Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion

Luke Spencer-Gardner, Asheesh Bedi, Michael J. Stuart, Christopher M. Larson, Bryan T. Kelly, Aaron Krych

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. Methods: All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). Results: Ten patients with a mean age of 18 years (range 14–28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7–3.5), the median post-operative mHHS was 89.7 (65.7–96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal. Conclusion: Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. Level of evidence: IV.

Original languageEnglish (US)
Pages (from-to)55-61
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume25
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Hip
Pain
Buttocks
Activities of Daily Living
Sports
Joints
Avulsion Fractures

Keywords

  • Avulsion fracture
  • Hamstring injury
  • Impingement
  • Ischial tuberosity
  • Ischiofemoral

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion. / Spencer-Gardner, Luke; Bedi, Asheesh; Stuart, Michael J.; Larson, Christopher M.; Kelly, Bryan T.; Krych, Aaron.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 25, No. 1, 01.01.2017, p. 55-61.

Research output: Contribution to journalArticle

Spencer-Gardner, Luke ; Bedi, Asheesh ; Stuart, Michael J. ; Larson, Christopher M. ; Kelly, Bryan T. ; Krych, Aaron. / Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2017 ; Vol. 25, No. 1. pp. 55-61.
@article{65487215e9f74cb9bb1e4c65fa5c27ae,
title = "Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion",
abstract = "Purpose: The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. Methods: All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). Results: Ten patients with a mean age of 18 years (range 14–28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7–3.5), the median post-operative mHHS was 89.7 (65.7–96.8) and HOS ADL and Sport subscales were 90 {\%} or greater in all cases. Five patients (50 {\%}) rated their hip as normal, and five patients (50 {\%}) rated their hip as near normal. Conclusion: Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. Level of evidence: IV.",
keywords = "Avulsion fracture, Hamstring injury, Impingement, Ischial tuberosity, Ischiofemoral",
author = "Luke Spencer-Gardner and Asheesh Bedi and Stuart, {Michael J.} and Larson, {Christopher M.} and Kelly, {Bryan T.} and Aaron Krych",
year = "2017",
month = "1",
day = "1",
doi = "10.1007/s00167-015-3812-4",
language = "English (US)",
volume = "25",
pages = "55--61",
journal = "Knee Surgery, Sports Traumatology, Arthroscopy",
issn = "0942-2056",
publisher = "Springer Verlag",
number = "1",

}

TY - JOUR

T1 - Ischiofemoral impingement and hamstring dysfunction as a potential pain generator after ischial tuberosity apophyseal fracture non-union/malunion

AU - Spencer-Gardner, Luke

AU - Bedi, Asheesh

AU - Stuart, Michael J.

AU - Larson, Christopher M.

AU - Kelly, Bryan T.

AU - Krych, Aaron

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Purpose: The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. Methods: All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). Results: Ten patients with a mean age of 18 years (range 14–28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7–3.5), the median post-operative mHHS was 89.7 (65.7–96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal. Conclusion: Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. Level of evidence: IV.

AB - Purpose: The purpose of this study was to describe the occurrence of ischiofemoral impingement (IFI) and hamstring dysfunction following malunion or non-union of ischial tuberosity apophyseal avulsion fractures and report the short-term outcomes of surgical treatment with regard to alleviating symptomatic extra-articular impingement. Methods: All patients who underwent surgery for recalcitrant hip and buttock pain in the setting of prior ischial tuberosity avulsion fracture at three tertiary-level hip preservation centres were included for this review. A total of ten patients met our inclusion criteria and underwent sciatic neurolysis, resection of the ischial tuberosity fragment and hamstring reattachment. Clinical outcomes scores were collected post-operatively including the Modified Harris Hip Score (mHHS) and the Hip Outcomes Score (HOS). Results: Ten patients with a mean age of 18 years (range 14–28) underwent surgery for symptomatic ischiofemoral impingement after ischial tuberosity avulsion fracture. At a mean of 2.2-year follow-up (range 1.7–3.5), the median post-operative mHHS was 89.7 (65.7–96.8) and HOS ADL and Sport subscales were 90 % or greater in all cases. Five patients (50 %) rated their hip as normal, and five patients (50 %) rated their hip as near normal. Conclusion: Malunion or non-union following ischial tuberosity apophyseal fracture can lead to IFI and hamstring dysfunction. Clinically, the resultant pain and dysfunction is often chronic, and can be debilitating. In select cases, a reliable surgical technique is presented to improve hamstring function and correct ischiofemoral impingement in this setting with good-to-excellent outcomes in the majority of cases at short-term follow-up. Level of evidence: IV.

KW - Avulsion fracture

KW - Hamstring injury

KW - Impingement

KW - Ischial tuberosity

KW - Ischiofemoral

UR - http://www.scopus.com/inward/record.url?scp=84944521856&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84944521856&partnerID=8YFLogxK

U2 - 10.1007/s00167-015-3812-4

DO - 10.1007/s00167-015-3812-4

M3 - Article

VL - 25

SP - 55

EP - 61

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

IS - 1

ER -