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Background: Many studies have examined the prevalence of acetabular version (AV) and femoral version (FV) abnormalities and their effect on patient-reported outcomes (PROs) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), but few have explored the prevalence and influence of combined version (CV) abnormalities. Purpose: To (1) describe the distribution of AV, FV, and CV in the largest cohort to date and (2) determine the relationship between AV, FV, and CV and PROs after hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were identified who underwent primary hip arthroscopy for FAIS between 2012 and 2018 and received computed tomography containing the pelvis and transcondylar knee slices. AV and FV were assessed on computed tomography, with CV calculated as their sum. PROs were collected preoperatively and 2 years postoperatively. The distributions of AV, FV, CV, and combinations thereof were described based on published ranges. The relationships between version measurements and PROs were analyzed based on a given measurement's distance from a normative value, defined as the mean within the study population (eg, relative acetabular anteversion [AAr]). These relationships were first assessed using univariate natural (restricted) cubic regression splines to account for nonlinearity. The relationship between each relative version group (to the mean) and PROs was then assessed using multiple linear regression, with the other 2 version measurements held constant. Results: In total, 566 patients were included (66.4% female; mean age, 32.6 ± 11.9 years; mean body mass index, 25.2 ± 5.1). The mean follow-up was 28.0 months. The mean AV, FV, and CV were 17.1°± 5.2°, 12.1°± 9.2°, and 29.3°± 11°, respectively. Univariate natural cubic regression splines demonstrated that AAr had a significant negative association with 4 of 5 PROs preoperatively and 3 of 5 PROs 2 years postoperatively (P ≤.018). All other relative version groups did not have a significant relationship with any PRO at either time point (P >.05). The association between AAr and relatively worse PROs was maintained after controlling for relative FV and CV via multiple linear regression, particularly in patients with relative femoral retroversion. Conclusion: FV and CV, as distinct measures, are not associated with outcomes after hip arthroscopy for FAIS. AAr is associated with worse preoperative status and less improvement at 2 years postoperatively, particularly in patients with relative femoral retroversion. [ABSTRACT FROM AUTHOR]

Background: Machine learning (ML) has emerged as a method to determine patient-specific risk for prolonged postoperative opioid use after orthopedic procedures. Purpose: We sought to analyze the efficacy and validity of ML algorithms in identifying patients who are at high risk for prolonged opioid use following orthopedic procedures. Methods: PubMed, EMBASE, and Web of Science Core Collection databases were queried for articles published prior to August 2021 for articles applying ML to predict prolonged postoperative opioid use following orthopedic surgeries. Features pertaining to patient demographics, surgical procedures, and ML algorithm performance were analyzed. Results: Ten studies met inclusion criteria: 4 spine, 3 knee, and 3 hip. Studies reported postoperative opioid use over 30 to 365 days and varied in defining prolonged use. Prolonged postsurgical opioid use frequency ranged from 4.3% to 40.9%. C-statistics for spine studies ranged from 0.70 to 0.81; for knee studies, 0.75 to 0.77; and for hip studies, 0.71 to 0.77. Brier scores for spine studies ranged from 0.039 to 0.076; for knee, 0.01 to 0.124; and for hip, 0.052 to 0.21. Seven articles reported calibration intercept (range: –0.02 to 0.16) and calibration slope (range: 0.88 to 1.08). Nine articles included a decision curve analysis. No investigations performed external validation. Thematic predictors of prolonged postoperative opioid use were preoperative opioid, benzodiazepine, or antidepressant use and extremes of age depending on procedure population. Conclusions: This systematic review found that ML algorithms created to predict risk for prolonged postoperative opioid use in orthopedic surgery patients demonstrate good discriminatory performance. The frequency and predictive features of prolonged postoperative opioid use identified were consistent with existing literature, although algorithms remain limited by a lack of external validation and imperfect adherence to predictive modeling guidelines. [ABSTRACT FROM AUTHOR]

Background: Patients with hip pain ≥2 years before hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) have been shown to achieve inferior short-term and midterm outcomes compared with patients with a shorter pain duration, although there is limited literature that has evaluated the time to achieve clinically significant outcomes (CSOs) in this population. Purpose: To compare the time to achieve CSOs after hip arthroscopic surgery for FAIS in patients with and without prolonged hip pain and to identify independent predictors of the delayed achievement of CSOs. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopic surgery for FAIS between January 2012 and July 2019 with 6-month, 1-year, and 2-year Hip Outcome Score–Activities of Daily Living (HOS-ADL) and Hip Outcome Score–Sports Subscale (HOS-SS) scores were identified. Patients with prolonged hip pain (preoperative duration ≥2 years) were propensity score matched to a control group (preoperative duration <2 years), controlling for age, sex, and body mass index (BMI). The times to achieve the minimal clinically important difference and Patient Acceptable Symptom State were compared between groups using Kaplan-Meier survival analysis. Multivariate Cox regression considering age, sex, BMI, pain duration, activity level, and chondral status was used to identify independent predictors of the delayed achievement of CSOs. Results: A total of 179 patients with prolonged hip pain were matched to 179 control patients (mean pain duration, 60.5 ± 51.2 vs 9.7 ± 5.1 months, respectively; P <.001) of a similar age, sex, and BMI (P ≥.488) with similar baseline HOS-ADL and HOS-SS scores (P ≥.971). The prolonged hip pain group showed delayed achievement of the minimal clinically important difference and Patient Acceptable Symptom State for both the HOS-ADL and HOS-SS on Kaplan-Meier analysis (P ≤.020). On multivariate Cox regression, hip pain duration ≥2 years was shown to be an independent predictor of the delayed achievement of CSOs, with hazard ratios ranging from 1.32 to 1.65 (P ≤.029). Additional independent predictors of the delayed achievement of CSOs included increasing age, increasing BMI, female sex, self-endorsed weekly participation in physical activity, and high-grade chondral defects (hazard ratio range, 1.01-4.89; P ≤.045). Conclusion: Findings from this study demonstrate that preoperative hip pain duration ≥2 years was an independent predictor of the delayed achievement of CSOs after primary hip arthroscopic surgery for FAIS. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that short-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) predict midterm outcomes, but a limited number of studies have evaluated whether short-term outcomes predict long-term outcomes and survivorship. Purpose: To evaluate whether achieving clinically significant outcomes at 2 years after hip arthroscopy for FAIS can predict patient-reported outcomes (PROs) and survivorship at 10 years. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between June 2012 and December 2012 with a minimum 10-year follow-up were identified. Using previously established thresholds, we classified patients who achieved the 2-year Patient Acceptable Symptom State (PASS) for the visual analog scale (VAS) for satisfaction as the high satisfaction group and patients who did not as the low satisfaction group. Minimum 10-year PROs were then compared between the groups, including scores for the Hip Outcome Score (HOS)–Activities of Daily Living and –Sports Specific, the modified Harris Hip Score, the VAS for pain, and the VAS for satisfaction. Reoperation-free survivorship was compared. Results: Of 120 eligible consecutive patients, 85 patients were included (70.8% follow-up rate), of whom 61.2% were female. The mean age was 34.0 ± 12.8 years, and the mean body mass index was 25.4 ± 4.6. Of the 85 patients, 29 (34.1%) did not achieve PASS for the VAS for satisfaction at 2 years postoperatively compared with 56 (65.9%) who did. The low satisfaction group had significantly worse acetabular chondral grades at the time of surgery (P =.008). At minimum 10-year follow-up, the high satisfaction group showed significantly better HOS-Activities of Daily Living, HOS-Sports Specific, modified Harris Hip Score, VAS pain, and VAS satisfaction scores (P ≤.031). Compared with the low satisfaction group, the high satisfaction group had a significantly lower rate of secondary surgery (1.8% vs 24.1%, respectively; P =.002). Conclusion: Patients who achieved PASS for the VAS for satisfaction at 2 years after hip arthroscopy demonstrated superior minimum 10-year outcomes compared with patients who did not, including greater PRO scores and a higher survivorship rate. The high satisfaction group had lower grade acetabular cartilage damage at the time of surgery compared with those who did not achieve PASS for the VAS for satisfaction at 2 years. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy (HA) has been proven to be an effective treatment for femoroacetabular impingement syndrome (FAIS) in both competitive athletes (CA) and non-CA at short-term follow-up. However, there is a paucity of literature investigating midterm outcomes comparing athletes with Controls. Hypothesis: Athletes would have significant improvements at 5 years, with favorable outcomes compared with their control counterparts, and high return-to-sport (RTS) rate. Study Design: Propensity-matched retrospective comparative cohort study. Level of Evidence: Level 3. Methods: CAs who underwent primary HA for FAIS from January 1, 2012 to April 30, 2017 were identified and propensity matched on a 1:4 basis to Controls by age, sex, and body mass index (BMI). Patient-reported outcomes (PROs) were collected preoperatively and at 5 years. Minimal clinically important differences (MCID) and patient acceptable symptom states (PASS) rates were calculated using previously published thresholds. Rate and duration of RTS were collected retrospectively. Results: A total of 57 high-level CA (33 female, 24 male; age, 21.7 ± 4.2 years; BMI, 23.1 ± 2.8 kg/m2) were propensity matched to 228 Controls (132 female, 96 male; P > 0.99; age, 23.3 ± 5.8 years; P = 0.02; BMI, 23.8 ± 4.3 kg/m2, P = 0.24). Significant differences were observed in preoperative Hip Outcome Score Sports Specific and Activities of Daily Living (HOS-ADL) subscales (CA, 74.9 ± 13.7 vs Controls, 66.4 ± 18.4; P = 0.01) and modified Harris Hip Score (mHHS) (CA, 64.7 ± 12.9 vs Controls, 59.7 ± 14.3; P = 0.04). Both groups demonstrated significant postoperative improvements in all outcome scores measured (P ≤ 0.01). At 5 years postoperatively, there were significant differences between groups in Visual Analog Scale (VAS) Pain (CA, 17.3 ± 17.6 vs Controls, 24.7 ± 25.9; P = 0.02). There were no significant differences in achieving MCID or PASS. Athletes RTS at a median of 25.2 weeks (Q1 22.4-Q3 30.7) with an overall RTS rate of 90%. Similar rates of revision were seen between CA patients (n = 3; 5.3%) and Control patients (n = 9; 3.9%) (P = 0.66). Conclusion: CAs demonstrated significant and durable improvements in PROs as well as high MCID and PASS achievement rates after primary HA, which were comparable with those of Controls. Clinicians should be aware that CA patients demonstrate higher preoperative mHHS and HOS-ADL scores than Controls and achieve lower average self-reported pain at 5 years postoperatively. In addition, CA patients demonstrate high rates of RTS at a median of 25 weeks postoperatively. Clinical Relevance: This study provides insight into CA versus Control PROs and rates of achieving MCID and PASS at a midterm follow-up of 5 years. Furthermore, this study offers perception into RTS rate, both in general as well as specified to individualized sports. [ABSTRACT FROM AUTHOR]

Background: The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. Purpose: To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. Study Design: Descriptive laboratory study. Methods: A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. Results: The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups (P =.01 to.02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups (P >.99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. Conclusion: The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. Clinical Relevance: This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest. [ABSTRACT FROM AUTHOR]

Background: Patients with borderline hip dysplasia (BHD) and concomitant femoroacetabular impingement syndrome (FAIS) have demonstrated similar outcomes at short- and midterm follow-up compared with equivalent patients without dysplasia. However, comparisons between these groups at long-term follow-up have yet to be investigated. Purpose: To compare long-term clinical outcomes between patients with BHD undergoing primary hip arthroscopy for FAIS versus matched control patients without BHD. Study Design: Cohort study; Level of evidence, 2. Methods: A retrospective cohort study was conducted on patients with BHD (lateral center-edge angle, 18°-25°) who underwent hip arthroscopy for FAIS between January 2012 and February 2013. Patients were propensity matched in a 1:3 ratio by age, sex, and body mass index to control patients without BHD who underwent primary hip arthroscopy. Groups were compared in terms of patient-reported outcomes (PROs) preoperatively and at 10 years postoperatively, including the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) and Sports subscale (HOS-SS), modified Harris Hip Score, 12-item International Hip Outcome Tool, visual analog scale (VAS) for pain and satisfaction. Achievement rates for minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were compared between groups. Kaplan-Meier survivorship curves were assessed between groups. Results: At a mean follow-up of 10.3 ± 0.3 years, 28 patients with BHD (20 women; age, 30.8 ± 10.8 years) were matched to 84 controls who underwent primary hip arthroscopy. Both groups significantly improved from preoperative assessment in all PRO measures at 10 years (P <.001 for all). PRO scores were similar between groups, aside from HOS-SS (BHD, 62.9 ± 31.9 vs controls, 80.1 ± 26.0; P =.030). Rates of MCID achievement were similar between groups for all PROs (HOS-ADL: BHD, 76.2% vs controls, 67.9%, P =.580; HOS-SS: BHD, 63.2% vs controls, 69.4%, P =.773; modified Harris Hip Score: BHD, 76.5% vs controls, 67.9%, P =.561; VAS pain: BHD, 75.0% vs controls, 91.7%, P =.110). Rates of PASS achievement were significantly lower in the BHD group for HOS-ADL (BHD, 39.1% vs controls, 77.4%; P =.002), HOS-SS (BHD, 45.5% vs controls, 84.7%; P =.001), and VAS pain (BHD, 50.0% vs controls, 78.5%; P =.015). No significant difference was found in the rate of subsequent reoperation on the index hip between groups. Kaplan-Meier survival analysis demonstrated comparable survivorship at long-term follow-up (P =.645). Conclusion: After primary hip arthroscopy, patients with BHD in the setting of FAIS had significantly improved PRO scores at 10-year follow-up, comparable with propensity-matched controls without BHD. Rates of MCID achievement were similar between groups, although patients with BHD had lower rates of PASS achievement. Patients with BHD had similar long-term hip arthroscopy survivorship compared with controls, with no significant difference in rates of revision hip arthroscopy or conversion to total hip arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy has proved successful in treating femoroacetabular impingement syndrome (FAIS) in patients with and without borderline hip dysplasia (BHD). Despite a high prevalence of BHD in patients who participate in sports with high flexibility requirements, a paucity of literature evaluates the efficacy of hip arthroscopy in treating FAIS in flexibility sport athletes with BHD. Purpose: To compare minimum 2-year patient-reported outcomes (PROs) and achievement of clinically significant outcomes in flexibility sport athletes with BHD undergoing primary hip arthroscopy for FAIS with capsular plication with results in flexibility sport athletes without dysplasia. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected for patients undergoing primary hip arthroscopy for FAIS with BHD, defined as a lateral center-edge angle of 18° to 25°, who reported participation in a sport with a high flexibility requirement, including dance, gymnastics, figure skating, yoga, cheerleading, and martial arts, according to previous literature. These patients were matched 1:2 to flexibility sport athletes without dysplasia, controlling for age, sex, and body mass index. Preoperative and minimum 2-year postoperative PROs were collected and compared between groups. Cohort-specific minimal clinically important difference and patient acceptable symptom state achievement was compared between groups. Results: In total, 52 flexibility sport athletes with BHD were matched to 104 flexibility sport athletes without BHD. Both groups showed similar sport participation (P =.874) and a similar level of competition (P =.877). Preoperative lateral center-edge angle (22.2°± 1.6° vs 31.5°± 3.9°; P <.001) and Tönnis angle (10.9°± 3.7° vs 5.8°± 4.4°; P <.001) differed between groups. Capsular plication was performed in all cases. Both groups achieved significant improvement in all PROs (P <.001) with no differences in postoperative PROs between groups (P ≥.147). High minimal clinically important difference (BHD group: 95.7%; control group: 94.8%) and patient acceptable symptom state (BHD group: 71.7%; control group: 72.2%) achievement for any PRO was observed with no differences between groups (P ≥.835). Conclusion: Flexibility sport athletes with BHD achieved similar outcomes as those of flexibility sport athletes without BHD after hip arthroscopy for FAIS with capsular plication. [ABSTRACT FROM AUTHOR]

Background: Minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds have been previously defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) at 1-year follow-up in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome; however, the MCID and PASS thresholds are yet to be defined for the PROMIS at 2-year follow-up. Purpose: (1) To establish MCID and PASS thresholds for the PROMIS Pain Interference (PROMIS-PI) and PROMIS Physical Function (PROMIS-PF) at 2-year follow-up and (2) to correlate PROMIS scores with hip-specific patient-reported outcome measure (PROM) scores. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome between August and November 2020 with preoperative and minimum 2-year postoperative data were identified. Collected scores included those for the PROMIS-PI, PROMIS-PF, Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS) for pain. MCID thresholds were calculated using the distribution-based method and PASS thresholds using the anchor-based method. Pearson correlation coefficients were used to compare scores between PROMs. Results: A total of 65 patients met the criteria for inclusion (72.3% female; mean age, 36.9 ± 13.5 years; mean body mass index, 26.2 ± 6.0). The mean follow-up was 25.3 ± 3.3 months. Significant preoperative to postoperative improvements were observed for all PROMs (P <.001). MCID thresholds and achievement rates were as follows: HOS-ADL, 10.1 and 75%, respectively; HOS-SS, 13.8 and 79%, respectively; iHOT-12, 14.0 and 67%, respectively; VAS pain, –13.8 and 78%, respectively; PROMIS-PI, –4.7 and 65%, respectively; and PROMIS-PF, 5.8 and 60%, respectively. PASS thresholds and achievement rates were as follows: HOS-ADL, 78.7 and 67%, respectively; HOS-SS, 76.4 and 62%, respectively; iHOT-12, 67.4 and 60%, respectively; VAS pain, 25.5 and 61%, respectively; PROMIS-PI, 57.0 and 65%, respectively; and PROMIS-PF, 45.6 and 58%, respectively. PROMIS-PI scores correlated most strongly with HOS-ADL (r = −0.836), HOS-SS (r = −0.767), and iHOT-12 (r = −0.719) scores and exhibited at least moderate correlations (r ≥−0.595) with the other PROM scores. PROMIS-PF demonstrated moderate correlations with all the other PROM scores (r ≥−0.586). Strong correlations were seen between the hip-specific PROM scores (r ≥−0.745). Conclusion: This study defined 2-year MCID and PASS thresholds for the PROMIS-PI and PROMIS-PF and demonstrated moderate to strong correlations between PROMIS scores and hip-specific PROM scores. [ABSTRACT FROM AUTHOR]

The purpose of this current concepts review is to highlight the evaluation and workup of hamstring injuries, nonoperative treatment options, and surgical decision-making based on patient presentation and injury patterns. Hamstring injuries, which are becoming increasingly recognized, affect professional and recreational athletes alike, commonly occurring after forceful eccentric contraction mechanisms. Injuries occur in the proximal tendon at the ischial tuberosity, in the muscle belly substance, or in the distal tendon insertion on the tibia or fibula. Patients may present with ecchymoses, pain, and weakness. Magnetic resonance imaging remains the gold standard for diagnosis and may help guide treatment. Treatment is dictated by the specific tendon(s) injured, tear location, severity, and chronicity. Many hamstring injuries can be successfully managed with nonoperative measures such as activity modification and physical therapy; adjuncts such as platelet-rich plasma injections are currently being investigated. Operative treatment of proximal hamstring injuries, including endoscopic or open approaches, is traditionally reserved for 2-tendon injuries with >2 cm of retraction, 3-tendon injuries, or injuries that do not improve with 6 months of nonoperative management. Acute surgical treatment of proximal hamstring injuries tends to be favorable. Distal hamstring injuries may initially be managed nonoperatively, although biceps femoris injuries are frequently managed surgically, and return to sport may be faster for semitendinosus injuries treated acutely with excision or tendon stripping in high-level athletes. [ABSTRACT FROM AUTHOR]

This article, titled "Hamstring Strains: Classification and Management," provides information on hamstring strain injuries (HSIs) in sports medicine and rehabilitation. The hamstring muscle complex (HMC) consists of several muscles that play a role in extending the hip and flexing the knee. HSIs are commonly "sprint-type" injuries that occur during high-speed running, affecting the proximal long head of the biceps femoris muscle. "Stretch-type" HSIs can also occur with end-range hip flexion and knee extension, typically involving the proximal semimembranosus tendon. The article discusses the grading of HSIs and outlines a 3-phase protocol for nonoperative treatment of Grade I and II HSIs. Grade III HSIs may require surgical repair, with a goal of returning to sport within 4 to 6 months postoperatively. [Extracted from the article]

Background: The effect of preoperative tear characteristics and the relative efficacy of open versus endoscopic surgical techniques have not been elucidated for the surgical treatment of proximal hamstring tendon injuries. Purpose: (1) To report on achievement rates of clinically significant outcomes at a minimum 2-year follow-up for multiple patient-reported outcomes (PROs) after surgical treatment of proximal hamstring injuries, stratified according to severity of proximal hamstring injury, and (2) to compare clinical outcomes associated with endoscopic versus open surgical repair for a subset of similarly classified tears. Study Design: Cohort study; Level of evidence, 3 Methods: A single-surgeon clinical registry was queried for patients who underwent surgical repair for proximal hamstring ruptures between January 2012 and March 2021. Injuries were classified by magnetic resonance imaging as follows: grade 1, incomplete tear with the involvement of 1 or 2 tendons; grade 2, complete tear with the involvement of 3 tendons and ≤2-cm retraction; and grade 3, complete tear with the involvement of 3 tendons and >2-cm retraction. The Patient Acceptable Symptom State (PASS) for multiple PROs was calculated and compared among injury grades and between surgical techniques. Results: Among 75 patients with a mean follow-up of 30.5 ± 5.1 months, 20 had grade 1 tears, 24 had grade 2 tears, and 31 had grade 3 tears. Favorable 2-year postoperative PROs were demonstrated by each grade for all measured PROs. Patients with grade 3 tears were noted to have significantly lower rates of 2-year PASS achievement for the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and Hip Outcome Score–Sports Specific (HOS-SS) scales (P ≤.032). Among grade 2 tears, patients treated endoscopically demonstrated significantly greater HOS-SS (endoscopic, 91.7%; open, 58.3%; P =.045) and Patient-Reported Outcomes Measurement Information System for Physical Function (endoscopic, 80.0%; open, 50.0%; P =.033) PASS achievement rates compared with those treated with the open technique. Complication rates were highest in patients with grade 3 tears (45.2%, P =.043). Conclusion: Surgical repair of proximal hamstring tendon tears with varying extents of tendon retraction resulted in high rates of achieving PASS at the 2-year follow-up. Among complete tears with <2 cm of retraction, endoscopic repairs exhibited equal or higher rates of achieving PASS compared with open repairs across multiple PROs at 2 years postoperatively. However, patients with complete tears and retraction >2 cm achieved lower rates of PASS on the HOS-ADL and HOS-SS scales and had a higher rate of complications. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) has proven to be an effective surgical intervention, with high rates of return to sport and work as well as favorable outcomes at short- and midterm follow-up. However, limited data exist on outcomes at long-term follow-up. Purpose: To evaluate patient-reported outcomes (PROs) at a minimum 10-year follow-up after primary hip arthroscopic surgery including labral repair, femoral osteochondroplasty, acetabular osteochondroplasty, and capsular closure for FAIS. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent primary hip arthroscopic surgery for FAIS between June 2012 and January 2013 were identified. PROs were collected preoperatively and at a minimum of 10 years postoperatively, including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Unique minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds were calculated, and their rates of achievement were analyzed. An alpha level of <.05 was used to determine statistical significance. Results: A total of 94 patients (55 female; mean age, 34.3 ± 12.4 years) were analyzed with a mean follow-up of 10.1 ± 0.3 years (range, 10.0-10.7 years). Patients demonstrated significant 10-year improvement across all PRO measures (P <.001). MCID and PASS thresholds were calculated as follows: HOS-ADL (10.4 and 85.3, respectively), HOS-SS (14.6 and 60.2, respectively), mHHS (8.8 and 76.0, respectively), VAS pain (14.6 and 27.5, respectively), and iHOT-12 (PASS: 71.4). The majority of patients achieved the MCID and PASS for each PRO measure: HOS-ADL (73.4% and 70.9%, respectively), HOS-SS (78.5% and 77.2%, respectively), mHHS (81.0% and 70.9%, respectively), VAS pain (88.6% and 70.9%, respectively), and iHOT-12 (PASS: 73.4%). Overall, 9 patients (9.6%) underwent subsequent revision hip arthroscopic surgery at a mean 4.9 ± 3.7 years (range, 1.1-10.1 years) postoperatively, and 6 patients (6.4%) underwent conversion to total hip arthroplasty at a mean 4.1 ± 3.1 years (range, 0.9-9.3 years) postoperatively. Conclusion: Patients who underwent primary hip arthroscopic surgery for FAIS utilizing contemporary methods of labral repair, acetabular and/or femoral osteochondroplasty, and capsular closure commonly experienced sustained clinical improvement and reported high levels of satisfaction at a minimum 10-year follow-up with low rates of reoperation. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy has become the mainstay surgical intervention for the treatment of femoroacetabular impingement syndrome (FAIS). However, postoperative outcomes and rates of secondary surgery are mixed in patients with differing levels of preoperative osteoarthritis (OA). Furthermore, there is a paucity of literature comparing patients with and without OA at long-term follow-up. Purpose: To compare outcomes and rates of secondary surgery at minimum 10-year follow-up, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), in patients with Tönnis grade 1 undergoing hip arthroscopy for FAIS compared with a propensity-matched control group of patients with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013 were identified. Patients with Tönnis grade 1 were propensity matched in a 1:2 ratio by age, sex, and body mass index (BMI) to patients with Tönnis grade 0. Patient-reported outcomes (PROs) were collected at varying timepoints including preoperatively and 1, 2, 5, and 10 years postoperatively and compared between the 2 cohorts. Rates of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier gross survivorship curve. A subanalysis was performed comparing patients with Tönnis grade 1 who converted to THA and those who did not. Results: A total of 31 patients with Tönnis grade 1 (age, 42.6 ± 9.0 years; BMI, 28.0 ± 6.3) were successfully matched to 62 patients with Tönnis grade 0 (age, 42.1 ± 8.5, P =.805; BMI, 26.1 ± 3.9, P =.117). Both the Tönnis grade 1 and Tönnis grade 0 groups demonstrated significant improvements regarding all PROs at minimum 10 years (P <.05 for all), except for the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) (P =.066) in the Tönnis grade 1 cohort. No significant difference (P >.05 for all) was noted between cohorts regarding any 10-year PRO. When the authors evaluated comparisons between preoperative and 1-, 2-, 5-, and 10-year PRO measures, significant differences were noted between cohorts regarding 2-year HOS-ADL (P =.021), Hip Outcome Score Sports-Specific subscale (P =.016), and modified Harris Hip Score (P =.026); otherwise, differences did not reach significance. High rates of 10-year MCID and PASS achievement were seen, with no significant differences between groups. Patients with Tönnis grade 1 had significantly higher rates of conversion to THA compared with patients who had Tönnis grade 0 (25.8% vs 4.8%; P =.006). Patients with Tönnis grade 1 had significantly lower gross survivorship compared with those who had Tönnis grade 0 (71.0% vs 85.5%, respectively; P =.04). Conclusion: Hip arthroscopy confers comparable postoperative clinical improvements to patients who have FAIS with and without mild OA; however, the benefits among patients with mild OA may be less durable. Patients with Tönnis grade 1 had significantly higher conversion to THA and reduced gross survivorship compared with patients with no evidence of preoperative OA, suggesting that patients with evidence of OA may need to be cautioned on the higher rate of conversion surgery. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated alterations in squat kinematics in patients with femoroacetabular impingement syndrome (FAIS). Little is known about the effects of arthroscopic hip surgery on biomechanics during a single-leg squat (SLS) in these patients. Purpose/Hypothesis: The purpose of this study was to determine if (1) lower extremity dynamic range of motion (ROM) during an SLS task improves after hip arthroscopy for FAIS and (2) correlations exist between changes in patient-reported outcomes (PROs) and changes in lower extremity dynamic ROM during an SLS after hip arthroscopy for FAIS. It was hypothesized that dynamic hip ROM would improve after hip arthroscopy and that hip dynamic ROM would be associated with changes in PRO scores at both 6 months and 1 year. Study Design: Descriptive laboratory study. Methods: Patients with FAIS performed 3 SLSs that were analyzed using a 20-camera motion capture system. Dynamic ROMs were calculated in 3 planes for the hip, knee, ankle, and pelvic segments. Squat depth was calculated as the change in vertical center of mass during the squat cycle. PROs including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports (HOS–Sports), International Hip Outcome Tool–12, and visual analog scale for pain scores were collected preoperatively and at the time of postoperative testing. Paired-samples t tests were used to compare kinematic variables pre- and postoperatively. Correlations were used to compare changes in PROs with changes in kinematics. All statistical analysis was performed using SPSS Version 26. Results: Fifteen patients were tested preoperatively and at a mean of 9 months postoperatively. All PRO measures improved postoperatively at 6 months and 1 year. Squat depth and sagittal plane hip and knee dynamic ROMs were significantly improved postoperatively. Positive correlations existed between changes in (1) hip ROM with the 6-month HOS-ADL score (r = 0.665) and (2) knee ROM with the 6 month (r = 0.590) and 1-year (r = 0.565) HOS–Sports scores. Conclusion: Dynamic sagittal plane hip and knee ROMs improve after hip arthroscopy for FAIS. These improvements demonstrate strong correlations with improvements in some but not all postoperative PROs. Clinical Relevance: The current study sought to better understand the role of dynamic movement in the diagnosis and treatment of FAIS. These findings indicate that dynamic ROM and squat depth can, similarly to PROs, serve as biomarkers for patient function both before and after hip arthroscopic surgery. [ABSTRACT FROM AUTHOR]

Background: Femoral torsion measurements and outcomes are variable throughout the literature and have focused on short-term follow-up. However, there is a paucity of literature investigating clinically meaningful outcomes at midterm follow-up after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To quantify femoral version using computed tomography imaging in patients with FAIS and to explore the relationship between version abnormalities and 5-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and November 2017 were identified. Patients were included if they had 5-year follow-up with completion of ≥1 patient-reported outcome (PRO) scores and excluded if they had Tönnis grade >1, revision hip surgery, a concomitant hip procedure, a developmental disorder, or a lateral center-edge angle <20°. Torsion groups were defined as severe retrotorsion (<0°), moderate retrotorsion (0.1°-5°), normal torsion (5.1°-20°), moderate antetorsion (20.1°-25°), and severe antetorsion (>25.1°) based on computed tomography measurements. Patient characteristics were analyzed among the torsion cohorts, as were preoperative and 5-year PROs: Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool, visual analog scale for pain, and visual analog scale for satisfaction. Achievement rates of cohort-specific thresholds for the minimal clinically important difference and Patient Acceptable Symptom State were calculated and compared among cohorts. Results: A total of 362 patients (244 female, 118 male; mean ± SD age, 33.1 ± 11.5 years; body mass index, 26.9 ± 17.8) met inclusion/exclusion criteria and were analyzed at a final mean follow-up of 64.3 ± 9.4 months (range, 53.5-115.5 months). Mean femoral torsion was 12.8°± 9.2°. The number of patients within each group was 20 for severe retrotorsion (torsion, −6.3°± 4.9°), 45 for moderate retrotorsion (2.7°± 1.3°), 219 for normal torsion (12.2°± 4.1°), 39 for moderate antetorsion (21.9°± 1.3°), and 39 for severe antetorsion (29.0°± 4.2°). No significant differences in age, body mass index, sex, smoking status, workers' compensation, psychiatric history, back pain, or physical activity were found among the torsional groups. All groups demonstrated significant improvements at 5 years postoperatively (P <.01 for all). All torsion subgroups demonstrated similar pre- to postoperative changes in PROs (P ≥.515) and PRO values at 5-year follow-up (P ≥.098). There were no significant differences in the achievement of the minimal clinically important difference (P ≥.422) or Patient Acceptable Symptom State (P ≥.161) for any of the PROs among the torsion groups. Conclusion: The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS in this study's cohort did not affect the propensity for clinically meaningful outcome improvement at midterm follow-up. [ABSTRACT FROM AUTHOR]

Background: Limited literature exists regarding how postoperative physical therapy (PT) may affect outcomes in patients with femoroacetabular impingement syndrome (FAIS) undergoing hip arthroscopy. Additionally, it is unknown how PT measures relate to traditional orthopaedic patient-reported outcomes (PROs). Purpose: To evaluate how the duration of PT may correlate with outcomes in patients with FAIS using both the Lower Extremity Functional Scale (LEFS) and standard orthopaedic PRO measures. Study Design: Cohort study; Level of evidence, 3. Methods: Patients from a single institution who underwent primary hip arthroscopy for FAIS between 2013 and 2016 were identified. Patients with a minimum 2-year follow-up and fully documented PT notes were included and stratified into 3 cohorts based on timing of PT discharge: 0 to 3 months, 3 to 6 months, and 6 to 12 months. Predictive regression models were developed to analyze the rate of improvement (ROI) in LEFS score as it relates to (1) postoperative day (POD) and (2) postoperative PT session number. Two-year PROs were collected, correlated with LEFS scores, and compared among cohorts. Results: A total of 95 patients were included (mean ± SD age, 34.6 ± 11.7 years; range, 14-55 years). Mean LEFS scores increased significantly from the initial score at 6 weeks, 3 months, and the time of PT discharge (P <.01 for all). The predicted ROI in LEFS score was 3.39% per PT session for sessions 0 to 13, 1.43% for sessions 14 to 27, and 0.37% for sessions 28 to 40. Patients who underwent 3 to 6 months of PT had significantly better Hip Outcome Score (HOS) relative to the 0- to 3-month cohort and significantly better visual analog scale (VAS) scores for satisfaction relative to the 6- to 12-month cohort. The predicted ROI in LEFS score was 0.96% per day from POD 0 to 45, 0.22% from POD 46 to 139, and 0.03% after POD 139. Moderate correlations were seen between LEFS score at the time of discharge and all 2-year PROs as follows: HOS Activities of Daily Living subscale (r = 0.488), HOS Sports-Specific subscale (r = 0.500), modified Harris Hip Score (r = 0.465), 12-item International Hip Outcome Tool (r = 0.494), VAS pain score (r = −0.346), and VAS satisfaction score (r = 0.459). Conclusion: Patients undergoing hip arthroscopy for FAIS derived substantial benefit from each PT visit during their first 13 PT sessions and then a smaller, yet still meaningful benefit from sessions 13 through 27. After session 40, or approximately 4.5 to 5 months, patients no longer benefited from additional PT sessions. Based on PRO scores, patients discharged from PT between 3 and 6 months had the best 2-year outcomes. LEFS score had moderate correlation with orthopaedic PRO scores. [ABSTRACT FROM AUTHOR]

Background: The learning curve for the surgical treatment of cam deformities in femoroacetabular impingement syndrome (FAIS) presents a challenge for young or inexperienced surgeons, with the leading cause of failed hip arthroscopy being incomplete resection. Historically, alpha angle measurements are typically used perioperatively to both diagnose cam deformity and evaluate the adequacy of cam resection. The computer-assisted Styker HipCheck system offers the surgeon real-time alpha angle measurements, assisting with the execution of cam resection. Indications: The indication for use is any hip arthroscopic procedure for femoroacetabular impingement requiring osteochondroplasty of cam deformity. Advantages of the HipCheck system include shortened operative time; reduced risk of inadequate or over-resection; accelerated learning curve; no requirement of preoperative computed tomographic imaging or pre-planning; being noninvasive, portable, and not requiring additional instruments; increased patient and surgeon satisfaction; and allowance of repeated quantitative and visual assessment, which is particularly beneficial for more difficult regions, such as posteromedial and posterolateral, to view the femoral head/neck. Technique Description: Briefly, after intra-articular procedures are complete, the peripheral compartment is accessed. We prefer a T-type capsulotomy. Next, the cam deformity is registered on Stryker HipCheck software, automatically calculating alpha angles as the hip is dynamically moved through 6 registered positions. A standard cam resection is then performed. Once complete, the hip is dynamically assessed and again registered with the HipCheck system in the same 6 positions to ensure adequate resection has been performed. Results: When comparing patients with FAIS undergoing computer-guided resection or standard resection, both surgical interventions demonstrated successful reduction in alpha angle and no difference in degree of resection. In addition, the various computer-guided views exhibited good correlations to clinical radiographs. Discussion: The HipCheck intraoperative system allows the surgeon to evaluate the adequacy of cam resection through the use of automated alpha angles. Furthermore, the system offers instantaneous feedback of cam resection at any desired position of the hip. This intraoperative technology may offer less experienced surgeons an aid when performing hip arthroscopy for cam resection in the setting of femoroacetabular impingement. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of information available to clinicians on outcomes of patients undergoing endoscopic surgery for labral repairs and femoroacetabular impingement syndrome with simultaneous repair of the gluteus medius and/or minimus muscles. Purpose: To determine whether patients with labral tears and concomitant gluteal pathology who undergo simultaneous endoscopic labral and gluteus medius and/or minimus repair experience similar outcomes to patients with isolated labral tears who undergo endoscopic labral repair alone. Study Design: Cohort study; Level of evidence, 3. Methods: A matched retrospective comparative cohort study was performed. Patients who underwent gluteus medius and/or minimus repair with concomitant labral repair between January 2012 and November 2019 were identified. These patients were matched in a 1:3 ratio by sex, age, and body mass index (BMI) to patients who underwent labral repair alone. Preoperative radiographs were assessed. Patient-reported outcomes (PROs) were assessed preoperatively and 2 years postoperatively. PRO measures included the Hip Outcome Score Activities of Daily Living and Sports subscales, modified Harris Hip Score, 12-Item International Hip Outcome Tool, and visual analog scales for pain and satisfaction. Published labral repair minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were utilized for these measures. Results: A total of 31 patients who underwent gluteus medius and/or minimus repair with concomitant labral repair (27 female, 4 male; age, 50.8 ± 7.3 years; BMI, 27.9 ± 5.2) were matched with 93 patients who underwent labral repair alone (81 female, 12 male; age, 50.9 ± 8.1 years; BMI, 28.5 ± 6.2). There were no significant differences in sex (P >.99), age (P =.869), or BMI (P =.592); preoperative radiographic measurements; or preoperative or 2-year postoperative PRO scores (P ≥.081). Changes between preoperative and 2-year postoperative PRO scores were significantly different for both groups for all PROs assessed (P <.001 for all). There were no significant differences in MCID or PASS achievement rates (P ≥.123), with low PASS achievement rates of 40% to 60% found in both groups. Conclusion: Patients who were treated with endoscopic gluteus medius and/or minimus repair with concomitant labral repair demonstrated comparable outcomes with those who were treated with endoscopic labral repair alone. [ABSTRACT FROM AUTHOR]

Purpose: To define the anatomical relationship of the major neurovascular structures to the standard endoscopic portals used in endoscopic hamstring repair. A secondary outcome was to determine the safest angle of insertion from each standard portal. Methods: Endoscopic portals were established in the 3 standard locations (lateral, medial, and inferior) and Steinmann pins inserted at various angles. Each hip was dissected and the distance between the pins and the pertinent anatomy measured. Results: The lateral portal placed the sciatic and posterior femoral cutaneous (PFC) nerves at greatest risk: direct injury to the sciatic nerve was seen in 11/30 (37%) of the lateral portals sited. A lateral portal with an approach at 60° was the most dangerous orientation with a mean distance of 0.36 ± 0.49 mm and 4.30 ± 2.69 mm from the sciatic and PFC nerves, respectively (p < 0.001). The 60° medial portal was the safest of all portals measured, at a mean distance of 67.37 ± 11.06mm (range, 47–78 mm) from the sciatic nerve and 58.90 ± 10.57 mm (range 40–70 mm) from the PFC nerve. Conclusions: While currently described techniques recommend establishing the standard lateral portal first, this study shows that it carries the highest risk of injury if used blind. We recommend that the standard medial endoscopic portal is established first to identify the neurovascular structures and minimise iatrogenic neurovascular injury. The inferior and lateral portals can then be established created under direct vision. The lateral portal should be inserted in a more horizontal orientation to decrease the risk of nerve injury. [ABSTRACT FROM AUTHOR]

Background: Individualized risk prediction has become possible with machine learning (ML), which may have important implications in enhancing clinical decision making. We previously developed an ML algorithm to predict propensity for clinically meaningful outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome. External validity of prognostic models is critical to determine generalizability, although it is rarely performed. Purpose: To assess the external validity of an ML algorithm for predicting clinically meaningful improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: An independent hip preservation registry at a tertiary academic medical center was queried for consecutive patients/athletes who underwent hip arthroscopy for femoroacetabular impingement syndrome between 2015 and 2017. By assuming a minimal clinically important difference (MCID) outcome/event proportion of 75% based on the original study, a minimum sample of 132 patients was required. In total, 154 patients were included. Age, body mass index, alpha angle on anteroposterior pelvic radiographs, Tönnis grade and angle, and preoperative Hip Outcome Score–Sports Subscale were used as model inputs to predict the MCID for the Hip Outcome Score–Sports Subscale 2 years postoperatively. Performance was assessed using identical metrics to the internal validation study and included discrimination, calibration, Brier score, and decision curve analysis. Results: The concordance statistic in the validation cohort was 0.80 (95% CI, 0.71 to 0.87), suggesting good to excellent discrimination. The calibration slope was 1.16 (95% CI, 0.74 to 1.61) and the calibration intercept 0.13 (95% CI, –0.26 to 0.53). The Brier score was 0.15 (95% CI, 0.12 to 0.18). The null model Brier score was 0.20. Decision curve analysis revealed favorable net treatment benefit for patients with use of the algorithm as compared with interventional changes made for all and no patients. Conclusion: The performance of this algorithm in an independent patient population in the northeast region of the United States demonstrated superior discrimination and comparable calibration to that of the derivation cohort. The external validation of this algorithm suggests that it is a reliable method to predict propensity for clinically meaningful improvement after hip arthroscopy and is an essential step forward toward introducing initial use in clinical practice. Potential uses include integration into electronic medical records for automated prediction, enhanced shared decision making, and more informed allocation of resources to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated a clinically impactful change in patients between 1 and 2 years after hip arthroscopy. Assessment of differences in patient-specific factors between patients who remain the same and those who change (ie, either improve or decline) could provide valuable outcome information for orthopaedic surgeons treating those patients. Purpose: To identify patients who experienced change in functional status between 1 and 2 years after hip arthroscopy for femoroacetabular impingement syndrome and assess differences in patient-specific factors between those who improved, remained the same, or declined in functional status. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data for patients who underwent hip arthroscopy at 1 of 7 centers were analyzed retrospectively at 1 year and 2 years postoperatively. Patients were categorized as "improved,""remained the same," or "declined" between 1- and 2-year follow-up based on the 12-item International Hip Outcome Tool (iHOT-12) minimal clinically important difference (MCID) value. A 1-way analysis of variance was used to assess differences in iHOT-12 scores, age, body mass index (BMI), alpha angle, and center-edge angle (CEA) between groups. Chi-square analyses were used to assess differences in the proportions of male and female patients in the outcome groups. Results: The study included 753 patients (515 women and 238 men), whose mean ± SD age was 34.7 ± 12 years. Average 1-year (±1 month) and 2-year (±2 months) iHOT-12 scores for all patients were 73.7 and 74.9, respectively. Based on the calculated MCID of ±11.5 points, 162 (21.5%) patients improved, 451 (59.9%) remained the same, and 140 (18.6%) declined in status between 1- and 2-year follow-up. Those who improved between 1 and 2 years had lower 1-year iHOT-12 scores (P <.0005). We found no difference in age, BMI, alpha angle, CEA, or sex between groups (P >.05). Conclusion: Between 1- and 2-year follow-up assessments, 21.5% of patients improved and 18.6% declined in self-reported functional status. Those with iHOT-12 scores indicating abnormal function at 1 year improved beyond the MCID at 2 years follow-up. Thus, any decisions about the failure or success of arthroscopic hip procedures should not be made until at least the 2-year follow-up. Failing to thrive at 1-year follow-up may not accurately predict outcomes at year 2 or beyond. This could potentially decrease the perceived need for revision surgery in patients who do not thrive before 2-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Gluteus medius tears are a common pathology affecting the lower extremity, predominantly in older female patients, and most often caused by chronic degenerative changes. Due to the associated morbidity with gluteus medius insufficiency, various surgical repair techniques are utilized, including open and endoscopic approaches, with equivalent biomechanical outcomes. Indications: Open gluteus medius double-row repair with acellular allograft augmentation is indicated for patients with massive, full thickness tears, full thickness tears with extensive retraction, degenerative tears, poor tissue quality, revision cases where tendon reduction to the footprint is challenging, and impaired hip abduction strength. The primary benefit of acellular allograft use is the provision of immediate structural strength to the repair construct. Technique Description: The patient is placed in the lateral decubitus position, and a direct lateral incision is made over the greater trochanter. The gluteus medius and/or minimus tendons are identified, mobilized, and provisionally reduced to the footprint. The tendon footprint is then debrided, and proximal anchors are placed. The graft is provisionally fixed to the tendon with sutures anteriorly and posteriorly to ensure correct placement. Sutures are passed from the proximal row through the tendon and prepared allograft, where 1 suture limb from each mattress is placed into a double-row anchor in the distal row. Once secured, the repair is checked through a range of dynamic positions. Results: Although outcomes studies are limited, case series of patients undergoing open gluteus medius repair with allograft have demonstrated favorable patient-reported outcomes, improved pain, improved hip abduction strength, and improved gait. Discussion: Open gluteus medius repair with acellular allograft provides immediate structural strength to the repair construct and should be considered in patients with massive, full thickness tears with extensive retraction, degenerative tears with poor tissue quality, revision cases, and impaired hip abduction strength. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Background: Allograft anterior cruciate ligament (ACL) reconstruction, while it may have a higher failure rate in younger and more active populations, continues to serve as a viable graft option for the appropriately indicated patient. Efficient bone-patellar tendon-bone (BTB) allograft preparation is beneficial to reduce operating time and ensure optimal reconstruction with bony fixation. Indications: ACL reconstruction with BTB allograft is indicated for skeletally mature and older patients, patients who are less active and have fewer physical demands, patients who have had previously harvested autograft, circumstances where an autograft harvest is inadequate, patients with multiligament knee injuries, and patients who prefer allograft use. Technique Description: The central third of the BTB allograft is harvested, aiming for a graft diameter of 10 mm along the tendon. The tibial bone plug is first cut to a length of 25 to 30 mm and width of 10 mm with the saw at a 70° angle to the bone. The patellar bone plug is cut to a length of 25 mm and width of 10 mm with the saw at a 45° angle to the bone. The bone plugs are mobilized, and soft tissue is dissected to free the graft. The graft is trimmed until it fits through a 10-mm sizer on each side. A single hole is created with a k-wire in the patellar bone plug, and a #5 Ethibond suture is passed. On the tibial bone plug, 2 holes are made perpendicular to one another, and a #2 Fiberwire suture is passed through each of these holes. These sutures allow for facilitated graft passage and tensioning. Once the graft is affixed with interference screws, the graft is arthroscopically evaluated throughout range of motion. Results: ACL reconstruction with BTB allograft provides high success rates in appropriately selected patients. Data demonstrate more optimal mechanical properties by harvesting the central third of the allograft tendon in younger donors. Non-irradiated and less chemically processed grafts are also preferred to optimize biomechanical properties. Discussion/Conclusion: Bone-patellar tendon-bone allograft with 2 bone plugs offers a reliable alternative to other allografts or autografts. Preparing the allograft in a fashion similar to an autograft harvest may increase familiarity with techniques and facilitate surgical efficiency and graft passage. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Background: Patients with femoroacetabular impingement syndrome (FAIS) may frequently have co-existing sacroiliac joint (SIJ) pain. It is known that patients with lower back pain undergoing total hip arthroplasty (THA) have inferior outcomes; however, it is unclear what the effect of SIJ pain is on outcomes after hip arthroscopy. Purpose: To determine whether patients undergoing hip arthroscopy with SIJ pain either subjectively or on physical examination achieve similar postoperative improvement in patient-reported outcomes (PROs) compared with patients without SIJ pain at 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with a minimum 2-year follow-up who underwent primary hip arthroscopy for FAIS with SIJ pain were matched in a 1:2 ratio to controls without SIJ pain. Baseline demographics, as well as postoperative PROs and rates of achievement of the minimal clinically important difference (MCID) or Patient Acceptable Symptom State (PASS) at 2-year follow-up were compared between the 2 groups. Results: A total of 73 patients (75 hips) with SIJ pain were matched to 150 control patients (150 hips) without SIJ pain. Both groups demonstrated statistically significant improvement in all PROs at 2 years (P <.05 for all). Patients with SIJ pain had significantly lower postoperative PRO scores for the Hip Outcome Score–Activities of Daily Living (HOS-ADL) (SIJ pain: 80.4 ± 22.4 vs no SIJ pain: 88.0 ± 15.1; P =.006), modified Harris Hip Score (mHHS) (SIJ pain: 73.2 ± 22.8 vs no SIJ pain: 80.0 ± 17.3; P <.001), and International Hip Outcome Tool–12 questionnaire (iHOT-12) (SIJ pain: 61.7 ± 25.9 vs no SIJ pain: 73.7 ± 23.7; P =.008). There were no statistically significant differences in improvement (delta) in PRO scores between the 2 groups (P >.05 for all). The SIJ pain group had significantly lower achievement of MCID for the HOS-ADL (SIJ pain: 65.2% vs no SIJ pain: 80.5%; P =.044) but not HOS-SS, mHHS, or iHOT-12 (P >.05 for all). The SIJ pain group had significantly lower achievement of PASS for the mHHS (SIJ pain: 27.5% vs no SIJ pain: 45.3%; P =.030) and iHOT-12 (SIJ pain: 31.0% vs no SIJ pain: 56.0%; P =.010) but not the HOS-ADL and HOS-SS (P >.05 for both). Only 4.1% of patients with SIJ pain and 2.4% of controls required revision surgery or converted to THA at the time of final follow-up (P =.69). Conclusion: Patients with FAIS and SIJ pain on history or physical examination experience significant improvement in PROs at 2 years after hip arthroscopy. However, they may be less likely to achieve the MCID or PASS and have significantly lower postoperative PROs compared with a matched cohort of patients without SIJ pain. Overall rates of revision and conversion to THA were similarly low in both groups. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of information in the literature on midterm outcomes from the arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) with concomitant labral treatment in patients with mild osteoarthritis (OA) using modern surgical techniques. Purpose: To compare outcomes of hip arthroscopy for the treatment of FAIS between patients with mild OA (Tönnis grade 1) and patients without OA (Tönnis grade 0) at minimum 5-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were identified who underwent primary hip arthroscopy for FAIS with routine capsular closure between January 2012 and December 2015. Patients with Tönnis grade 1 were matched 1:3 by age, sex, and body mass index to patients without OA. The Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score, and 12-item International Hip Outcome Tool were collected preoperatively and at 5 years postoperatively and compared between groups using an independent t test. Survivorship rate and percentage achievement of a Patient Acceptable Symptom State (PASS) or minimal clinically important difference (MCID) were compared using a Fisher exact test. Results: A total of 50 patients (54 hips) with Tönnis grade 1 were matched to 162 patients (162 hips) with Tönnis grade 0. The mean ± SD age and body mass index of the Tönnis grade 1 group were 44.5 ± 9.6 years and 28.5 ± 5.5, respectively. Patient-reported outcome (PRO) scores improved significantly for both groups from presurgery to 5 years postoperatively for all PROs (P ≤.03). There were no significant differences in preoperative PROs between the groups. Patients with Tönnis grade 1 had significantly lower postoperative scores on the HOS-ADL (74.7 ± 22.6 vs 83.0 ± 20.1; P =.04) and HOS-SS (58.8 ± 33.7 vs 71.8 ± 29.3; P =.03) than patients with grade 0. Patients with Tönnis grade 1 also had significantly lower rates of achievement of the MCID (57.1% vs 80.2%; P <.01) and PASS (34.1% vs 53.4%; P =.03) for any PRO when compared with patients with Tönnis grade 0. Gross survivorship was significantly lower for Tönnis grade 1 versus grade 0 (77.8% vs 96.9%; P <.001). Conclusion: Patients with Tönnis grade 1 arthritis experienced significant improvement in PROs after hip arthroscopy for the treatment of FAIS. However, they had significantly lower postoperative HOS-ADL and HOS-SS scores with significantly lower rates of achievement on the MCID and PASS, with a significantly lower gross survivorship rate at a minimum 5 years postoperatively in comparison with those with Tönnis grade 0 changes. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of information in the literature on midterm outcomes of endoscopic gluteus medius and/or minimus repair with concomitant labral treatment using only modern surgical techniques. Purpose: To define the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) at a minimum of 5 years postoperatively for patients undergoing endoscopic hip abductor repair with routine capsular closure. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent primary endoscopic repair of gluteus medius and/or minimus tears between January 2012 and December 2015 by the senior author were eligible for inclusion. Patient-reported outcome scores were assessed preoperatively and at 5 years postoperatively: Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sport Specific (HOS-SS), modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The MCID was uniquely calculated using the distribution method, and the PASS was determined via the anchor-based method utilizing receiver operating characteristic curves and Youden index. Results: A total of 46 patients were included in the study. The majority were female (87.0%), with a mean ± standard deviation age of 59.1 ± 8.9 years and body mass index of 27.3 ± 6.9. Significant postoperative improvements (P <.001) in each of the 5 patient-reported outcomes were observed at 5 years postoperatively. The MCID threshold values were calculated as follows: HOS-ADL, 11.5; HOS-SS, 15.1; mHHS, 13.3; iHOT-12, 11.8; and VAS, 15.8. The PASS thresholds were calculated as follows: HOS-ADL, 75.7; HOS-SS, 79.7; mHHS, 81.2; and iHOT-12, 60.8. A majority of patients achieved a clinically significant outcome, with 96.2% of patients reaching a threshold score for the MCID or PASS for at least 1 patient-reported outcome. Conclusion: Endoscopic hip abductor repair with concomitant arthroscopic labral treatment has a high rate of achievement of clinically significant outcomes and survivorship at a minimum 5-year follow-up. We defined the MCID for the HOS-ADL, HOS-SS, mHHS, iHOT-12, and VAS outcome scores to be 11.5, 15.1, 13.3, 11.8, and 15.8, respectively. The PASS threshold scores for the HOS-ADL, HOS-SS, mHHS and iHOT-12 scores of 75.7, 79.7, 81.2, and 60.8, respectively. Future researchers and clinicians can use the MCID and PASS values established in this study to better evaluate mid-term outcomes of patients undergoing hip abductor repair. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence supports surgical intervention for hip abductor tears; however, the influence of fatty infiltration (FI) on outcomes after repair remains uncertain and has been addressed only in small case series. Purpose: To clarify the relationship between FI and surgical outcomes for hip abductor tears. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic review and meta-analysis was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. FI severity was assessed by Goutallier-Fuchs (G-F) grade. The relationship between FI and improvement in Harris Hip Score (HHS)/modified Harris Hip Score (mHHS) and visual analog scale (VAS) score for pain was examined with mixed-effects metaregression. Outcomes with open and endoscopic techniques were also compared. Results: A total of 4 studies (206 repairs in 201 patients) were eligible. High-grade FI was associated with significantly less improvement in HHS/mHHS than both no FI (6.761 less; 95% CI, 3.983-11.570; P =.002) and low-grade FI (7.776 less; 95% CI, 2.460-11.062; P <.001) but did not significantly influence VAS score (P >.05). Controlling for FI severity, we found no significant difference in HHS/mHHS improvement between open versus endoscopic repair (P >.05 at each level), but open repair resulted in significantly greater improvement in VAS score for every G-F grade (all P <.005). Conclusion: Surgical intervention for symptomatic hip abductor tendon tears improved outcomes as reflected by change in HHS/mHHS; however, the presence of high-grade FI resulted in less improvement. FI severity did not influence VAS scores for pain. Although no differences were found between open and endoscopic repairs in terms of FI-adjusted improvement in HHS/mHHS, open repairs resulted in significantly greater pain relief at each FI level. [ABSTRACT FROM AUTHOR]

Background: Increased attention has been directed toward the acetabular morphology in the management of patients with femoroacetabular impingement syndrome (FAIS). Whether acetabular version influences patient-reported outcomes remains poorly understood. Purpose: To use computed tomography (CT)–based 3-dimensional (3D) bone models to (1) quantify acetabular version in patients with FAIS, (2) compare acetabular version on 3D bone models with current plain radiographic parameters, and (3) explore the relationship between the magnitude of acetabular version and minimum 2-year clinical outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Three-dimensional models of the pelvis and femur were generated by semiautomated segmentation and aligned to a standard coordinate system. Acetabular version was quantified at the 3-o'clock position, and 3 groups were identified: acetabular retroversion (AR; <15°), normal acetabular version (NV; 15°-25°), and acetabular anteversion (AA; >25°). Patient demographic characteristics, plain radiographic parameters, and clinical outcomes were analyzed, including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Results: Preoperative CT scans were acquired in 105 consecutive patients before hip arthroscopy for FAIS, of which 84 (80.0%) completed minimum 2-year patient-reported outcomes. The mean ± SD age and body mass index of patients were 33.9 ± 12.6 years and 26.0 ± 5.4, respectively; 70.2% were female. The number of patients and the mean central acetabular version within each group were as follows: AR (n = 12; 11.3°± 2.7°), NV (n = 56; 20.7°± 2.9°), and AA (n = 16; 28.5°± 2.7°). Posterior wall sign was the only plain radiographic parameter that was significantly more observed in the AR group than in the other 2 groups. At minimum 2-year follow-up, significant between-group differences in the mHHS, iHOT-12, and VAS for pain and satisfaction (P <.05) were appreciated, while post hoc analysis with Bonferroni correction (P <.0167) found lower scores on the mHHS, iHOT-12, and VAS for pain and satisfaction in patients with AR as compared with NV. Lower scores on the VAS for satisfaction were reported in patients with AR when compared with AA (P =.006) but not on the mHHS (P =.023), iHOT-12 (P =.032), or VAS for pain (P =.072). Conclusion: Traditional plain radiographic indices to describe AR, including crossover sign and ischial spine sign, were not reliable in defining AR according to 3D models derived from CT scans. Only the posterior wall sign was observed in a higher proportion in the AR group. Patients with AR demonstrated inferior outcomes when compared with patients with NV and AA after hip arthroscopy for FAIS. [ABSTRACT FROM AUTHOR]

Background: The International Hip Outcome Tool 12-Item Questionnaire (IHOT-12) has been proposed as a more appropriate outcome assessment for hip arthroscopy populations. The extent to which preoperative patient factors predict achieving clinically meaningful outcomes among patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) remains poorly understood. Purpose: To determine the predictive relationship of preoperative imaging, patient-reported outcome measures, and patient demographics with achievement of the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for the IHOT-12 at a minimum of 2 years postoperatively. Study Design: Case-control study; Level of evidence, 3. Methods: Data were analyzed for consecutive patients who underwent hip arthroscopy for FAIS between 2012 and 2018 and completed the IHOT-12 preoperatively and at a minimum of 2 years postoperatively. Fifteen novel machine learning algorithms were developed using 47 potential demographic, clinical, and radiographic predictors. Model performance was evaluated with discrimination, calibration, decision-curve analysis and the brier score. Results: A total of 859 patients were identified, with 685 (79.7%) achieving the MCID, 535 (62.3%) achieving the PASS, and 498 (58.0%) achieving the SCB. For predicting the MCID, discrimination for the best-performing models ranged from fair to excellent (area under the curve [AUC], 0.69-0.89), although calibration was excellent (calibration intercept and slopes: –0.06 to 0.02 and 0.24 to 0.85, respectively). For predicting the PASS, discrimination for the best-performing models ranged from fair to excellent (AUC, 0.63-0.81), with excellent calibration (calibration intercept and slopes: 0.03-0.18 and 0.52-0.90, respectively). For predicting the SCB, discrimination for the best-performing models ranged from fair to good (AUC, 0.61-0.77), with excellent calibration (calibration intercept and slopes: –0.08 to 0.00 and 0.56 to 1.02, respectively). Thematic predictors for failing to achieve the MCID, PASS, and SCB were presence of back pain, anxiety/depression, chronic symptom duration, preoperative hip injections, and increasing body mass index (BMI). Specifically, thresholds associated with lower likelihood to achieve a clinically meaningful outcome were preoperative Hip Outcome Score–Activities of Daily Living <55, preoperative Hip Outcome Score–Sports Subscale >55.6, preoperative IHOT-12 score ≥48.5, preoperative modified Harris Hip Score ≤51.7, age >41 years, BMI ≥27, and preoperative α angle >76.6°. Conclusion: We developed novel machine learning algorithms that leveraged preoperative demographic, clinical, and imaging-based features to reliably predict clinically meaningful improvement after hip arthroscopy for FAIS. Despite consistent improvements after hip arthroscopy, meaningful improvements are negatively influenced by greater BMI, back pain, chronic symptom duration, preoperative mental health, and use of hip corticosteroid injections. [ABSTRACT FROM AUTHOR]

Background: Data on outcomes in patients with borderline hip dysplasia (BHD) who undergo hip arthroscopy remain limited, particularly in regard to return to sport (RTS). Purpose: To evaluate outcomes in patients with BHD and their ability to RTS after hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS). Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with self-reported athletic activity and radiographic evidence of BHD, characterized by a lateral femoral center-edge angle (LCEA) between 18° and 25° and a Tönnis angle >10°, who underwent hip arthroscopy for FAIS between November 2014 and March 2017 were identified. Patient characteristics and clinical outcomes including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction were analyzed at minimum 2-year follow-up. In addition, all patients completed an RTS survey. Results: A total of 41 patients with a mean age and body mass index (BMI) of 29.6 ± 13.4 years and 25.3 ± 5.6, respectively, were included. Mean LCEA and Tönnis angle for the study population were 22.7°± 1.8° and 13.3°± 2.9°, respectively. A total of 31 (75.6%) patients were able to RTS after hip arthroscopy at a mean of 8.3 ± 3.2 months. A total of 14 patients (45.2%) were able to RTS at the same level of activity, 16 patients (51.6%) returned to a lower level of activity, and only 1 (3.2%) patient returned to a higher level of activity. Of the 11 high school and collegiate athletes, 10 (90.9%) were able to RTS. All patients demonstrated significant improvements in all patient-reported outcome measures (PROMs) as well as in pain scores at a mean of 26.1 ± 5.4 months after surgery. Patients who were able to RTS had a lower preoperative BMI than patients who did not RTS. Analysis of minimum 2-year PROMs demonstrated better HOS-ADL, HOS-SS, mHHS, iHOT-12, and VAS outcomes for pain in patients able to RTS versus those who did not RTS (P <.05). Conclusion: Of the patients with BHD studied here, 75.6% of patients successfully returned to sport at a mean of 8.3 ± 3.2 months after hip arthroscopy for FAIS. Of the patients who successfully returned to sport, 45.2% returned at the same level, and 3.2% returned at a higher activity level. [ABSTRACT FROM AUTHOR]