike twice a day for 6 weeks (15 min
a session) plus PT stage one (isometric and passive normal.
motion) plus an abductor pillow for 4 weeks at night.
ROM at 90 degrees of hip flexion presents with 45
After 6 weeks will put him in our regular post FAI degrees ER, 15 degrees IR. Abduction is 40 degrees.

program.
All position generate joint discomfort, even without
provocative maneuvers.

What would you do?

Case Response:
Scope later?
Scope now?
Marc R. Safran, MD
Stanford University, CA, USA
At all?
Open procedure?

Recommended weight
I had a very similar case in an NFL running back

– treated non-op on crutches.and the following bearing status?
season had one of his best years productivity wise,
Other recommendations?
and no hip symptoms.

24 ISAKOS NEWSLETTER 2013: Volume II