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Background/Objectives: Long-standing groin pain is a severe issue for athletes, often associated with the cleft sign on magnetic resonance imaging (MRI) scans, yet its underlying causes are poorly understood. The purpose of this study is to histologically examine the pubic plate structure in cadavers with and without the cleft sign on MRI, shedding light on the pathology behind the cleft sign. Methods: Three fresh human pelvic cadavers underwent 3.0T MRI to detect the cleft sign before histological dissection of pubic plates. Pubic plate tissues were fixed in formalin, decalcified, and processed. Of the two cleft sign-negative specimens, one was cut into sagittal sections, and the other was cut into coronal sections for histology. For the cleft sign positive specimen, a sagittal section was cut. Moreover, 5 µm thick sections were cut at different axial levels for each orientation. Sections were subjected to Safranin O, Alcian blue, and Herovici’s staining or hematoxylin and eosin staining. Results: MRI confirmed that one specimen had a cleft sign in the inferior region on both sides of the pubis and that two specimens had no cleft sign. Both sagittal and coronal sections showed the presence of a cartilage structure continuing from the pubic symphysis to 3 mm laterally within the pubic plate. In the specimen with a positive cleft sign, cartilage damage within the pubic symphysis and pubic plate was identified as revealed by Safranin O staining, Herovici’s staining, and H&E staining. Conclusions: This study elucidated the existence of a cartilage component extending from the pubic symphysis to the pubic plate. The cleft sign in MRI correlated with a disruption in the cartilage component in histology within this specific area.

Purpose: To perform a systematic review to assess the effect of capsular repair compared with nonrepair on patient-reported outcome measures (PROMs) and conversion to total hip arthroplasty (THA) after hip arthroscopy in patients with femoroacetabular impingement syndrome. Methods: We initially searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PubMed databases, as well as ongoing clinical trials (https://clinicaltrials.gov), on December 15, 2022. The eligibility criteria were randomized controlled trials (Level Ⅰ) and prospective comparative studies (Level II) of patients who underwent capsular repair and nonrepair via hip arthroscopy with a minimum follow-up period of 2 years. We registered this protocol a priori on PROSPERO (identification No. CRD42021239306). We assessed the risk of bias using the Methodological Index for Non-randomized Studies (MINORS) appraisal tool. Results: This review included 5 studies with a total of 639 patients (270 with capsular repair [average age, 35.4 years; 41% female patients] and 369 with nonrepair [average age, 37.3 years; 38% female patients]). In the included studies, surgical procedures consisting of labral repair and pincer or cam osteoplasty were performed via hip arthroscopy. The modified Harris Hip Score was measured in all the included studies, and the standardized mean difference in PROMs for capsular repair versus nonrepair in the included studies was 0.42 (95% confidence interval [CI], 0.20 to 0.63). A sensitivity analysis of randomized controlled trials achieved consistent results (standardized mean difference in PROMs, 0.31; 95% CI, 0.02 to 0.60). Capsular repair was not associated with a reduction in revision surgery (risk difference, –0.02; 95% CI, –0.06 to 0.03; 26 of 270 patients with capsular repair vs 42 of 369 with nonrepair) but was associated with a reduction in conversion to THA (risk difference, –0.05; 95% CI –0.09 to –0.01; 12 of 270 patients with capsular repair vs 38 of 369 with nonrepair). The average Methodological Index for Non-randomized Studies (MINORS) score in the included studies was 20. Conclusions: Patients who undergo capsular repair in conjunction with other arthroscopic hip preservation techniques have better PROMs and a lower incidence of THA conversion. Level of Evidence: Level II, systematic review of Level I and II investigations.

Osteochondritis dissecans (OCD) of the knee is an uncommon injury in young active patients. There is currently a lack of knowledge regarding clinical outcomes and return-to-sport rates after fragment fixation surgery using hydroxy appetite poly-L-lactic acid (HA/PLLA) threaded pins for knee OCD among athletes. Our purpose was to investigate the clinical outcomes and return-to-sport rates following osteochondral fragment fixation using HA/PLLA pins for the treatment of knee OCD lesions among athletes. A total of 45 patients were retrospectively reviewed. In total, 31 patients were excluded, and 14 patients were included. Pre- and postoperative patient-reported outcome scores (PROSs), including the International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcome Scale (KOOS), were compared. In addition, patients were categorized into four groups according to postoperative sports status: higher, same, lower than preinjury, or unable to return to sports. The mean age was 14.4 years (SD 1.67). All patients were male. All PROSs significantly improved at 6, 12, and 24 months postsurgery compared to presurgery. 50% of the patients returned to sports at the same or higher level after surgery. Fragment fixation using HA/PLLA pins leads to favorable clinical outcome scores and high return-to-sport rates in the treatment of athletes with knee OCD.

Abstract This 10-year retrospective observational study investigated longitudinal losses in psoas major and paraspinal muscle area in 1849 healthy individuals (1690 male, 159 female) screened using computed tomography. Logistic regression analysis revealed significant decreases in psoas major and paraspinal muscle area at 10 years relative to the baseline area regardless of age or sex, starting at 30 years of age. Only aging [≥ 50 s (odds ratio [OR]: 1.72; 95% confidence interval [CI] 1.05–2.84; p = 0.03) and ≥ 60 s (OR: 2.67; 95% CI 1.55–4.60; p 45 min daily (Calories = METs (walking: 3.0) × duration of time (h) × weight (60 kg) × 1.05) can reduce paraspinal muscle loss, which may in turn decrease the risk of falls, low-back pain, and sarcopenia.

Currently, hip braces are recommended and typically worn by femoroacetabular impingement (FAI) patients after hip arthroscopic surgery. However, there is currently a lack of literature regarding the biomechanical effectiveness of hip braces. The purpose of this study was to investigate the biomechanical effect of hip braces after hip arthroscopic surgery for FAI. Overall, 11 patients who underwent arthroscopic FAI correction and labral preservation surgery were included in the study. Standing-up and walking tasks in unbraced and braced conditions were performed at 3 weeks postoperatively. For the standing-up task, videotaped images of the hip’s sagittal plane were recorded while patients stood from a seated position. After each motion, the hip flexion-extension angle was calculated. For the walking task, acceleration of the greater trochanter was measured using a triaxial accelerometer. For the standing-up motion, the mean peak hip flexion angle was found to be significantly lower in the braced condition than in the unbraced condition. Furthermore, the mean peak acceleration of the greater trochanter was significantly lower in the braced condition than in the unbraced condition. Patients undergoing arthroscopic FAI correction surgery would benefit from usage of a hip brace in terms of protecting repaired tissues during early postoperative recovery.

Background and purpose — The current literature does not clarify the predictors of cam regrowth and poor clinical outcome following hip arthroscopic femoroacetabular impingement (FAI) correction surgery. Therefore, we investigated the prevalence and risk factors of cam regrowth following arthroscopic FAI correction surgery in skeletally immature patients compared with skeletally mature patients. Patients and methods — 33 teenagers (36 hips as 4 underwent bilateral hip arthroscopies, average age 16.7 [SD 1.6] years, 21 boys [22 hips], 12 girls [14 hips]) undergoing arthroscopic FAI correction and 74 adult controls (74 hips, average age 41 [SD 12] years, 42 men [42 hips], 32 women [32 hips]) were retrospectively reviewed. Postoperative radiographs were obtained, and cam regrowth was evaluated. Clinical characteristics, radiographic findings, arthroscopic findings, and procedures between skeletally immature (SI) and mature (SM) patients were compared. Average follow-up period was 28 months in the SI group and 24 months in the SM group. Results — Preoperatively, 27 of 36 hips were SI, having either a Risser sign grade ≤ 4 of iliac apophysis or open physes of the proximal femur. Cam regrowth was present in 4 of 27 SI hips. The number of cam regrowth cases was significantly higher in SI patients than in SM patients (0/74 hips). 6 patients required revision hip arthroscopic surgeries (4 men: FAI recurrence due to cam regrowth; 2 women: capsulolabral adhesions). At the last follow-up, the mean modified Harris hip score and nonarthritic hip score were significantly improved postoperatively. Interpretation — 4 of 27 SI hips (95% CI 0.04–0.3) had bone regrowth after cam resection arthroscopically. Our case series showed a non-negligible risk of cam regrowth in SI patients, especially in male patients and patients aged approximately 15 years.

Objective: To investigate clinical outcomes and return to sport timeline for athletes with acetabular dysplasia after endoscopic shelf acetabuloplasty (ESA). Design: A retrospective review. Setting: Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan between 2012 and 2019. Patients: Fifteen elite athletes (median age: 20 years) of 253 patients undergoing ESA, arthroscopic labral repair/reconstruction, cam osteochondroplasty, and capsular plication. The mean follow-up period was 27.8 months after surgery. Main Outcome Measures: Patient-reported outcome scales (PROSs), including the modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool 12, Hip Outcome Score-Sports, and Vail Hip Score. Results: After ESA, all 15 elite athletes were able to return to sport effectively and compete at a preoperative level. The mean time between the operation and the first practice was 6.5 months, while the mean time between the ESA procedure and the first game was 9.6 months. Approximately 27.8 months after surgery, PROS outcomes improved significantly with no hips requiring emergency revision surgery at the final follow-up. At a mean of 47.1 months after surgery, 7 athletes decided to retire from their sport. Up to 71.1 months after surgery, the additional 8 patients continued to compete in their sport at an elite level. Conclusions: ESA enables elite athletes with acetabular dysplasia to return to competition at a mean of 9.6 months postsurgery. The ESA procedure is an effective and promising method of treating elite athletes with acetabular dysplasia. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical outcome of arthroscopic surgery for femoroacetabular impingement (FAI) between athlete and nonathlete patients. Design: Retrospective case-control study. Level of Evidence III. Patients and Methods: Seventy-four patients who underwent arthroscopic FAI correction from March 2009 to April 2012 were enrolled in this study. The patients were divided into 2 groups, according to their sports participation (47 in the athlete group and 27 in the nonathlete group). Main Outcome Measures: We reviewed clinical and radiographic data for all patients, up to a minimum of 2 years after surgery. We used analysis of covariance to compare the mean patient reported outcome scores including modified Harris hip score (MHHS) and the nonarthritis hip score (NAHS) preoperatively, at 6, 12, and 24 months after surgery. Results: The mean age at the time of surgery in the athlete group was significantly lower than that in the nonathlete group. Although there was no significant difference in preoperative MHHS and NAHS, the mean NAHS at 6, 12, and 24 months postoperatively and the mean MHHS at 24 months postoperatively in athletes were significantly higher than that in nonathletes (P < 0.05). Conclusions: Although arthroscopic FAI correction and labral preservation surgery is generally beneficial, it appears to provide a better clinical outcome in athletes than in nonathletes. [ABSTRACT FROM AUTHOR]