Bucci Gabriella, McGovern Ryan P, Singleton Steven B, Christoforetti John J
Texas Health Research Foundation, Fort Worth, Texas, USA.
Texas Health Orthopedic Specialists, Frisco, Texas, USA.
Video J Sports Med. 2022 Apr 12;2(2):26350254221074697. doi: 10.1177/26350254221074697. eCollection 2022 Mar-Apr.
Insufficiency of hip capsular structures has recently gained recognition as a cause of pre-arthritic hip pain, leading to hip joint instability and progressive chondrolabral injury. An accurate evaluation of capsular integrity can help orthopedic surgeons plan capsular management prior to hip arthroscopy.
The proposed iliofemoral bounce test is meant to be applied preoperatively for identification of hip capsular integrity when microinstability is suspected or in the setting of revision hip arthroscopy.
After induction of general anesthesia and complete muscle relaxation, the patient is placed in a supine figure-four position by placing the foot of the pathologic hip on the contralateral knee. Two examination techniques are performed: (1) The examiner places one hand on the patient's contralateral anterior superior iliac spine and applies consecutive downward pressure in a "rocking" manner to the pelvis; (2) the examiner applies a preload and release force to the flexed knee (examined hip), with the contralateral pelvis stabilized, and observes the response of the knee to this loads.
Technique 1: The expected physiologic response in a preserved joint is a "bounce" of the contralateral hip (examined hip), evidenced by an up-and-down movement of the knee in response to the rocking movement applied. This movement reflects the integrity and functionality of the hip capsule ligaments' elastic recoil forces, allowing the hip to remain in a stable state in response to destabilizing forces. In contrast, when capsular insufficiency is present, a lack of bouncing will be observed due to unrestricted external rotation of the hip to constrain the hip joint. Technique 2: In a preserved joint capsule, the knee will return to its preload position, while in capsular insufficiency, no bouncing of the knee will be observed.
DISCUSSION/CONCLUSION: The iliofemoral bounce test is a novel, dynamic, and reproducible examination technique for clinicians to evaluate patient's true hip capsular integrity and for preoperative identification of the proper capsular management, either with a less invasive capsulotomy or performing a capsular closure, plication or even reconstruction, when necessary.
髋关节囊结构功能不全近来被认为是关节炎前期髋关节疼痛的一个原因，会导致髋关节不稳定及软骨唇渐进性损伤。准确评估关节囊完整性有助于骨科医生在髋关节镜检查前规划关节囊处理方案。
拟议的髂股弹跳试验旨在术前应用，以在怀疑存在微不稳定或翻修髋关节镜检查时识别髋关节囊完整性。
全身麻醉诱导及肌肉完全松弛后，将患侧足部置于对侧膝部，使患者呈仰卧“4”字位。进行两种检查技术：（1）检查者一手置于患者对侧前上棘，以“摇摆”方式连续向下按压骨盆；（2）检查者在稳定对侧骨盆的同时，对屈曲的膝关节（检查侧髋关节）施加预负荷及释放力，并观察膝关节对该负荷的反应。
技术1：在关节正常的情况下，预期的生理反应是对侧髋关节（检查侧髋关节）出现“弹跳”，表现为膝关节随施加的摇摆运动出现上下移动。该运动反映了髋关节囊韧带弹性回缩力的完整性和功能，使髋关节在受到破坏稳定的力时能保持稳定状态。相反，当存在关节囊功能不全时，由于髋关节外旋不受限制无法约束髋关节，将观察不到弹跳。技术2：在关节囊正常的情况下，膝关节会回到预负荷位置，而在关节囊功能不全时，将观察不到膝关节弹跳。
讨论/结论：髂股弹跳试验是一种新颖、动态且可重复的检查技术，可供临床医生评估患者真正的髋关节囊完整性，并在术前确定合适的关节囊处理方案，必要时可采用创伤较小的关节囊切开术，或进行关节囊闭合、折叠甚至重建。
