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Background: Cigarette smoking has been shown to negatively affect outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The effect of cessation of cigarette smoking before surgery has not been well established., Purposes: (1) To report minimum 2-year patient-reported outcomes (PROs) of former smokers who underwent primary hip arthroscopy for FAIS and (2) to compare these results with those of a propensity-matched control group of nonsmokers., Study Design: Cohort study; Level of evidence, 3., Methods: Data were collected for all patients who underwent primary hip arthroscopy for FAIS between December 2008 and November 2017. Patients were eligible if they indicated that they had previously smoked cigarettes but had quit smoking at least 1 month before surgery and had minimum 2-year postoperative outcomes for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and visual analog scale (VAS) for pain. The percentage of hips achieving the minimal clinically important difference (MCID) were recorded. The study group was then propensity matched in a 1:1 ratio by age, sex, and body mass index (BMI) to patients who had never smoked., Results: A total of 83 former-smoking patients (84 hips; age, 45.0 ± 13.5 years) were included at a median follow-up of 38.6 months (interquartile range, 27.5-48.2 months); all patients had stopped smoking at a mean ± standard deviation of 14.3 ± 24.5 months preoperatively. Former smokers demonstrated significant improvement from preoperatively to the minimum 2-year follow-up for all recorded PROs ( P < .001 for all) and achieved the MCID for the mHHS, NAHS, and VAS at favorable rates (75.0%-81.6%). Logistic regression analysis did not identify a significant relationship between cessation time and rates of achieving MCID for mHHS, NAHS, or VAS. When compared with 84 never-smokers (84 hips), the former smokers demonstrated similar preoperative scores, postoperative scores, and improvement on all recorded PROs ( P > .05 for all). Both groups achieved MCID for mHHS, NAHS, and VAS at similar rates and demonstrated similar rates of revision surgery., Conclusion: Former smokers who underwent primary hip arthroscopy for FAIS demonstrated significant improvement in PROs at minimum 2-year follow-up. When compared with a propensity-matched control group of never-smokers, they achieved similar postoperative PROs and rates of achieving psychometric thresholds., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.E.J. has received education payments from Medwest. A.J.C. has received education payments from Supreme Orthopedic Systems. A.C.L. has received grant support from Arthrex, education payments from Arthrex/Medwest and Smith & Nephew, consulting fees from Graymont Professional Products, speaking fees from Arthrex, and hospitality payments from Stryker. B.G.D. has received education payments from Medwest; consulting fees from Arthrex, Medacta, and Stryker; speaking fees from Arthrex and Stryker; royalties from Arthrex, DJO, and Medacta; and honoraria from Medacta. 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., (© The Author(s) 2022.)

Background: Return to sports (RTS) and patient-reported outcomes (PROs) for elite athletes with femoral version abnormalities undergoing hip arthroscopy have not been well established., Purposes: To (1) report minimum 2-year PROs and RTS rates in elite athletes with femoral retroversion who underwent primary hip arthroscopy and (2) compare clinical results to those of a propensity-matched control group of elite athletes with normal femoral version who underwent primary hip arthroscopy., Study Design: Cohort study; Level of evidence, 3., Methods: Data were prospectively collected and retrospectively reviewed for elite (professional and collegiate) athletes with femoral version <5°, as measured on magnetic resonance imaging scans, who underwent hip arthroscopy for femoroacetabular impingement syndrome between March 2010 and April 2018. Inclusion criteria were preoperative and minimum 2-year follow-up PROs for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia, and previous ipsilateral hip surgery or conditions. Rates of achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold were recorded in addition to RTS. Athletes with retroversion were propensity matched in a 1:2 ratio to elite athletes with normal femoral version (5°-20°) for comparison., Results: A total of 33 elite athletes (33 hips) with femoral retroversion who underwent hip arthroscopy met the inclusion criteria, and follow-up was available for 30 hips in 30 athletes (90.9%) at an average of 36.1 ± 25.6 months. Elite athletes with femoral retroversion demonstrated significant improvements in all recorded PROs, achieved the MCID and PASS for the HOS-SSS at high rates (86.7%), and returned to sports at a rate of 83.3%. PROs, rates of achieving MCID and PASS for the HOS-SSS, and RTS rates were similar between the study and propensity-matched control group., Conclusion: Elite athletes with femoral retroversion undergoing primary hip arthroscopy demonstrated favorable PROs and high RTS rates at a minimum 2-year follow-up. These results were comparable with those of a propensity-matched control group of elite athletes with normal femoral version., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.E.J. has received education payments from Medwest. A.C.L. has received grant support from Arthrex and Stryker, education payments from Arthrex and Smith & Nephew, consulting fees from Graymont Professional, and nonconsulting fees from Arthrex. B.G.D. has received education payments from Medwest; consulting fees from Arthrex, Medacta, and Stryker; speaking fees from Arthrex and Stryker; and royalties from Arthrex, DJO, and Medacta. 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., (© The Author(s) 2022.)

Background: There is limited literature evaluating patient-reported outcomes (PROs) in cigarette smokers undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at midterm follow-up., Purpose: (1) To report minimum 5-year PROs for cigarette-smoking patients who underwent primary hip arthroscopy for FAIS and (2) to compare these results with a propensity-matched control group of never-smoking patients., Study Design: Cohort study; Level of evidence, 3., Methods: Data were collected for all patients who underwent primary hip arthroscopy for FAIS between June 2009 and March 2016. Patients were eligible if they indicated that they smoked cigarettes within 1 month of surgery and had minimum 5-year postoperative outcomes for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and International Hip Outcome Tool-12 (iHOT-12). The percentages of patients achieving the Patient Acceptable Symptom State (PASS) and maximum outcome improvement satisfaction threshold were recorded. The study group was then propensity matched in a 1:2 ratio to patients who had never smoked for comparison., Results: Included were 35 patients (35 hips) with a mean age of 39.4 ± 13.0 years and mean follow-up of 64.6 ± 4.1 months. These patients demonstrated significant improvement from preoperatively to a minimum 5-year follow-up for all recorded PROs ( P < .05). When compared with 70 control patients (70 hips), smoking patients demonstrated significantly worse preoperative scores for all PROs ( P < .05). Study patients also demonstrated worse minimum 5-year scores for all recorded PROs compared with control patients, which did not reach statistical significance but trended toward significance for HOS-SSS (70.4 vs 81.9; P = .076) and iHOT-12 (74.7 vs 82.2; P = .122). Smoking patients also trended toward lower rates of achieving PASS for the iHOT-12 compared with never-smoking patients (50.0% vs 68.2%; P = .120)., Conclusion: Patients who smoked cigarettes and underwent primary hip arthroscopy for FAIS demonstrated significant improvement in PROs at a minimum 5-year follow-up. When compared with a propensity-matched control group of never-smokers, they trended toward lower postoperative HOS-SSS and iHOT-12 scores and lower rates of achieving PASS on the iHOT-12., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.E.J. has received education payments from Medwest. D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. B.R.S. has received grants from Arthrex, education payments from Medwest and Smith & Nephew, and speaker fees from DJO Global. A.C.L. has received research support from Arthrex, Stryker, and Medacta; education payments from Medwest and Smith & Nephew; consulting fees from Arthrex and Graymont Medical; speaking fees from Arthres; and hospitality payments from Zimmer Biomet. B.G.D. has received research support from Arthrex, the Kauffman Foundation, and Stryker; consulting fees from Adventist Hinsdale Hospital, Arthrex, Medacta, and Stryker; education payments from Arthrex, Breg, and Medacta; speaking fees from Arthrex; honoraria from Medacta; royalties from Amplitude, Arthrex, DJO Global, Medacta, Stryker, and Orthomerica; and hospitality payments from Zimmer Biomet; and has had ownership interests in the American Hip Institute, Hinsdale Orthopaedics, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. 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., (© The Author(s) 2022.)

Background: There is a paucity of literature evaluating the effect of cigarette smoking on outcomes in patients undergoing hip arthroscopy and labral reconstruction., Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores for patients who smoke cigarettes and underwent primary hip arthroscopic labral reconstruction and (2) to compare these results with those of a propensity-matched control group of patients who have never smoked., Study Design: Cohort study; Level of evidence, 3., Methods: Data were collected for all patients who underwent primary hip arthroscopy for labral reconstruction between January 2011 and January 2019. Patients were eligible for the study if they indicated that they smoked cigarettes within 1 month of surgery and had minimum 2-year postoperative outcome scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and the visual analog scale (VAS) for pain. The percentage of patients achieving the minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) was recorded. Rates of revision surgery were also documented. These patients were then propensity matched in a 1:3 ratio to patients who had never smoked (controls) for comparison., Results: A total of 20 patients (20 hips) were included with a mean follow-up of 39.9 ± 13.0 months and mean age of 41.4 ± 10.4 years. These patients demonstrated significant improvement from preoperatively to the minimum 2-year follow-up for mHHS, NAHS, and VAS ( P < .05). They also achieved MCID for mHHS and VAS at acceptable rates, 70% for both. When outcomes were compared with those of 60 control patients (60 hips), patients who smoke demonstrated lower preoperative PRO scores but similar minimum 2-year postoperative PRO scores for mHHS and NAHS. Patients who smoke demonstrated lower rates of achieving PASS for mHHS (55% vs 75%) and NAHS (40% vs 61.7%) compared with controls; however, these findings were not statistically significant. Rates of secondary surgery were statistically significantly higher in the smoking group compared with controls (25% vs 5%; P = .031). Survivorship for the smoking patients was 80% and 98.3% for the control group. At the two-year mark survivorship was 90% for the smoking group and 100% for the control group ( P = .06)., Conclusion: While smokers can still derive significant improvement from hip arthroscopy, their ultimate functional outcome and rate of secondary surgeries are inferior to those of nonsmokers. As smoking is a significant and modifiable risk factor, we should continue to counsel smokers on smoking cessation prior to and after surgery., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.G.D. has received research support from Arthrex, the Kauffman Foundation, and Stryker; consulting fees from Adventist Hinsdale Hospital, Arthrex, Medacta, and Stryker; education payments from Arthrex, Breg, and Medacta; speaking fees from Arthrex; honoraria from Medacta; royalties from Amplitude, Arthrex, DJO Global, Medacta, Stryker, and Orthomerica; and hospitality payments from Zimmer Biomet and has had ownership interests in the American Hip Institute, Hinsdale Orthopaedics, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. A.E.J. has received education payments from Medwest. D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. B.R.S. has received grants from Arthrex and speaker fees from DJO Global. A.C.L. has received research support from Arthrex, Stryker, and Medacta; education support from Arthrex, Medwest, and Smith & Nephew; consulting fees from Arthrex and Graymont Medical; and hospitality payments from Zimmer Biomet. 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., (© The Author(s) 2022.)

Background: Ligamentum teres (LT) reconstruction is an appropriate alternative in select cases of LT full-thickness tears, resulting in hip micro- or macroinstability. Graft fixation at the acetabular fossa is critical to achieving the best functional results., Purpose: The purpose of this study is to compare the pullout strength of 2 graft fixation methods used for LT reconstruction of the hip., Study Design: Controlled laboratory study., Methods: In 7 cadaveric specimens, the acetabular socket was prepared after the native LT was transected and the femoral head was removed. Seven separate tibialis anterior grafts were then prepared by suturing a running-locking No. 2 suture on each tail of the graft. Three specimens had fixation of the graft to the acetabulum using an adjustable cortical suspension suture button; the remaining 4 were fixed to the acetabulum using a knotless suture anchor. Specimens were then mounted onto a custom jig within a mechanical test frame to allow for the in-line pull of the graft fixation construct. After a preload of 5 N, each specimen was loaded to failure at 0.5 mm/s. Stiffness and load to failure were measured for each specimen construct., Results: Suture button fixation had a higher mean load to failure when compared with the knotless anchor fixation method (mean ± SD, 438.1 ± 114.3 vs 195.9 ± 50.0 N; P = .01). There was no significant difference in mean stiffness between the methods of fixation (24.5 ± 1.4 vs 26.5 ± 5.8 N/mm; P = .6)., Conclusion: In this cadaveric study, the suture button fixation demonstrated greater load to failure than the knotless anchor fixation., Clinical Relevance: Results of this study can guide surgical decision making when selecting an acetabular fixation method for LT reconstruction., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was sponsored by Arthrex in the form of direct funding as well as in kind donations of cadaveric specimens and surgical products used in the completion of the study aims. A.C.L. has received research support from Arthrex, Stryker, and Medacta; education payments from Arthrex, Medwest, and Smith & Nephew; consulting fees from Arthrex and Graymont Medical; and hospitality payments from Zimmer Biomet. M.K.R. has received research support from Arthrex, education payments from Smith & Nephew, and hospitality payments from Prime Surgical. R.P.R. has received research support from Arthrex and education payments from Arthrex and Smith & Nephew. P.J.R. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. B.A.E. has received consulting fees, nonconsulting fees, and royalties from Arthrex. B.G.D. has received research support from Arthrex, ATI, Stryker, and Pacira Pharmaceuticals; education payments from Arthrex, Breg, and Medwest; consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; speaking fees from Arthrex and Pacira Pharmaceuticals; honoraria from Medacta; and royalties from Amplitude, Arthrex, DJO Global, MAKO Surgical, Medacta, Stryker, and Orthomerica. B.G.D has also had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. 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., (© The Author(s) 2021.)

Background: Gluteus medius (GM) tears are a known cause of dysfunction and disability predominantly in older women., Purpose: To report on return to activity, patient-reported outcomes (PROs), and a uniquely calculated minimal clinically important difference (MCID) at a minimum 2-year follow-up for active patients who had undergone either an endoscopic or an open GM repair., Study Design: Case series; Level of evidence, 4., Methods: Patients were considered eligible if they (1) underwent a GM repair with or without concomitant central and peripheral compartment procedures; (2) had baseline preoperative and minimum 2-year scores for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain; and (3) participated in a physical activity or sport within 1 year before their surgery. Return to activity was defined as the patient being able to participate in his or her activity at a minimum of 2 years postoperatively., Results: Of 87 eligible patients, 84 (96.6%) met all inclusion criteria. The mean follow-up was at 44.5 months. Six patients (7.1%) underwent an open GM repair, while the remaining 78 (92.9%) underwent an endoscopic GM repair. Concomitant central and peripheral compartment arthroscopic procedures were performed in 69 patients (82.1%). All PROs significantly ( P < .001) improved as follows: mHHS, from 59.0 to 85.8; NAHS, from 57.9 to 84.0; HOS-SSS, from 32.6 to 63.7; and VAS pain, from 5.4 to 1.9. A total of 57 patients (67.9%) returned to their preoperative activity at the 2-year follow-up. The MCID was calculated for the mHHS, NAHS, and HOS-SSS to be 7.5, 7.4, and 10.9, respectively, with 79.3%, 86.4%, and 70.2% of patients achieving the MCID for each respective PROs., Conclusion: Active patients over the age of 50 years may benefit from endoscopic or open repair of GM tears, as the majority of patients in our cohort were able to return to their activity of choice. All measured PROs had significantly improved at a minimum 2-year follow-up, with high survivorship, satisfaction, and clinical effectiveness. Patients with partial-thickness tears compared with full-thickness tears and those who underwent isolated GM repair compared with GM repair with concomitant procedures had similar return to activity rates and PROs at the latest follow-up., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.B.M. has received educational support and hospitality payments from Arthrex, Stryker, and Smith & Nephew. P.J.R., J.S., and D.R.M. have received hospitality payments from Arthrex, Stryker, and Smith & Nephew. A.C.L. has received research support from Arthrex, Stryker, and Medacta; educational support from Medwest and Smith & Nephew; consulting fees from Arthrex and Graymont Medical; and hospitality payments from Arthrex, Smith & Nephew, Stryker, and Zimmer Biomet. B.G.D. has received research support from Arthrex, ATI, the Kauffman Foundation, Stryker, and Pacira Pharmaceuticals; educational support from Arthrex, Breg, and Medwest; consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; speaking fees from Arthrex and Pacira Pharmaceuticals; and royalties from Amplitude, Arthrex, DJO Global, MAKO Surgical, Medacta, Stryker, and Orthomerica and has had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. 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., (© The Author(s) 2021.)

Background: Labral tears are the most common abnormalities in patients undergoing hip arthroscopic surgery. Appropriate management is crucial, as it has been shown that better overall outcomes can be achieved with labral restoration., Purpose: To report the patient-reported outcomes (PROs) at minimum 2-year follow-up of patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique in the setting of femoroacetabular impingement syndrome (FAIS)., Study Design: Case series; Level of evidence, 4., Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery for FAIS for labral tear repair using the knotless controlled-tension anatomic technique. Patients were excluded if they had prior hip conditions, prior ipsilateral surgery, Tönnis grade >1, a lateral center-edge angle (LCEA) <25°, or workers' compensation claims. Preoperative and postoperative scores at minimum 2-year follow-up were recorded for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The proportion of patients who achieved the minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS) for the mHHS, HOS-SSS, and iHOT-12 were also reported., Results: A total of 309 hips were included. The mean patient age was 36.2 years (range, 12.8-75.9 years). The mean preoperative LCEA and alpha angle were 31.9° and 57.1°, respectively. A significant improvement on the mHHS (62.6 ± 15.7 preoperatively vs 86.9 ± 16.2 at 2-year follow-up), NAHS (63.1 ± 16.7 vs 86.1 ± 16.7), and HOS-SSS (39.8 ± 22.0 vs 74.2 ± 27.3) was found ( P < .001 for all). A significant decrease was shown for VAS scores ( P < .001). Also, 78.6% and 82.2% of patients achieved the MCID and PASS for the mHHS, respectively; 60.8% and 69.9% of patients met the MCID and PASS for the HOS-SSS, respectively; and the MCID for the iHOT-12 was met by 77.3% of patients., Conclusion: In the setting of FAIS and labral tears, patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique demonstrated significant improvement in several validated PRO measures, the VAS pain score, and patient satisfaction at a minimum 2 years of follow-up. Based on this evidence, labral tear repair using the knotless controlled-tension anatomic technique seems to be a safe option., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. J.S. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. P.J.R. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. A.C.L. has received research support from Arthrex, Stryker, and Medacta; educational support from Medwest and Smith & Nephew; consulting fees from Arthrex and Graymont Medical; and hospitality payments from Zimmer Biomet. B.G.D. has had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and the Munster Specialty Surgery Center and has received research support from Arthrex, ATI, Stryker, and Pacira Pharmaceuticals; educational support from Arthrex, Breg, and Medwest; consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; speaking fees from Arthrex and Pacira Pharmaceuticals; and royalties from Arthrex, DJO Global, MAKO Surgical, Stryker, and Orthomerica. 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., (© The Author(s) 2020.)

Background: Gluteus medius (GM) tears are a well-established source of pain and disability. An open approach has been recognized with complete full-thickness and large GM tears, yet the current literature provides few reports on outcomes for this specific situation., Purpose: To report and analyze minimum 2-year patient-reported outcomes (PROs) from patients who underwent open GM repair in the setting of a full-thickness tear with or without concomitant hip arthroscopy through use of contemporary tendon repair techniques., Study Design: Case series; Level of evidence, 4., Methods: Prospectively collected data were retrospectively reviewed for patients who underwent hip preservation surgery and total hip arthroplasty (THA) between April 2008 and May 2017. Patients were included in this study if they underwent open repair of GM full-thickness tears. The exclusion criteria were incomplete follow-up, workers' compensation status, repair regarding size and pattern of the GM, open repair of partial GM tear, open repair with allograft or autograft augmentation, and/or additional gluteus maximus transfer. Pre- and postoperative PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) score for pain and satisfaction were recorded. Statistical significance was set at P < .05., Results: A total of 36 patients were included, of whom 12 received concomitant hip arthroscopy for intra-articular procedures. The mean ± SD age, body mass index, and follow-up time were 65.18 ± 12.69 years, 28.97 ± 4.95 kg/m 2 , and 40.8 ± 26.19 months, respectively. At minimum 2-year follow-up, the following outcome measures improved significantly: mHHS (from 54.72 ± 15.89 to 73.12 ± 19.47; P < .0001), NAHS (from 56.05 ± 12.47 to 75.22 ± 19.15; P < .0001); HOS-SSS (from 20.30 ± 20.21 to 44.23 ± 35.85; P < .0001), and VAS (from 4.95 ± 2.70 to 2.67 ± 2.81; P < .0001). There was 1 (2.8%) conversion to THA at 48 months after the index procedure., Conclusion: Patients who underwent open repairs in the setting of full-thickness GM tears via contemporary tendon repair techniques, with or without concomitant hip arthroscopy, achieved favorable results in several PRO scores at minimum 2-year follow-up., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. P.J.R. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. J.S. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. A.C.L. has received research support from Arthrex, Stryker, and Medacta; educational support from Medwest and Smith & Nephew; consulting fees from Arthrex and Graymont Medical; food and beverage from Smith & Nephew, Stryker, Zimmer Biomet, Arthrex; and travel and lodging from Stryker and Arthrex. B.G.D. has had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; has received research support from Arthrex, ATI, the Kauffman Foundation, Stryker, and Pacira Pharmaceuticals; has received consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; has received educational support from Arthrex, Breg, and Medwest; has received speaking fees from Arthrex and Pacira Pharmaceuticals; and receives royalties from Arthrex, DJO Global, MAKO Surgical, Stryker, and Orthomerica. 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., (© The Author(s) 2020.)

Background: A femoral head "divot" is a rare finding during hip arthroscopy. A linear chondral indentation can be observed on the femoral head, just lateral and parallel to the acetabular labrum., Purpose/hypothesis: The purpose of this study was to describe a novel arthroscopic sign and retrospectively review patients with this finding. We hypothesized that this sign would be found in patients with characteristics consistent with hip microinstability., Study Design: Case series; Level of evidence, 4., Methods: Intraoperative images of patients undergoing primary hip arthroscopy between July 2017 and July 2019 were reviewed for evidence of a femoral head divot. Preoperative characteristics, physical examination findings, radiographic measurements, and magnetic resonance imaging (MRI) findings were described., Results: Of 690 available cases, 14 cases (13 patients; 2.0%) had evidence of a femoral head divot. The mean patient age was 29.1 years, and all but 1 patient (92.3%) were female. Ligamentous laxity was present in 81.8% of patients, anterior apprehension test was positive in 78.6%, and painful internal snapping was present in 50.0%. The mean lateral center-edge angle, anterior center-edge angle, and Tönnis angle were 19.2°, 20.3°, and 12.4°, respectively. The divot was identified in 5 of 12 available MRI scans, most commonly on axial proton density sequence. Intraoperatively, all hips had labral tears, iliopsoas bursitis was demonstrated in 78.6%, and the ligamentum teres was damaged in 42.9%. Labral repair was performed in 12 of the 14 hips, with 2 patients undergoing labral reconstruction. Iliopsoas fractional lengthening was performed in 50.0%, capsular plication was performed in 78.6%, and capsular repair was performed in the remainder., Conclusion: The femoral head divot sign is a rare arthroscopic finding during hip arthroscopy. The results of this study demonstrated that patients who have a divot also present with characteristic radiographic or physical examination findings of hip microinstability due to either acetabular dysplasia or ligamentous laxity. Recognition of a femoral head divot may be valuable for the diagnosis of microinstability during hip arthroscopy and may help guide appropriate management, such as capsular plication. Further studies are needed to determine the exact prevalence of the femoral head divot in patients with microinstability and to evaluate the effect of this finding on patient outcomes., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: P.J.R. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. J.S. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. M.B.M. has received educational support and hospitality payments from Arthrex, Stryker, and Smith & Nephew. A.C.L. reports educational support from Medwest and Smith & Nephew; research support from Arthrex, Stryker, and Medacta; food and beverage from Smith & Nephew, Stryker, Zimmer Biomet, Arthrex; travel and lodging from Stryker and Arthrex; and consulting fees from Arthrex and Graymont Medical. B.G.D. has had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; has received research support from Arthrex, ATI, the Kauffman Foundation, Stryker, and Pacira Pharmaceuticals; has received consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; has received educational support from Arthrex, Breg, and Medwest; has received speaking fees from Arthrex and Pacira Pharmaceuticals; and receives royalties from Arthrex, DJO Global, MAKO Surgical, Stryker, and Orthomerica. The American Hip Institute Research Foundation funded this research and is where our study was performed. 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., (© The Author(s) 2020.)

Background: Labral reconstruction has been advocated as an alternative to debridement for the treatment of irreparable labral tears, showing favorable short-term results. However, literature is scarce regarding outcomes and return to sport in the nonelite athletic population., Purpose: To report minimum 1-year clinical outcomes and the rate of return to sport in athletic patients who underwent primary hip arthroscopy with labral reconstruction in the setting of femoroacetabular impingement syndrome and irreparable labral tears., Study Design: Case series; Level of evidence, 4., Methods: Data were prospectively collected and retrospectively analyzed for patients who underwent an arthroscopic labral reconstruction between August 2012 and December 2017. Patients were included if they identified as an athlete (high school, college, recreational, or amateur); had follow-up on the following patient-reported outcomes (PROs): modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS); and completed a return-to-sport survey at 1 year postoperatively. Patients were excluded if they underwent any previous ipsilateral hip surgery, had dysplasia, or had prior hip conditions. The proportions of patients who achieved the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for mHHS and HOS-SSS were calculated. Statistical significance was set at P = .05., Results: There were 32 (14 females) athletes who underwent primary arthroscopic labral reconstruction during the study period. The mean age and body mass index of the group were 40.3 years (range, 15.5-58.7 years) and 27.9 kg/m 2 (range, 19.6-40.1 kg/m 2 ), respectively. The mean follow-up was 26.4 months (range, 12-64.2 months). All patients demonstrated significant improvement in mHHS, NAHS, HOS-SSS, and VAS ( P < .001) at latest follow-up. Additionally, 84.4% achieved MCID and 81.3% achieved PASS for mHHS, and 87.5% achieved MCID and 75% achieved PASS for HOS-SSS. VAS pain scores decreased from 4.4 to 1.8, and the satisfaction with surgery was 7.9 out of 10. The rate of return to sport was 78%., Conclusion: At minimum 1-year follow-up, primary arthroscopic labral reconstruction, in the setting of femoroacetabular impingement syndrome and irreparable labral tears, was associated with significant improvement in PROs in athletic populations. Return to sport within 1 year of surgery was 78%., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. P.J.R. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. R.W.-S. has received educational support from DePuy and Encore Medical and hospitality payments from Acumed, Arthrex, Globus Medical, Stryker, and Smith & Nephew. J.S. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. A.C.L. has received research support from Arthrex and Stryker, educational support from Medwest and Smith & Nephew, consulting fees from Arthrex and Graymont Medical, and hospitality payments from Smith & Nephew, Stryker, and Zimmer Biomet. B.G.D. has ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; has received research support from Arthrex, ATI, the Kauffman Foundation, and Pacira Pharmaceuticals; has received consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; has received educational support from Arthrex, Breg, and Medwest; has received speaking fees from Arthrex and Pacira Pharmaceuticals; and receives royalties from Arthrex, DJO Global, MAKO Surgical, Stryker, and Orthomerica. 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., (© The Author(s) 2020.)

Background: Labral reconstruction has been described as a solution for the irreparable labrum. Initial techniques employed autografts, while more recent procedures have utilized allografts. No study, to our knowledge, has compared graft types., Purpose: To compare outcomes between patients who underwent primary labral reconstruction with a hamstring allograft versus hamstring autograft., Hypothesis: No significant differences in outcomes will be found between patients who underwent primary labral reconstruction with an allograft versus autograft., Study Design: Cohort study; Level of evidence, 3., Methods: Data from September 2010 to March 2015 were reviewed. Inclusion criteria were primary hip arthroscopic surgery with labral reconstruction using either a hamstring allograft (ALLO group) or autograft (AUTO group), with minimum 2-year follow-up scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Exclusion criteria were previous ipsilateral hip surgery, previous hip conditions, preoperative Tönnis osteoarthritis grade >1, and workers' compensation claims. Significance was set at P = .05., Results: Twenty-nine patients (29 hips) were included (85.3% follow-up). There were 17 patients (17 hips) in the ALLO group and 12 patients (12 hips) in the AUTO group. All patient-reported outcome scores demonstrated significant improvements at latest follow-up except for the mHHS for the AUTO group ( P = .064). Comparisons between the ALLO and AUTO groups at the preoperative and latest follow-up time points showed no significant differences (preoperative mean [range]: mHHS, 67.5 [33.0-100.0] and 65.8 [29.0-96.0], respectively [ P = .826]; NAHS, 65.6 [26.3-92.5] and 58.5 [35.0-79.0], respectively [ P = .322]; HOS-SSS, 43.7 [12.5-100.0] and 40.1 [19.0-78.0], respectively [ P = .707]) (latest follow-up mean [range]: mHHS, 86.4 [56.0-100.0] and 81.4 [57.0-100.0], respectively [ P = .46]; NAHS, 87.7 [60.0-100.0] and 82.4 [56.3-100.0], respectively [ P = .396]; HOS-SSS, 81.7 [0.0-100.0] and 70.9 [27.8-100.0], respectively [ P = .423])., Conclusion: Primary arthroscopic hip labral reconstruction yielded improvements in patient-reported outcome scores and high patient satisfaction. In this small series, no differences were found in clinical outcomes between hamstring allografts and autografts. Based on these results, hamstring allografts and autografts may be considered comparable graft choices for primary reconstruction. Because of the avoidance of donor site morbidity and the possible increase in patient satisfaction, allografts may be the preferred choice in a surgical setting when they are accessible., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.C.L. has received research support from Arthrex, educational support from Medwest and Smith & Nephew, and hospitality payments from Stryker. B.G.D. has ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; has received research support from Arthrex, ATI, the Kauffman Foundation, and Pacira Pharmaceuticals; has received consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; has received educational support from Arthrex, Breg, and Medwest; has received speaking fees from Arthrex and Pacira Pharmaceuticals; and receives royalties from Arthrex, DJO Global, MAKO Surgical, Stryker, and Orthomerica. 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.

Background: The rate of hip arthroscopic surgery has recently increased; however, there is limited literature examining patient-reported outcomes (PROs) in cigarette smokers., Purpose/hypothesis: The purpose of this study was to evaluate whether smoking status for patients undergoing hip arthroscopic surgery affects clinical findings and PRO scores. We hypothesized that patients who smoke and undergo primary hip arthroscopic surgery will have similar clinical examination findings and preoperative and postoperative PRO scores compared with nonsmoking patients., Study Design: Cohort study; Level of evidence, 3., Methods: Data were collected on all patients who underwent primary hip arthroscopic surgery from February 2008 to July 2015. A retrospective analysis of the data was then conducted to identify patients who reported cigarette use at the time of the index procedure. Patients were matched 1:2 (smoking:nonsmoking) based on sex, age within 5 years, labral treatment (repair vs reconstruction vs debridement), workers' compensation status, and body mass index within 5 kg/m 2 . All patients were assessed preoperatively and postoperatively using 4 PRO measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool-12 (iHOT-12). Pain was estimated using a visual analog scale. Satisfaction was measured on a scale from 0 to 10. Significance was set at P < .05., Results: A total of 75 hips were included in the smoking group, and 150 hips were included in the control group. Preoperatively, the smoking group had significantly lower PRO scores compared with the control group for the mHHS, NAHS, and HOS-SSS. Both groups demonstrated significant improvement from preoperative levels. A minimum 2-year follow-up was achieved, with a mean of 42.5 months for the smoking group and 47.6 months for the control group ( P = .07). At the latest follow-up, the smoking group reported inferior results for all outcome measures compared with controls. The improvement in PRO scores and rates of treatment failure, revision arthroscopic surgery, and complications was not statistically different between the groups., Conclusion: Patients who smoke had lower PRO scores preoperatively and at the latest follow-up compared with nonsmokers. Both groups demonstrated significant improvement in all PRO scores. These results show that while hip arthroscopic surgery may still yield clinical benefit in smokers, these patients may ultimately achieve an inferior functional status. To optimize results, physicians should advise patients to cease smoking before undergoing hip arthroscopic surgery., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.C.L. has received research support from Arthrex, educational support from Medwest Associates and Smith & Nephew, and hospitality payments from Stryker. A.G.G. has received research support from Arthrex and hospitality payments from Smith & Nephew, Stryker, and Zimmer Biomet. B.G.D. has ownership interests in Hinsdale Orthopaedics, American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; receives research support from Arthrex, ATI, Kauffman Foundation, and Pacira Pharmaceuticals; is a consultant for Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; has received educational support from Arthrex and Medwest Associates; receives royalties from Arthrex, DJO Global, MAKO Surgical, Stryker, and Orthomerica; is a paid speaker/presenter for Arthrex and Pacira Pharmaceuticals; and has received hospitality payments from Arthrex, Medacta, and Stryker. 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.