スポーツ整形外科医S. Uのブログ Sports Physician S.U Blog

Dr. Soshi Uchida of Wakamatsu hospital for sports injury is an orthopedic surgeon dedicated to research and treatment of hip, shoulder, knee and elbow sports injuries We will do our best for the treatment for the patients with smile and special skills. 関節鏡視下手術のテクニックを駆使して、最小侵襲で患者さんを治療しているドクターが綴るスポーツ医学の小ネタです。 22 年間のJリーグ のチームドクター(柏→川崎(富士通時代)→大分 2010年からJリーグ入りしたギラヴァンツ北九州)の経験と、自身の柔道(3段)とラグビーをしてきており、幅広いスポーツ選手を診療しています。私の持ち味は、笑顔で診察します。 怪我をした選手に勇気、元気、根気を与えることをモットーとしています。カナダ トロント大学へ医学留学を2年間しており、英語を話せる外国人の診察もしています。nSports Physician SU Sports Medicine Blog

Hip Arthroscopy 股関節鏡視下手術

Dr Soshi Uchida MD, PhD has been practicing his passion, orthopaedic surgery, for the last decade. The principles of sports medicine emphasize a comprehensive team approach in the conservative treatment of injuries with the goal of helping the patient return to a healthy state, and focuses on the prevention of new or recurrent injuries. When surgery is necessary, Dr. Uchida's specialty in arthroscopic techniques, especially hip arthroscopy, emphasizes less invasive surgery for a potentially easier and quicker recovery. These principles, initially developed for the competitive athlete, apply to all injuries whether they occur in the recreational environment, work place, or at home. He is a well-known figure in hip arthroscopic surgery, lecturing, travelling and teaching widely. In addition he has contributed extensively to the design and development of special instruments for arthroscopic surgery of the hip joint. Many patients living in Fukuoka, Nagasaki, Oita, Osaka, Kobe, Kyoto, Tokyo, Yokohama present to our hospital for their hip problem.

AOSSM & ISAKOS Hip Arthroscopy Course The Hip in the Athlete – An International Perspective

Soshi Uchida Soshi Uchida MD, Orthopaedic Surgeon 内田宗志 is invited as a faculty of AOSSM & ISAKOS Hip Arthroscopy Course The Hip in the Athlete – An International Perspective.
アメリカスポーツ整形外科AOSSM と ISAKOSとの共催による Hip Arthroscopy Courseの International facultyとして3人のうちの1人として招待されました。


Preliminary Program
AOSSM & ISAKOS Hip Arthroscopy Course
The Hip in the Athlete – An International Perspective
Friday, April 13, 2018
3:00 – 3:10PM Welcome & Course Overview
Brian D. Busconi, MD & Marc R. Safran, MD
3:10 – 3:20PM Evolution of Groin Pain in Athletes – From Adductor to Sports Hernia to FAI
Brian D. Busconi, MD
3:20 – 3:30PM Evaluation of the Patient – H & P
Allston Stubbs, MD, MBA
3:30 – 3:40PM Essentials of Imaging – XR, MRI, CT Include collision software
Anil S. Ranawat, MD
3:40 – 3:50PM Ultrasound
J. W. Thomas Byrd, MD
3:50 – 4:00PM Indications for Hip Arthroscopy
Shane J. Nho, MD, MS
4:00 – 4:10PM Panel Discussion
SESSION II (Not surgical -describe what to do about it)
4:10 - 4:20PM Hip in the Athlete – Patterns of Damage in Differing Sports
Marc R. Safran, MD
4:20 – 4:30PM FAI – Anatomy and Pathophysiology and Pattern Damage CAM, Pincer, AIIS and Ilioischial
Michael Dienst, MD
4:30 – 4:40PM The Dancer and Gymnast Hip – Microinstability
Marc R. Safran, MD
4:40 – 4:50PM The Contact Athlete – Hip Dislocation / Macro Instability (Football, Ice Hockey, Wrestling)
J. W. Thomas Byrd, MD
4:50 – 5:00PM European Perspective the Hip in Soccer
Nicolas Bonin, MD
5:00 – 5:20PM BREAK

5:20 – 5:30PM DDH – How Image, How Repair, Limitations
Anil S. Ranawat, MD
5:30 – 5:40PM Adolescent Hip Disorders –LCP, SCFE
Victor M. Ilizaliturri, MD
5:40 – 5:50PM Hip OA – Is There a Role
Allston Stubbs, MD, MBA
5:50 – 6:00PM Greater Trochanteric Pain Syndrome / Gluteal Tears
Benjamin G. Domb, MD
6:00 – 6:10PM Deep Gluteal Space Syndrome
Hal D. Martin, DO
6:10 – 6:20PM Proximal Hamstring Injuries
Brian D. Busconi, MD
6:20 – 6:30PM Extra-articular Impingement: Trochanteric Ischiofemoral Impingement
Soshi Uchida, MD, PhD
6:30 – 6:45PM Core Muscle Injuries - Dx & Rx
Brian D. Busconi, MD
6:45 – 7:30PM DINNER BREAK (Pizza & Beer)
7:30 – 7:40PM Rehabilitation – Pre-Surgery – Tips, Tricks, Pearls
Stephen K. Aoki, MD
7:40 – 7:50PM Hip Practice Management
John J. Christoforetti, MD
7:50 – 8:00PM Economics of Hip Arthroscopy
Richard Chad Mather III, MD
8:00 – 8:10PM Outcomes in the Athlete – What Outcomes Should I Use Nicholas Mohtadi, MD, MSc, FRCSC
8:10 – 8:25PM Results / Outcomes of Hip Arthroscopy in Athletes
Marc J. Philippon, MD
8:25 – 9:00PM Panel Discussion, Cases
Saturday, April 14, 2018
SESSION I - A/S Basic, Cartilage and Labrum
7:00 – 7:10AM Overview
Brian D. Busconi, MD & Marc R. Safran, MD
7:10 – 7:25AM Hip Access – Tips & Tricks & Portal Anatomy
Stephen K. Aoki, MD
7:25 – 7:35AM Acetabular Sided Lesions – Pincer
Hal D. Martin, DO
7:35 – 7:45AM PeriAcetabular Issues: AIIS, Rim Stress Fx
Richard Chad Mather III, MD

7:45 - 7:55AM Chondral Injury Resection / MFx Repair / Biocartilage
John J. Christoforetti, MD

7:55 – 8:10AM Labral Repair / Fixation / Resection
Nicholas Mohtadi, MD, MSc, FRCSC
8:10 – 8:20AM Labral Reconstruction
Marc J. Philippon, MD
8:20 – 8:30AM Capsular Treatment – Interportal, Capsular, Repair
Shane J. Nho, MD, MS
8:30 – 11:30AM Morning Lab – Central Compartment
Portal Placement, Capsulotomy, Rim Trimming, Labral
Refixation / Reconstruction
11:30AM – 12:30PM LUNCH
SESSION II - Cam and Capsule
12:30 – 12:45PM Femoral Sided Pathology & Treatment Cam and LCP and SCFE Michael Dienst, MD
12:45 – 1:00PM How Manage Capsule in DDH Can mention Cam
Benjamin G. Domb, MD

1:00 – 1:10PM How to Arthroscopically Manage the Bone DDH
Sochi Uchida, MD, PhD

1:10 – 1:20PM Iliopsoas Tendon
Victor M. Ilizaliturri, MD
1:20 – 1:40PM Rehabilitation – Post Op
FAI & Labral Repair
OCD of Cartilage
Capsular Injury
Repair Gluteus
Nicolas Bonin, MD
1:45 – 5:00PM Afternoon Lab – Cam and IP and Capsule
Femoral Osteochondroplasty, Capsular Repair, Psoas Tendon
Brian D. Busconi, MD (Chair)
Marc R. Safran , MD (Chair)
Stephen K. Aoki, MD
J. W. Thomas Byrd, MD
John J. Christoforetti, MD
Benjamin G. Domb, MD
Victor M. Ilizaliturri, MD
Hal D. Martin, DO
Richard Chad Mather III, MD
Nicholas Mohtadi, MD, MSc, FRCSC
Shane J. Nho, MD, MS
Marc J. Philippon, MD
Anil S. Ranawat, MD
Allston Stubbs, MD, MBA

Sochi Uchida, MD, PhD
Nicolas Bonin, MD
Michael Dienst, MD

Sherwin S. W. Ho, MD, BA
Leandro Ejinisman, MD
Patrick Birmingham, MD
Jason L. Koh, MD
James T. Rosneck, MD
Jonathan D. Packer, MD
Thomas Sean Lynch, MD
Aaron J. Krych, MD

Upcoming Meetings
This is a page listing the latest course offerings from the AOSSM.

Soshi Uchida MD, Orthopaedic Surgeon 内田宗志

Soshi Uchida work at  内田宗志 (DR SU)は下記の病院で診察をしています。

Wakamatsu Hospital for University of Occupational and Environmental Health (産業医科大学若松病院)

Wakamatsu hospital for UOEH

Arex Oyamadai Orthopaedic CLinic 右をクリック 

Arex- Oyamadai English site

 第一 第3木曜日

Kyoto Shimogamo Hospital 右をクリック  京都下鴨病院


学会などで 予定が変更になりますので 詳しくはお問い合わせください。

プロスポーツ選手や芸能人などの診察は、医師の守秘義務の元 漏洩しないように 格別の注意を払って、診察をしています。詳しくはお問い合わせください。

第38回北九州股関節研究会 の ご案内



日時    :平成29年9月12日(火)    18時50分〜20時00分

場所    :リーガロイヤルホテル小倉   
  3階    オーキッド
北九州市小倉北区浅野2−14−2 TEL   093−531−1121

製品紹介 18時50分〜   「経皮吸収型製剤について」 久光製薬株式会社

特別講演 19時00分〜

座   長:飯塚病院   整形外科   部長   原   俊彦   先生

『   アスリートの股関節痛の診断と治療−鏡視下手術最前線2017− 』


演    者:産業医科大学若松病院    整形外科    スポーツ関節鏡センター
    内田    宗志     が講演をさせていただきます。


日整会専門医認定資格継続単位[2、11]1単位   または

共催   北九州股関節研究会/久光製薬株式会社

Soshi Uchida work at  内田宗志 (DR SU)は下記の病院で診察をしています。

Wakamatsu Hospital for University of Occupational and Environmental Health (産業医科大学若松病院)

Wakamatsu hospital for UOEH

Arex Oyamadai Orthopaedic CLinic 右をクリック 

Arex- Oyamadai English site

 第一 第3木曜日

Kyoto Shimogamo Hospital 右をクリック  京都下鴨病院

Arthroscopic Management for OCD lesion関節鏡視下の骨軟骨移植で大腿骨頭離断性骨軟骨炎 (大腿骨頭軟骨損傷)をがっつり治す

さて今回は 私の3ヶ月前に掲載された英語論文を 日本語訳をしましたので、 股関節の軟骨損傷を鏡視下に がっつり治すという日本語のテーマですがご一読いただけましたら幸いです。

Arthroscopic osteochondral autologous transplantation for the treatment of osteochondritis dissecans of the femoral head
Soshi Uchida*, Hajime Utsunomiya, Eisaburo Honda, Shiho Kanezaki, Eiichiro Nakamura, Cecilia Pascual-Garrido, and Akinori Sakai
Wakamatsu hospital of University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
SICOT J 2017, 3, 18


Uchida et al

Abstract – Osteochondritis dissecans (OCD) of the femoral head is an unusual cause of hip pain. It can be associated with other intra-articular pathologies including: acetabular labral tears or bone deformities such as Legg-Calve- Perthes Disease (LCPD). In this article, we propose a modern surgical technique using an arthroscopic antegrade and retrograde osteochondral autologous transplantation (OAT) procedure for assessing and treating OCD lesions of the femoral head.

Osteochondritis dissecans (OCD) in the hip is an uncommon condition characterized by the separation of the osteochondral lesion from the subchondral bone. Lindholm et al. reported 36 patients treated for OCD lesions of the elbow, ankle, and hip during a period of 20 years. Only six (five men and one woman) of the 36 patients had OCD lesions of the hip [1]. Several studies have shown a higher prevalence of OCD of the femoral head in patients with Legg-Calve-Perthes disease (LCPD) [2–4].

The vast majority of patients with symptomatic OCD lesions of the femoral head require surgical management when nonsurgical treatment fails. Fragment removal can cause joint incongruity predisposing toward osteoarthritis. Thus ideally, the aim of surgical interventions should be to restore the articular surface congruity and preserve normal joint kinematics.

Numerous surgical procedures including: fragment fixation with bone pegs, osteochondral autograft transplantation (OAT), fresh OAT allograft, and joint arthroplasty have all been reported. Arthroscopic osteochondral autologous transplantation (OAT) is a well-developed and promising technique for the treatment of isolated, full-thickness cartilage lesions in knee and ankle joints [5–7].

In the literature, however, most of the patients treated for osteochondral lesions in the hip require an open surgical dislocation procedure. Hip arthroscopy is a fascinating tool for assessing and treating hip pathologies including labral tears and femoroacetabular impingement (FAI). Our previous report demonstrated antegrade OAT for treating OCD lesion of femoral head as an innovative and novel technique [8]. In addition, retrograde OAT for chondral lesion of the medial central area of the femoral head has also been reported [9]. The purpose of this article was to demonstrate a novel surgical technique and case presentation of arthroscopic OAT for the treatment of OCD lesion of femoral head.
しかしながら、文献上、股関節の骨軟骨病変に対して治療された大半の患者らは、OpenのSurgical dislocation手技を必要とする。股関節鏡は、関節唇断裂及びFAIを含めた股関節病変の評価及び治療に対する魅力的なツールである。我々の以前の報告は、革新的及び斬新なテクニックとして、大腿骨頭のOCD病変の治療に対するAntegradeのOATを実証した。されに追加して、大腿骨頭の内側中心領域の軟骨病変に対するRetrograde OATも報告してきた。本稿の目的は、大腿骨頭のOCD病変の治療に対する鏡視下OATの新たな手術テクニックと症例を提示することにあった。

Surgical technique
Hip arthroscopy
The patient was placed in a modified supine position on the traction table (Hip Positioning System, Smith & Nephew Endoscopy, Andover, MA), under general and epidural anesthesia, with a well-padded perineal post. Countertraction on the contralateral leg was obtained by abduction. The involved hip was internally rotated and slightly flexed. First, arthroscopic evaluation for intra-articular lesions, including labral tearing and associated cartilage damage, was performed through an anterolateral portal (ALP) and a midanterior portal (MAP). Intra-portal capsulotomy using a beaver knife (Becton Dickinson, Franklin Lakes, NJ) was completed to improve accessibility of the scope and surgical instruments.
患者は、全身麻酔及び硬膜外麻酔下で、十分にパッドされたペロニールポストを伴った牽引テーブル(Hip Positioning System, Smith & Nephew Endoscopy, Andover, MA)上に仰臥位に設置された。対側下肢のカウンター牽引が外転によって得られた。罹患股関節は、内旋及び軽度屈曲された。まず、関節唇断裂及びそれに関連される軟骨損傷を含めた関節内病変に対する関節鏡評価が、前外側ポータル(ALP)と中前ポータル(MAP)を介して実施された。Beaverナイフ(Becton Dickinson, Franklin Lakes, NJ)を用いたポータル間関節包切開が、スコープと手術インスツルメントの操作性を改善するために達成された。

Case 1: antegrade osteochondral autograft
A 40-year-old female patient presented to us with a 12-month history of left hip pain. Physical examination showed limited range of motion (ROM) with a flexion of 90_ and internal rotation of 15_. She had positive impingement sign and hip dial test. Plain radiographs showed a lateral center edge angle (LCEA) of 23_ and an alpha angle of 65_ suggesting borderline hip dysplasia and concomitant cam impingement (Figure 1A). Computed tomography (CT) and magnetic resonance imaging (MRI) confirmed an OCD lesion of the femoral head (Figures 1B and 1C).


Partial tearing at the anterior site of the acetabular labrum (9:30 position) and associated cartilage softening at rim lesion were observed. This last was classified as grade 1 of the Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) [10]. The thermoplasty was carried out using a radiofrequency probe for the treatment of the partial tearing of the labrum (VAPER, DePuy Mitek, Raynham, MA). Next, the OCD lesion was observed at the anterosuperior portion of the femoral head (Figure 2A). A proximal midanterior portal (PMAP) was established to access the OCD lesion. This was performed with the hip at 10_ of extension. The condition of the cartilage was evaluated using a probe and determined that refixation was not appropriate (Figure 2A).
股関節唇の前方部位(9:30)における部分断裂と、それに関連される軟骨Softeningのリム病変が観察された。後者は、MAHORNのグレード1として分類された。関節唇の部分断裂の治療に対して、RFプローブ(VAPER, DePuy Mitek, Raynham, MA)を用いた温熱形成術が実施された。次にOCD病変が、大腿骨頭の前上方部位に観察された(図2A).PMAPがOCD病変をアクセスするために設置された。これは、股関節伸展10度で実施された。軟骨の状態が、プローブを用いて評価され、再固定が適切でないことが決定された(図2A)。


A decision was made to proceed with osteochondral transplantation. Next, viewing from the ALP, the degenerative cartilage lesion was resected using a shaver (DYONICS BONECUTTERTM PLATINUM 4.5 mm, Smith & Nephew Endoscopy, Andover, MA) and a curette inserted through the PMAP (Relevator, DePuy Mitek, Tokyo, Japan) (Figure 2B).
骨軟骨移植の決定が行われた。次に、ALP鏡視で、PMAPから挿入された、シェーバー(DYONICS BONECUTTERTM PLATINUM 4.5 mm, Smith & Nephew Endoscopy, Andover, MA)とキュレット(Relevator, DePuy Mitek, Tokyo, Japan)を用いて,

The OAT technique was performed using the MosaicPlasty autologous osteochondral grafting system (Smith & Nephew Endoscopy, Andover, MA). The size of the lesion was determined to be 8.5 mm in diameter. This was assessed making sure the chisel was perpendicular to the articular surface (Smith & Nephew Endoscopy, Andover, MA). After releasing traction a cylindrical autologous osteochondral graft (8.5 mm diameter) was harvested arthroscopically from the ipsilateral knee joint with full extension of hip and knee (Figure 2C).
OATテクニックは、MosaicPlasty自家骨軟骨移植システム(Smith & Nephew Endoscopy, Andover, MA)を用いて実施された。病変のサイズは、直径8.5mmであると決定された。このシステムは、チゼルが関節面に対して垂直であることを評価できるものであった(Smith & Nephew Endoscopy, Andover, MA)。牽引解除後、円筒形の自家骨軟骨グラフト(8.5mm径)が、股関節及び膝完全伸展状態で、同側膝関節から鏡視下で採取された(図2C)。

The superior lateral aspect of the intercondylar notch was used as the donor site. The Chizel (Smith & Nephew Endoscopy, Andover, MA) was introduced through the superolateral portal in the knee and driven into the bone to a depth of 12 mm. The harvester, containing the graft, was then removed by twisting the T-handle. At the recipient site, a drill guide at a 90_ angle to the recipient site was inserted, through the PMAP, while viewing through the scope located in the ALP. The subchondral bone was drilled to a depth of 14 mm. The dilator was inserted into the drill guide and tapped to the desired depth. The osteochondral autograft was placed over the lesion and tapped into position, until articular surface, making sure it flushed with the host joint surface (Figures 2D and 2E).
顆間窩の上外側面がDonor siteとして用いられた。Chizel (Smith & Nephew Endoscopy, Andover, MA)が膝の上外側ポータルから挿入され、12mmの深さまで骨内に打ち込まれた。それから、Harvester内のグラフトが、Tハンドルをツイストすることによって取り出された。Recipient siteにおいて、ALPから鏡視しながら、PMAPを介して、Recipient siteに対して90度の角度でドリルガイドが挿入された。軟骨下骨が14mmの深さまでドリリングされた。ダイレーターがドリルガイド内に挿入され、望まれる深さまでテーパーされた。骨軟骨自家グラフトが、病変上に配置され、Host側の関節面とそれがフラッシュすることを確認しながら、関節面まで、タップされた(図2D及び2E)。

After the central compartment procedure was finalized, the traction was released to assess the peripheral compartment. A cam lesion that had diffuse cartilage damage (International Cartilage Research Society (ICRS) grade II) was seen at the femoral head-neck junction.
Central compartment手技の終了後、牽引が、Peripheral compartmentをアクセスするために解除された。瀰漫性軟骨損傷(ICRSグレード2)を有したCam病変が、大腿骨頭頚部移行部に観察された。
Arthroscopic dynamic assessment confirmed cam impingement. Thus, cam osteoplasty was carried out using a motorized round burr. Lastly, capsular closure was performed in the hip at 40_ of flexion, through the MAP as described previously. A total of two side-to-side stitches were placed to close the capsule. Modified Harris hip score (MHHS) improved from 59.4 preoperatively to 88 at three years after surgery. Non-arthritis hip score improved from 72.5 to 87.5 at three years after surgery.
鏡視下動的評価によりCamインピンジメントが確認された。Cam osteoplastyが、シェーバーラウンドバーを用いて実施された。最後に、関節包縫縮が、以前に詳細したように、MAPを介して、股関節屈曲40度で実施された。合計2本のSide-to-sideスティッチが関節包を閉鎖するために配置された。MHHSは、術前59.4点から、術後3年で88点に改善された。NAHSは、術前72.5点から、術後3年で87.5点に改善された。

Case 2: retrograde osteochondral autograft transplantation
A 18-year-old badminton male player presented with right hip pain for the past 18 months. The pain was worsened by walking and stepping. Physical examination showed pain on internal rotation and hip flexion at 90_. Plain X-ray identified a lateral center edge angle (LCEA) of 18_ and an OCD lesion with concomitant deformity of the femoral head. OCD lesion of the femoral head, hip dysplasia, and Perthes like deformity of proximal femur was diagnosed (Figures 3A and 3B).


Perthes like deformity was classified as Stulberg grade I. CT and MRI demonstrated an OCD lesion of femoral head partially separated from the subchondral bone in association with a cystic lesion in the subchondral bone at the central-superior portion of the femoral head [11]. Since nonsurgical treatment failed, hip arthroscopy and retrograde osteochondral autograft transplantation were indicated.
During the central compartment procedure, an anterosuperior acetabular labral tear (slightly degenerative flattened) was confirmed. Labral repair was performed with a suture anchor fixation (Figures 4A and 4B). After releasing traction, a dynamic assessment to evaluate impingement was performed confirming FAI cam impingement (Figure 4C). Cam osteoplasty was performed (Figure 4D).
Central compartment手技中に、前上方関節唇断裂(軽度変性)が確認された。関節唇修復が、スーチャーアンカー固定法を用いて実施された(図4A及び4B)。牽引解除後、インピンジメントを評価するための動的評価が、CamタイプFAIインピンジメントを確認するために実施された(図4C)。Cam osteoplastyが行なった(図4D)。


After reapplying traction, the OCD lesion (ICRS grade III) was observed in the weightbearing area and perifoveal area of the femoral head (Figures 6A and 6B).

Under fluoroscopy, a CROSSTRAC Hip Guide System (Smith & Nephew Endoscopy, Andover, MA) was introduced through the ALP (Figure 5). The aimer of CROSSTRAC GUIDE SYSTEM was placed at the center of a completely separated OCD lesion and a 2.4 mm guide-wire was drilled from greater trochanter with direct visualization from the MAP (Figure 5).
透視下で、CROSSTRAC Hip Guide System(Smith & Nephew Endoscopy, Andover, MA)がALPを介して挿入された(図5)。CROSSTRAC GUIDE SYSTEMのエイマーが、完全に分離されたOCD病変の中心に配置され、MAPからの直接鏡視下で、2.4mmガイドワイヤーが、大転子からドリリングされた(図5)。


Then, the aimer of CROSSTRAC GUIDE SYSTEM was placed at the partially separated OCD lesion and three 2.0 mm K-wires were introduced from the greater trochanter toward the articular surface of femoral head using CROSSTRAC GUIDE SYSTEM, performing a retrograde fixation with K-wires of the OCD lesion of the femoral head (Figure 6C and 6E).
その後、CROSSTRAC GUIDE SYSTEMのエイマーが、部分的に分離されたOCD病変に配置され、3本の3.0mmK-ワイヤーが、CROSSTRAC GUIDE SYSTEMを用いて、大転子から大腿骨頭の関節面に向けて挿入され、大腿骨頭のOCD病変のK-ワイヤーを用いてRetrograde固定が実施された(図6C及び6E)。


After releasing traction, a cylindrical autologous osteochondral graft (10 mm diameter) was harvested arthroscopically from the ipsilateral knee joint in a full extension of knee (Figure 2C). The superior lateral aspect of the intercondylar notch was used as the donor site. The 10-mm size Chizel (Smith & Nephew, Andover, MA) was introduced through the superolateral knee portal. It was driven into the bone to a depth of 25 mm. The harvester, containing the graft, was then removed by twisting the T-handle.
牽引解除後、円筒形自家骨軟骨グラフト(10mm直径)が、完全伸展膝の同側膝関節から鏡視下に採取された(図2C)。顆間窩の上外側面がDonor siteとして用いられた。10mmサイズのChizel(Smith & Nephew, Andover, MA)が上外側膝ポータルを介して挿入された。それは、深さ25个泙嚢内に打ち込まれた。それから、ハーベスター内のグラフトがT-ハンドルをツゥイストすることによって取り出された。

For retrograde OAT procedure, a Core reamer (anterior cruciate ligament (ACL) drill guide system) was utilized to make a graft tunnel through the 2.4 mm ACL drill guide wire from greater trochanter to reach out to the articular surface of the femoral head (Figure 6F). The autologous OATS was delivered through the tunnel by using bone tunnel dilator from greater trochanter (Figure 6G).
Retrograde OAT手技に対して、Coreリーマー(ACLドリルガイドシステム)が、大転子から、大腿骨頭の関節面の外まで、2.4mmACLドリルガイドを介してグラフトの骨孔を作成するために用いられた(図6F)。自家OATSが、大転子から、骨孔ダイレーターを用いる事によって、骨孔を介して運び込まれた(図6G)。

Postoperative X-ray showed good healing of OAT and retrograde fixation at OCD lesion of the femoral head (Figure 7). Since the patient required the removal of K-wires, second-look hip arthroscopy at 12 months was performed demonstrating good healing of the OCD lesion of the femoral head (Figure 8).



Modified Harris hip score (MHHS) improved from 69.8 preoperatively to 100 at 14 months after surgery.
Non-arthritis hip score improved from 88.7 to 100 at 14 months after surgery.
Postoperative rehabilitation
Postoperative rehabilitation was used for both antegrade and retrograde OAT procedures. The patients were placed in a brace (Philippon brace, Bledsoe, Dallas, TX), for three weeks, to protect the hip and limit abduction and rotation. Gentle passive range of motion (ROM) exercise was initiated during the first week, under the supervision of a physiotherapist.
術後リハビリテーションは、AnteguradeとRetrogradeの両方のOAT手技に対して用いられた。患者は、股関節を保護し、外転及び回旋を制限するために、3週間、ブレース(Philippon brace, Bledsoe, Dallas, TX)が装着された。緩徐な受動可動域エクササイズが、理学療法士の指導下で、第1週中に開始された。
The patient remained non-weight bearing, during the first four weeks. Active hip flexion was limited, during phase I (the first four weeks), to minimize the risk of hip flexor inflammation. From week four to five, weight bearing was gradually increase and the patient was progressed to full weight bearing at eight weeks after surgery. The patients were allowed to start swimming and do stationary bikewith resistance at four months after surgery. Endurance strengthening began at 24 weeks after surgery; only after range of motion was maximized and after good stability in gait and movement was observed. Throughout this phase, there was no low impact aerobic conditioning.
In this study, we demonstrated two cases with OCD lesions of femoral head treated with an arthroscopic antegrade and retrograde OAT technique for treating OCD lesions in the hip. In this article, the first case was associated with acetabular labral tear and the second case was associated with LCPD, acetabular labral tear, and hip dysplasia. There are several studies looking at OCD lesions with LCPD. Rowe et al. have shown that seven of 363 hips (about 2%) with LCPD have concomitant OCD lesions [12].
本研究において、我々は、股関節のOCD病変の治療に対するための鏡視下Antegrade及びRetrograde OATテクニックで治療された大腿骨頭のOCD病変を有した2例を示した。本稿において、最初の症例は、股関節唇断裂に関連があり、2例目の症例は、LCPD、股関節唇断裂及び股関節形成不全に関連があった。ペルテス病に伴うOCD病変を観察したいくつかの研究が存在する。Roweらは、ペルテス病を有する363股のうち7股(約2%)がOCD病変の共存を有することを示した。
Steenbrugge and Macnicol reported four cases with OCD lesions of the femoral head diagnosed about four years following the occurrence of LCPD [4]. We think OCD lesion of femoral head may sequel to other hip pathologies including labral tears and/or LCPD.
Clohisy et al. described good clinical outcomes of residual Perthes like deformity and hip dysplasia treated with open surgical dislocation and concomitant periacetabular osteotomy [13]. Several studies have shown that shelf acetabuloplasty is also useful for treating Perthes like deformity with concurrent hip dysplasia [14, 15]. Recently, we developed a new endoscopic technique of shelf acetabuloplasty for treating hip dysplasia as well as intra-articular pathologies [16]. Thus, we utilized endoscopic shelf procedure concomitantly with arthroscopic OAT procedures. There are several case reports of patients with osteochondral lesions of the femoral head undergoing OAT procedure.
Clohisyらは、Open Surgical dislocationとPAOの併用で治療されたペルテス様残存変形と股関節形成不全の良好な臨床的Outcomeを詳細した。7研究は、Shelf acetabuloplastyもまた、股関節形成不全を伴うペルテス様変形を治療することに対して有用である。最近、我々は、股関節形成不全だけでなく、関節内病変の治療に対してShelf acetabuloplastyの新しい鏡視下テクニックを開発した。したがって、我々は、鏡視下Shelf手技と同時に、鏡視下OAT手技も利用してきた。大腿骨頭の骨軟骨病変に対してOAT手技を受けた患者の症例報告がいくつか存在する。
Nam et al. reported two cases of osteochondral lesions of the femoral head who had undergone OAT procedure combined with osteochondral fragment fixation after traumatic anterior dislocation of the hip joint. They demonstrated good clinical outcomes and graft incorporation showed by the MRI study [17]. Girard et al. demonstrated the surgical technique and clinical outcomes following OAT after treating 10 patients with OCD lesions of the femoral head. They revealed excellent well healed incorporation of autologous graft in all radiographs [18].
Gagala et al. also reported good result following fragment fixation combined with OAT for treating osteochondral defect after posterior fracture dislocation of the hip joint. They proposed good clinical outcomes and graft congruity confirmed by MRI [19]. All those case reports described require an open surgical dislocation with a trochanteric osteotomy to assess and treat the osteochondral lesion.
Gagalaらもまた、股関節の後方脱臼骨折後の骨軟骨欠損の治療のためのOATと組み合わせたFragment固定後の良好な結果を報告した。彼らは、良好な臨床成績とMRIによって確認されたGraftの適合性を提案した。それらすべての詳細された症例報告は、骨軟骨病変を評価し治療するために、転子部骨切り術を伴うOpen surgical dislocation法を必要とするものである。
Contrary to arthroscopic procedures, open approaches could have higher rates of complications, such as, non-union of the greater trochanter and slower recovery [20]. Hip arthroscopy is less invasive and promising tool for assessing and treating hip intra-articular pathologies. Matsuda and Safran demonstrated good clinical outcomes after arthroscopic internal fixation of an OCD lesion in the femoral head using metal headless compression screws [21]. Arthroscopic OAT would be more advantageous if OCD lesion is irreparable and degenerative. Kubo et al. described a new surgical technique of arthroscopic antegrade OAT procedure for treating OCD at the anterosuperior aspect of the femoral head [8]. Cetinkaya et al. also described a surgical technique with arthroscopic retrograde OAT procedures for treating OCD lesion at the central weight-bearing area of the femoral head [9].
鏡視下手技とは対照的に、Openアプローチ法は、大転子癒合不全のような合併症のより高い発生率とより遅延した回復を有する可能性が考えられる。股関節鏡は低侵襲手技であり、股関節内病変の評価及び治療に対する有望なツールである。Matsuda及びSafranは、Metal headless compressionスクリューを用いて、大腿骨頭OCD病変の鏡視下内固定後の良好な臨床成績を実証した。鏡視下OATは、OCD病変が修復不能で変性している場合に、より利点となると考えられる。KuboとUchidaらは、大腿骨頭の前上方面におけるOCDを治療するための、鏡視下Antegrade OAT手技の新しい手術テクニックを詳細に報告した。Cetinkayaらも、大腿骨頭の荷重中心部におけるOCD病変の治療に対する鏡視下Retrograde OAT手技を用いた手術テクニックを詳細した。

Indication and contraindication
The indication of antegrade OAT technique is an OCD lesion (ICRS classification grades III and IV) at the anteriorsuperior or anterior-lateral aspect of the femoral head [22]. The indication of retrograde OAT technique is OCD lesion at center and/or posterior aspect of the femoral head. Contraindication of these techniques are an infection surrounding hip joint and osteoarthritis (Table 1).
Antegrade OATテクニックの適応は、大腿骨頭の前上方または前外側面におけるOCD病変(ICRS分類グレード3及び4)である。Retrograde OATテクニックの適応は、大腿骨頭の中心及び/または後方領域のOCD病変である。これらのテクニックの禁忌は、股関節周辺の感染及びOAである(表1)。

Advantage and disadvantage
Arthroscopic OAT to treat OCD lesion of the femoral head has several advantages and some disadvantages. The advantages are that this procedure is minimally invasive and it has the potential for early rehabilitation and quicker recovery. Concurrent lesions can be readily assessed and treated arthroscopically. Surgeons are able to assess impingement issues and other intra-articular pathologies, such as, acetabular labral tears, ligamentous tearing, and cartilage delamination since OCD of the femoral head is often associated with other pathologies.
However, considerable disadvantages are that this procedure is meticulous and technically demanding. The targeting of retrograde drilling is also is difficult despite the use of CROSSTRAC system. There is the possibility of donor-site morbidity, such as, donor-site pain in the knee joint.
しかしながら、この手技は、慎重性を要し、技術的に高難度というかなりの欠点を有する。Retrogradeドリリングのターゲッティングもまた、CROSSTRACシステムの使用にもかかわらず、難しい。膝関節のDonor-site痛のようなDonor-site morbidityの可能性も存在する。

Hip arthroscopy plays a crucial therapeutic and diagnostic tool for the treatment of several hip pathologies including: labrum tears, cartilage damage and impingement. These reported techniques add a potential role of hip arthroscopy for the treatment of OCD.

股関節 軟骨損傷 疲労骨折 大腿骨頭骨軟骨移植などでお困りの方は ぜひお問い合わせください。

Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement 関節外インピンジメントを引き起こした転位したNonunion AIISサッカー選手への鏡視下治療

今週は 先月 Orthopaedicというジャーナルに掲載された 我々の論文
産業医科大学若松病院にフェローとして来られた 柴原基(しばはらもとい)先生が執筆された論文

Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement
関節外インピンジメントを引き起こした転位した癒合不全の下前腸骨棘Nonunion AIISの鏡視下治療

Motoi Shibahara, MD, PhD; Yasuo Ohnishi, MD, PhD; Eisaburo Honda, MD; Dean K. Matsuda, MD; Soshi Uchida, MD, PhD
The authors are from the Department of Orthopaedic Surgery and Sports Medicine (MS, YO, EH, SU), Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan; and DISC Sports and Spine (DKM), Marina del Rey, California.
Orthopedics. 2017

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Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement.


This report describes a case of nonunion of an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture with resultant subspine impingement combined with symptomatic femoroacetabular impingement (FAI). A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running. The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI by physical examination and radiological findings. The authors performed arthroscopic AIIS decompression, with concurrent FAI correction and labral repair and capsular closure. At 4 months after surgery, a radiograph and a computed tomography scan showed complete bony union of the AIIS apophyseal nonunion. Modified Harris Hip Sore and Nonarthritic Hip Score improved from 74.8 and 61, respectively, to 100 for both at final follow-up. The effectiveness of arthroscopic decompression of the AIIS as part of a comprehensive minimally invasive surgery including FAI correction and labral repair resulted in complete union of the AIIS and pain-free return to sport and bony union.
本稿は、症候性FAIを合併し結果として、Subspineインピンジメントを伴ったnonunion 下前腸骨棘(AIIS) 骨端裂離骨折の1例を紹介する。思春期の16歳男性サッカー選手は、Kicking及びランニングにより増悪する右鼠蹊部痛の6ヶ月の病歴を呈した。患者は、理学検査及びレントゲン所見によって、CamタイプFAI以外に、二次性関節外インピンジメントを引き起こすAIIS骨端裂離骨折後の転位した偽関節の合併と診断された。著者らは、鏡視下AIIS除圧術と同時にFAIの矯正及び関節唇修復そして関節包縫合を実施した。術後4ヵ月におけるレントゲンとCTは、AIIS骨端癒合不全の完全な骨癒合を示した。MHHSとNAHSは、それぞれ、74.8点と61点から、最終経過観察時に、両方100点に改善した。FAIの矯正と関節唇修復術を含めた包括的最小侵襲手術の一部としてAIISの鏡視下除圧術の効果は、AIISの完全統合と無痛スポーツ復帰及び骨癒合をもたらした。

Avulsion fractures of the anterior inferior iliac spine (AIIS) apophyses are common injuries in pediatric and adolescent athletes.1 Because the origin of the straight head of the rectus femoris is the AIIS, violent contraction of this muscle during activities such as running, jumping, or kicking may cause an avulsion fracture.1 A recent study reported AIIS extra-articular impingement against the distal femoral neck with excessive distal and/or anterior protrusion and that AIIS impingement can be developmental or the result of prior AIIS avulsions.2

Hip arthroscopy has been used as an effective surgery for the assessment and treatment of acetabular labral tears with femoroacetabular impingement (FAI). A recent study revealed that AIIS impingement combined with FAI can be treated by hip arthroscopy.2

Matsuda and Calipusan3 published a case report of an adolescent athlete with an AIIS avulsion fracture with subsequent distal protruding malunion who was successfully treated with hip arthroscopy including arthroscopic “spinoplasty.”

However, to the current authors’ knowledge, extra-articular impingement resulting from nonunion of an AIIS apophyseal avulsion fracture combined with FAI has not been reported. The authors present the clinical and radiographic findings and the arthroscopic treatment of a patient with displaced nonunion of the AIIS causing extra-articular impingement.

Case Report

A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running and refractory to nonoperative treatment, including nonsteroidal anti-inflammatory drugs and physiotherapy. He attempted to return to soccer, but his groin pain increasingly worsened.

He had no previous significant medical history and no evidence of trauma to the hip or symptoms from the lumbar spine or contralateral hip. On physical examination, he had tenderness over the right groin region. Hip range of motion was limited to 90° of flexion, 20° of flexed-hip internal rotation with a positive anterior impingement sign, and 30° of external rotation. An anteroposterior pelvic radiograph showed nonunion of the AIIS protruding distally at the level of the apex of the femoral head (Figure 1A).

The lateral center edge angle was 29°4 with a cephalad crossover sign suggesting focal pincer impingement. The false profile view showed anterior distal protrusion of the AIIS with cortical hypertrophy (Figure 1B).5
LCEAは、29度であり、限局性Pincerインピンジメントを示唆する頭側クロスオーバーサインをともなうことが示された。False profile viewは、(図1B)。

The triradiate and femoral capital physes remained opened. Axial computed tomography scans with 3-dimensional reconstruction confirmed prominent deformity of the AIIS and nonunion of the AIIS avulsion fracture extending below the anterosuperior acetabular rim (Figure 1C).
Triradiate及びFemoral capital physesは離解したままであった。3D再構成を伴う軸CTスキャンから、AIISの隆起変形と前上方寛骨臼縁下まで延長するAIIS裂離骨折のnonunionが確認された(図1C)。

Magnetic resonance arthrography showed anterosuperior labral tearing (Figure 1D). The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI.

Figure 1

Surgical Technique
Supine hip arthroscopy was performed on a traction table. The anterolateral portal and mid-anterior portal were established. Interportal capsulotomy was performed. Perilabral focal synovitis was visualized at the level of the AIIS. An anterosuperior labral tear was treated with labral refixation after limited acetabuloplasty of the anterosuperior rim (Figures 2A-B).

The anterosuperior capsule was undercut with a shaver and a radiofrequency probe in the area of the AIIS to expose the rim and the AIIS. Decompression of the inferior AIIS was performed using a motorized round burr via the mid-anterior portal (Figure 2C). After releasing traction, a dynamic impingement test in hip abduction showed significant cam impingement. Femoroplasty was performed with confirmed eradication of ongoing FAI and subspinal impingement (Figure 2D).


Finally, capsular closure was performed to stabilize the joint as previously described.6 Postoperative radiograph and computed tomography scans showed complete bony union of the AIIS apophyseal nonunion (Figure 3).

Figure 3

Postoperative Rehabilitation
The patient was placed in a brace for 3 weeks to protect the hip and limit abduction and rotation. Gentle passive range of motion exercise was initiated during the first we
ek, under the supervision of a physiotherapist. The patient remained non– weight bearing during the first 4 weeks. Active hip flexion was limited during phase I (the first 4 weeks) to minimize the risk of hip flexor tendonitis. From week 4 to 5, weight bearing gradually increased, and the patient was liberalized to full weight bearing at 8 weeks postoperatively.

With improved mobility, stability, and proprioception, the patient began running and using a resistance stationary bike at 3 months postoperatively. Endurance strengthening and agility drills commenced at 4 months when a radiograph confirmed complete union of the AIIS avulsion.

The patient returned to soccer 4 months postoperatively without pain and discomfort. Preoperative modified Harris Hip Score and Nonarthritic Hip Score improved from 74.8 and 61, respectively, to 100 for both at final follow-up.


This report presents the first known case of an AIIS nonunion with subspine impingement that was successfully treated with arthroscopic inferior osteoplasty of the inferior protruding region with resultant bony union.
Most AIIS avulsion fractures occur with an extension movement of the hip joint with the knee flexed during running, turning, and kicking activities.1,7
本稿では、AIIS突出領域を鏡視下下方Osteoplastyによって結果的に骨癒合し良好に治療しえたSubspineインピンジメントを伴うAIIS nonunionの初めての症例を紹介する。大半のAIIS裂離骨折は、ランニング、Turning及びKicking運動時の膝屈曲状態の股関節伸展動作で発生する。

Avulsion of the AIIS apophysis is usually related to hip hyperextension and knee flexion while attempting to kick a ball, which prompts maximum exertion of the rectus femoris tendon.7 Repetitive hip flexion and internal rotation can cause nonunion of an AIIS avulsion fracture.

The authors believe the current AIIS fracture displaced during an avulsion mechanism, causing the distal protrusion with resultant symptomatic subspine impingement. The nonunion was caused by repetitive micromotion from ongoing abutment with the proximal femur. However, another possible mechanism might be a preexisting type 3 AIIS (with developmental distal protrusion) that initially fractured via a mechanical conflict without displacement, with resultant nonunion from ongoing repetitive micromotion.
著者らは、このAIIS骨折が、剥離骨折発生時に転位し遠位突出を引き起こしものであり、その結果として症候性Subspineインピンジメントをもたらしたと信じる。骨癒合不全は、近位大腿骨との現存するAbutmentからの反復性Micromotionによって引き起こされた。しかしながら、別の可能性のあるメカニズムとして、タイプ3 AIIS(発達性遠位突出)が既存する状態で、最初は、転位を有さなかった骨折が、それによる反復性Micromotionの力学的衝突を介して、結果的にnonunionとなったということも考えられる。

Either pathomechanism might cause the patient’s history of acute pain, subspine impingement, and distal protruding AIIS with nonunion. Although conservative management can provide satisfactory outcomes for avulsion fractures of the AIIS,8-10 the course of treatment varies, ranging from 3 weeks to 4 months.7 If conservative management fails, surgical intervention is indicated. Generally, surgery has been proposed for the minority of patients with displacement of greater than 2 cm, symptomatic nonunion, and bony hypertrophy.11

Several reports have described that open reduction and internal fixation can provide excellent results.12 On the other hand, exostosis resection has also had good results, with a full range of hip motion if symptomatic impingement was clearly significant.13
観血的整復術(大きく開いて行う手術方法) 及び内固定法の多くの報告が、優れた結果を提供可能であることを述べてきた。その一方で、症候性インピンジメントが明らかに有意である場合、外骨腫の切除もまた、股関節完全可動域を伴った良好な結果をもたらす。

Anterior inferior iliac spine impingement has been increasingly defined as a source of hip pain.14 Larson et al2 noted that hip dysfunction in patients with a prominent AIIS was most likely related to impingement, occurring between an AIIS prominence and the anterior aspect of the femoral neck when the hip was flexed to more than 90°.

The current patient also had symptomatic intra-articular pathology, including cam FAI and labral tearing, in addition to subspine impingement and nonunion of the AIIS. Concurrent FAI and labral pathology in the setting of subspine impingement has been previously described.3,14
Preoperative and intraoperative findings distinguished AIIS impingement from FAI. The authors observed specific findings, including groin pain with straight hip flexion and tenderness over the AIIS on physical examination, excessive anterior and distal extension of the AIIS on false profile view, and sclerosis of the margin of the AIIS on anteroposterior view.
術前と術中所見は、AIISインピンジメントとFAIの区別を認めた。著者らは、理学検査に関して、Straight股関節屈曲を伴う鼠蹊部痛と、AIIS上の圧痛、そして、False profile view上のAIISの過剰な前方及び遠位の延長、及びAP view上のAIIS辺縁の硬化を含めた、特異的所見を観察した。

Arthroscopic findings also confirmed focal synovitis at the level of the prominent AIIS. However, the authors were not able to detect reactive changes at the anterior distal femoral neck. It is likely that this patient had components of subspine and femoroacetabular impingement contributing to his symptoms and both were simultaneously and successfully addressed with hip arthroscopy.

Untreated or residual AIIS impingement is also an important predictor of revision hip arthroscopy in patients with FAI.14,15 Therefore, it is recognized that symptomatic AIIS impingement not responding to conservative measures should be considered for arthroscopic AIIS decompression.

Hip arthroscopic surgery provides an attractive and less invasive alternative to more open approaches. Matsuda and Calipusan3 reported a similar case showing that arthroscopic decompression of the AIIS was effective in the treatment of the AIIS malunion concomitant with FAI.

Unlike that case, the current case had nonunion of the AIIS. The authors performed arthroscopic decompression of the AIIS, labral repair, and cam osteoplasty to reduce impingement, promoting successful healing of the nonunion proximal to the decompressed area. The authors surmise that by eradicating ongoing AIIS impingement, the nonunion was relieved of repetitive abutment and micromotion, enabling spontaneous bony union without internal fixation.
その症例とは異なり、本症例は、AIISのnonunionを有した。著者らは、AIISの鏡視下除圧、関節唇修復及びインピンジメントを削減し、除圧された領域に対して近接したnonunionの良好な治癒を促進するために、Cam Osteoplastyを実施した。著者らは、現存するAIISインピンジメントを消失させることによって、nonunionが反復性アバットメントとマイクロモーションから解放され、内固定無しの自然な骨癒合を可能にしたと推測する。

Although one may question whether labral repair was required with confirmed detachment only at the 3-o’clock rim position, limited proximal labral takedown was performed during focal acetabuloplasty with subsequent refixation. Because the 3-o’clock position has the smallest acetabular safety angle and the lowest depth of the drilling with higher risk of iatrogenic chondral penetration,16 the authors opted for suture anchor fixation at the 2-o’clock position, which enabled successful labral reattachment without acetabular chondral violation.

Advantages of this less invasive approach are a shorter recovery time and the ability to assess and treat concurrent intra-articular pathology. Disadvantages of this approach are complications specific to arthroscopic surgery, including, but not limited to, traction-related injury. Limitations of this study included only one case and short-term follow-up. Further studies are needed to determine the optimal treatment for AIIS nonunion in the setting of subspine impingement.
この低侵襲アプローチ法の利点は、早期回復と、同時に関節内病変を評価し治療するその能力にある。本アプローチ法の欠点は、牽引関連損傷に限らない股関節鏡に関連される特異的な合併症が含まれる。本研究の制限には、1例限定であること、及び短期経過観察であることが含まれる。今後の研究は、Subspineインピンジメントの設定におけるAIIS nonunionに対する最適治療を決定するために必要とされる。

Arthroscopic AIIS decompression, with concurrent FAI decompression and labral repair when indicated, is a minimally invasive surgery. It can provide clinical benefit and bony union for patients with protruded nonunion of the AIIS.



 First Authorの柴原基先生です。 
一緒に仕事をしている写真が全くなく ステーキを食べている写真か 走っている時の写真がありました。(笑)上の写真は ステーキを食べている写真、 下の写真は ケンブリッジで柴原先生が発表した次の日にジョギングをご一緒した時の写真です。

柴原基先生は 6月1日に 下記に開院されます。



Arthroscopic Shoelace Capsular Closure Technique in the Hip using Ultratape Arthroscopy Techniques

Our manuscript entitled Arthroscopic Shoelace Capsular Closure Technique in the Hip using Ultratape
Arthroscopy Techniques has been accepted for publication in Journal of Arthroscopy techniques

関節鏡視下に 靴紐縫いのテクニックで 股関節包を縫縮する 新しいテクニックが

Arthroscopy Techniquesに アクセプトされました。

効果抜群の 方法として 注目されています。

投稿して 約3週間という 異例の早さの アクセプトでした。

Ref.: Mss. No. ARTH-16-794R1
Arthroscopic Shoelace Capsular Closure Technique in the Hip using Ultratape
Arthroscopy Techniques

shoelace suture

Dear Dr. Uchida:

Thank you for your revision of the above-referenced manuscript. Everything is satisfactory and I am pleased to inform you that it has been accepted for publication in our open-access online journal, Arthroscopy Techniques.

Please note that the production process often requires the best plans to change. Thus, we cannot give you a specific date of publication.

Again, congratulations on the acceptance of your article.


Melissa B. Schmidt
Managing Editor
Arthroscopy Techniques


 Hip arthroscopy is promising tool for assessing and treating intra-articular pathologies including labral tears, cartilage injuries and ligamentum teres tears of the hip. Inter-portal capsulotomy allows for better visualization and accessibility of the arthroscope and working instruments. The hip capsule has been defined as a crucial stabilizer of the hip joint. Thus, capsular closure is recognized as an important procedure to prevent postoperative instability after hip arthroscopic surgery. Despite the routine capsular closure during hip arthroscopy, there are a small subset of patients that complain of hip pain and dysfunction after surgery most likely because of disruption of hip closure site following routine complete capsular closure using strong suture for treating hip instability.
This technical note describes the arthroscopic shoelace capsular suture technique using a strong ultratape, for treating FAI with capsular laxity and borderline hip dysplasia

動画です。共著者の Ceciliaのナレーションです。


Dr. Soshi Uchida is taking care of the patient in Fukuoka, Tokyo and Kyoto.



尾山台整形外科クリニック 東京関節鏡センター

東京都世田谷区でも第1 第3木曜日午前中と土曜日隔週で診察をしています。詳しくは御問い合わせください。


古都 京都でも 第四木曜日に外来をしています。 午後手術をしています。

大阪 奈良 和歌山などの関西方面の方や愛知県 三重県、岐阜県、名古屋、岐阜 福井 や 北陸 石川 富山  股関節鏡が必要な方が来られて 診察を受けられています。

livedoor プロフィール
Dr Soshi Uchida website
英語のホームページを作成しました。 たずねてみてください。 Dr Soshi Uchida website
産業医科大学若松病院 連絡先 〒808−0024 北九州市若松区浜町1丁目17−1 電話 093−761−0090 当科へのお問い合わせメール uoehwakamatsusports@gmail.com 8月31日より変更になりました。 当院への外来予約専用ダイヤル TEL:093-285-3203 * 月〜金 9時〜18時 までご連絡下さい。

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