Zacharias Anthony J, Call Cory J, Prince Samantha R, Turner Elizabeth H G, Goodspeed David C, Spiker Andrea M
Department of Orthopedic Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Froedtert & the Medical College of Wisconsin, Pleasant Prairie, Wisconsin, USA.
Video J Sports Med. 2023 Jan 19;3(1):26350254221138859. doi: 10.1177/26350254221138859. eCollection 2023 Jan-Feb.
Heterotopic ossification (HO), or the abnormal formation of bone in extra-skeletal tissue, is a well-known complication of orthopedic trauma, tendon avulsions, chronic injuries, spinal cord injuries, and soft tissue damage from surgery. Heterotopic ossification commonly develops at the direct or indirect head of the rectus femoris. Athletes are especially susceptible to chronic microtearing and acute tendon avulsion, which may result in HO. When HO develops in the setting of concurrent intra-articular hip pathology, it may be amendable to arthroscopic excision, depending on its size and location.
Heterotopic ossification that develops adjacent to the hip joint can affect range of motion of the joint and is often a source of pain. Arthroscopic excision is indicated when the HO that develops within or about the hip joint is symptomatic and is of a location and size that it can be reached and excised arthroscopically.
In this technical note, we describe our method to excise HO using initial arthroscopic surgery to address femoroacetabular impingement syndrome (FAIS) and perform initial dissection of the HO fragment. Heterotopic ossification resection was then completed via an anterior open approach followed by reconstruction of the rectus femoris origin with Achilles allograft. This is followed by our HO prophylaxis protocol of indomethacin 75 mg daily for 4 days, followed by naproxen 500 mg 2 times daily through postoperative day 30, although many other regimens exist for HO prophylaxis.
Using arthroscopy for the removal of symptomatic HO at the time of surgery allows for the management of concomitant intra-articular pathology and efficient and precise dissection of the undersurface of the HO fragment.
DISCUSSION/CONCLUSION: Heterotopic ossification is a well-characterized complication of soft tissue damage, including tendon avulsion, trauma, previous surgery, and chronic microtear of the hip musculature. Oftentimes, HO develops in a location that can be reached arthroscopically. Surgeons should consider combining intra-articular arthroscopic surgery with arthroscopic excision of HO when appropriate, noting that there are many advantages to arthroscopic removal when compared with open procedures.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
异位骨化（HO），即骨骼外组织中异常的骨形成，是骨科创伤、肌腱撕脱、慢性损伤、脊髓损伤以及手术所致软组织损伤的一种常见并发症。异位骨化通常发生在股直肌的直接或间接附着点处。运动员尤其容易发生慢性微撕裂和急性肌腱撕脱，这可能导致异位骨化。当在合并髋关节内病变的情况下发生异位骨化时，根据其大小和位置，可能适合进行关节镜下切除。
髋关节附近发生的异位骨化会影响关节活动范围，且常常是疼痛的来源。当髋关节内或其周围发生的异位骨化有症状，且其位置和大小能够通过关节镜到达并切除时，可进行关节镜下切除。
在本技术说明中，我们描述了使用初始关节镜手术处理股骨髋臼撞击综合征（FAIS）并对异位骨化碎片进行初步解剖，以切除异位骨化的方法。然后通过前方开放入路完成异位骨化切除，随后用跟腱同种异体移植物重建股直肌起点。术后给予消炎痛75毫克，每日1次，共4天，之后给予萘普生500毫克，每日2次，持续至术后30天，这是我们的异位骨化预防方案，不过对于异位骨化的预防还有许多其他方案。
在手术时使用关节镜切除有症状的异位骨化，能够处理合并的关节内病变，并高效、精确地解剖异位骨化碎片的下表面。
讨论/结论：异位骨化是软组织损伤的一种特征明确的并发症，包括肌腱撕脱、创伤、既往手术以及髋关节肌肉组织的慢性微撕裂。通常，异位骨化发生在能够通过关节镜到达的位置。外科医生在适当的时候应考虑将关节内关节镜手术与异位骨化的关节镜切除相结合，需注意与开放手术相比，关节镜切除有许多优势。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿发表包含患者发布声明或其他书面批准形式的内容。
