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Review
. 2022 Nov 11;10(11):23259671221131341.
doi: 10.1177/23259671221131341. eCollection 2022 Nov.

Imaging Diagnosis, Prevalence, and Clinical Outcomes of Arthroscopic Surgery for Anterior Inferior Iliac Spine Impingement: A Systematic Review and Meta-analysis

Naomi Kobayashi  1 , Emi Kamono  1 , Yuya Yamamoto  1   2 , Yohei Yukizawa  1 , Hideki Honda  1 , Shu Takagawa  1 , Toshihiro Misumi  3 , Yutaka Inaba  2
Affiliations
Review

Imaging Diagnosis, Prevalence, and Clinical Outcomes of Arthroscopic Surgery for Anterior Inferior Iliac Spine Impingement: A Systematic Review and Meta-analysis

Naomi Kobayashi et al. Orthop J Sports Med. .

Abstract

Background: Subspine impingement, or anterior inferior iliac spine (AIIS) impingement, is a type of extra-articular pathology associated with femoroacetabular impingement syndrome and often requires subsequent arthroscopic surgery.

Purpose: To examine the diagnostic accuracy, prevalence, and clinical outcomes of arthroscopic treatment for AIIS impingement.

Study design: Systematic review; Level of evidence, 4.

Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist was applied. We searched for studies on the prevalence, diagnostic accuracy, and results of surgical treatment for AIIS impingement. For each included study, data synthesis and statistical analysis were performed to identify pooled prevalence, calculate clinical outcome scores, and estimate adverse events. The QUADAS (a quality assessment tool for diagnostic accuracy studies) was used to assess the quality of the diagnostic accuracy studies, and the Risk of Bias Assessment tool for Nonrandomized Studies was used to assess the quality of the studies on arthroscopic treatment efficacy.

Results: Out of an initial 791 studies, 23 were included. AIIS impingement was diagnosed by plain radiography with 76% to 86% sensitivity, 3-dimensional computed tomography with 80% to 81.8% sensitivity, magnetic resonance imaging with 80% sensitivity, and ultrasound with 92.5% sensitivity. For patients who underwent hip arthroscopy, the pooled prevalence of AIIS impingement was 18%. Significant improvement between pre- and postoperative clinical outcomes was observed: 25.75 points for the modified Harris hip score (mHHS), 46.88 points for the Hip Outcome Score-Sport subscale, 20.85 points for the Nonarthritic Hip Score, and -2.92 points for the pain visual analog scale. The minimal clinically important difference on the mHHS was exceeded by 94% of patients. The pooled incidence of surgical complications was 1%. Of 6 included studies on diagnostic accuracy, 2 were identified as having a low risk of bias, and 4 included >2 factors with a high risk of bias. All 9 included studies on treatment outcomes had at least 1 factor with a high risk of bias.

Conclusion: Several imaging modalities assist in the diagnosis of AIIS impingement. The overall prevalence of AIIS impingement in patients that underwent hip arthroscopy was 18%. Clinical outcomes after arthroscopic AIIS decompression were generally favorable, with a relatively low rate of surgical complications.

Keywords: anterior inferior iliac spine (AIIS) impingement; femoroacetabular impingement; hip arthroscopy; subspine impingement.

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Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Flowchart of the systematic review conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. *Titles and abstracts did not meet our inclusion criteria.
Figure 2.
Figure 2.
Forest plots showing prevalence of anterior inferior iliac spine impingement in the primary arthroscopy (18%), revision arthroplasty (23%), and high-kicking athlete (72%) populations. Heterogeneity was identified as high for all 3 populations, with I 2 values of 82%, 97%, and 93%, respectively. The funnel plot for prevalence studies revealed a symmetric property regarding publication bias.
Figure 3.
Figure 3.
Forest plots of MD between pre- and postoperative improvements in patient-reported outcome scores. The mean differences in mHHS, percentage of mHHS exceeding MCID, HOS-S, NAHS, and VAS were 25.75, 94, 46.88, 20.85, and -2.92, respectively. The I 2 values for heterogeneity were 93%, 0%, 97%, 81%, and 0%, respectively. The funnel plot for patient-reported outcome scores studies revealed an asymmetric property regarding publication bias. HOS-S, Hip Outcome Score–Sport subscale; MCID, minimal clinically important difference; MD, mean difference; mHHS, modified Harris Hip Score; NAHS, Nonarthritic Hip Score; VAS, visual analog scale for pain.
Figure 4.
Figure 4.
Incidence of complications and reoperations after arthroscopic surgery for AIIS impingement. Incidence of complication was 1% and incidence of reoperation was 2%. The I 2 value was 0% for both complications and reoperations, suggesting low heterogeneity. The funnel plots for complications and reoperations revealed asymmetric properties regarding publication bias.
Figure 5.
Figure 5.
Risk of bias for the studies on diagnostic accuracy. ,,,,,
Figure 6.
Figure 6.
Risk of bias for the studies on arthroscopic treatment outcomes.
See this image and copyright information in PMC

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