Title:
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Anterior instability of the hip
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The evolution of humans to an upright stance has led to a change in the postural
relationship between the human pelvis and the lower limb. However, despite the
uncovering of the femoral head anteriorly, the bipedal hip remains inherently stable due
to its bony anatomy and strong ligamentous support. Deviation from normal osseous
anatomy results in a loss of constraint to dynamic movement with pathological
translation of the femoral head (1,2). A similar scenario is expected with compromise of
the surrounding soft tissue structures.
A presentation of nine clinical cases describes the condition thought to result from
compromise of the anterior hip ligaments. A triad of clinical signs are described. To
investigate the patho-mechanical mechanism in these patients, a magnetic resonance
imaging (MR.I) study of symptomatic hips was performed. Although increased joint ,
translation was not demonstrated in this study, distinctive appearances of the
iliofemoral ligament were identified. Results of a cadaveric study then go on to
demonstrate the stabilizing roles of the anterior capsular ligaments. With damage to the
anterior capsule, increased translation of the femoral head was seen not only
throughout movement range, but specifically correlated with the functional positions of
the iliofemoral and pubofemoral ligaments.
The concept of instability of the hip due to soft tissue laxity is postulated to result in
progressive damage to the labrum and chondral surfaces as the femur abuts the
acetabular rim during extra-physiological motion. Chronic capsular injury may
destabilise previously asymptomatic hips with subsequent development of pain in
young, active patients. Knowledge of the function of the capsule and its reinforcements is critical if hip surgeons are to manage these patients appropriately and understand the implications of capsular compromise on long-term function.
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