Intraoperative Findings and Clinical Outcomes Associated With Arthroscopic Management of Subspine Impingement: A Propensity-Matched, Controlled Study
Authors: Shapira J, Yelton MJ, Glein RM, Rosinsky PJ, Maldonado DR, Meghpara MB, Ankem HK, Lall AC, Domb BG
DOI: 10.1016/j.arthro.2021.03.057
Background
Subspine impingement (SSI) occurs due to a prominent anterior inferior iliac spine causing pain and limited hip motion. Its impact on arthroscopic outcomes alongside femoroacetabular impingement (FAI) is not well established.
Methods
This propensity-matched controlled study compared intraoperative findings and 2-year postoperative outcomes between patients with FAI plus SSI and those with FAI alone undergoing hip arthroscopy.
Key Findings
- Patients with SSI had more complex intraoperative pathology, requiring additional procedures such as labral reconstruction and subspine decompression.
- Despite increased surgical complexity, clinical outcomes (pain relief, function, and patient-reported outcomes) were comparable between SSI and non-SSI groups.
- Rates of secondary surgery did not differ significantly.
Conclusions
Arthroscopic treatment of SSI, including targeted decompression and labral management, yields outcomes comparable to patients without SSI, despite more complex pathology.
What Does This Mean for Providers?
- Recognize SSI as a contributor to more complex labral pathology requiring tailored surgical approaches, including subspine decompression and possibly labral reconstruction.
- Do not consider SSI a contraindication for arthroscopy; appropriate management can achieve outcomes similar to isolated FAI cases.
- Preoperative imaging and intraoperative assessment should focus on identifying SSI to guide comprehensive treatment plans.
- Counsel patients regarding the potential need for more extensive procedures but reassure regarding comparable postoperative outcomes.