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Background: The minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), substantial clinical benefit (SCB), and maximum outcome improvement (MOI) satisfaction threshold for the Hip Outcome Score Sport-Specific Subscale (HOS-SSS) have not been established in athletes undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To determine threshold MCID, PASS, SCB, and MOI satisfaction threshold values for the HOS-SSS in athletes undergoing hip arthroscopy for FAIS at minimum 2–year follow–up. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Anchor questions were administered to recreational, organized amateur, high school, college, and professional athletes who underwent primary hip arthroscopy for FAIS between May 2015 and March 2019. Patients were included if they were younger than 50 years, answered the anchor questions, and had preoperative and minimum 2–year follow–up for the HOS-SSS, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia (lateral center–edge angle <18°), and previous ipsilateral hip surgery or conditions. Receiver operating characteristic (ROC) analysis was used to determine PASS, SCB, and MOI satisfaction for the HOS-SSS. Two distribution methods were used to calculate MCID for HOS-SSS. Results: A total of 225 athletes who underwent primary hip arthroscopy met the inclusion criteria. Of those athletes, 200 (88.9%) who had minimum 2–year follow–up and information regarding return to sport (RTS) were included. The cohort included 124 (62.0%) women and 76 (38.0%) men with a mean ± standard deviation age of 29.4 ± 10.4 years, body mass index of 25.6 ± 5.4, and follow–up of 29.5 ± 5.1 months. Athletes experienced significant improvements in HOS-SSS, mHHS, NAHS, and VAS from preoperative to latest postoperative follow–up (P <.001), and mean satisfaction was 8.2. The RTS rate was 83.7%. ROC analysis determined that the PASS, MOI satisfaction threshold, SCB absolute score, SCB change score, and MCID (baseline/change score methods) for the HOS-SSS were 77.0, 44.6%, 92.7, 30.6, and 10.6, respectively, with athletes achieving thresholds at high rates (80.0%, 80.5%, 45.0%, 54.0%, and 79.5%, respectively). Conclusion: This study identified values for the HOS-SSS that can be used to define clinically meaningful outcomes in athletes after primary hip arthroscopy for FAIS. The PASS, MOI satisfaction threshold, SCB absolute score, SCB change score, and MCID for the HOS-SSS at minimum 2–year follow–up in athletes after primary hip arthroscopy were 77.0, 44.6%, 92.7, 30.6, and 10.6, respectively. [ABSTRACT FROM AUTHOR]

Background: Athletes with femoroacetabular impingement syndrome (FAIS) who undergo hip arthroscopy with iliopsoas fractional lengthening (IFL) in the context of painful internal snapping have demonstrated favorable patient–reported outcomes (PROs), return to sport (RTS), and resolution of internal snapping symptoms at short term follow–up. Midterm outcomes have not been established. Purposes: (1) To report minimum 5–year PROs and RTS rate in competitive athletes who underwent primary hip arthroscopy for FAIS and intra–bursal IFL for painful internal snapping and (2) to compare these clinical results with those of a propensity score–matched control group of competitive athletes who underwent primary hip arthroscopy without painful internal snapping and IFL. Study Design: Cohort study; Level of evidence, 3. Methods: Data were reviewed for consecutive surgeries performed by a single surgeon between February 2010 and December 2013. Patients were considered eligible if they were professional, collegiate, or high school athletes and received a primary hip arthroscopy for FAIS and intra–bursal IFL without extended capsulotomy for painful internal snapping. Indications for IFL were painful internal snapping on preoperative physical examination. Inclusion criteria were preoperative and minimum 5–year follow–up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Rates of achieving the minimal clinically important difference were also reported. For comparison, athletes in the IFL group were propensity matched by age, sex, body mass index, lateral and anterior center–edge angles, and sports level to a control group of athletes without internal snapping who underwent primary hip arthroscopy for FAIS without IFL. Results: A total of 105 competitive athletes in the IFL group were included in the study with a follow–up of 66.8 ± 6.9 months (mean ± SD). The IFL cohort showed significant improvement in all recorded PROs at minimum 5–year follow–up (P <.001). Furthermore, they demonstrated favorable rates of achieving the minimal clinically important difference for the modified Harris Hip Score (82.0%), Nonarthritic Hip Score (85.4%), and Hip Outcome Score–Sport Specific Subscale (82.8%). Further, 89.5% of athletes in the IFL cohort successfully returned to sport. A total of 42 athletes in the IFL group were propensity matched to 54 control athletes. When groups were compared, they demonstrated similar improvement in PROs and rates of RTS, revision arthroscopy, and achieving psychometric thresholds. Conclusion: Competitive athletes undergoing primary hip arthroscopy and intra–bursal IFL in the context of FAIS and painful internal snapping demonstrated favorable PROs and RTS rate at minimum 5–year follow–up. These results were comparable with those of a control group of athletes not requiring IFL. [ABSTRACT FROM AUTHOR]

Background: Patient-reported outcomes (PROs) and return to sports (RTS) have not been established in athletes undergoing primary hip arthroscopy and subspine decompression for femoroacetabular impingement syndrome (FAIS) and subspine impingement (SSI). Purpose: (1) To report minimum 2-year PROs and RTS in competitive athletes undergoing primary hip arthroscopy for treatment of FAIS with subspine decompression for treatment of SSI and (2) to compare clinical results with a matched control group of athletes without SSI. Study Design: Cohort study, Level of evidence, 3. Methods: Data were reviewed for professional, collegiate, and high school athletes undergoing primary hip arthroscopy for FAIS with arthroscopic subspine decompression for SSI between February 2011 and October 2018. Inclusion criteria included preoperative and minimum 2-year follow-up scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale for pain. Rates of achieving the minimal clinically important difference (MCID) were also calculated. For comparison, athletes in the SSI group were propensity matched according to age at the time of surgery, sex, body mass index, lateral center-edge angle, alpha angle, sport level, acetabular labrum articular disruption grade, and sport type to a control group of athletes without SSI. Results: A total of 30 SSI athletes were included in the study, with a mean plus or minus standard deviation follow-up of 32.1 ± 7.1 months and age of 20.9 ± 5.7 years. The SSI cohort demonstrated significant improvement in all recorded PROs (P <.001), returned to sports at high rates (88.5%), and achieved the MCID for the Hip Outcome Score–Sport Specific Subscale at a high rate (80.0%). Furthermore, these patients had a low rate of undergoing revision surgery (6.7%). When compared with a propensity-matched control group of 59 athletes, the SSI group demonstrated similar rates of RTS, revision, and achieving the MCID for all PROs. Conclusion: Competitive athletes with FAIS and SSI who underwent primary hip arthroscopy and subspine decompression had favorable outcomes and high RTS rates at minimum 2-year follow-up. These results were comparable with those of a control group of athletes without SSI undergoing primary hip arthroscopy. [ABSTRACT FROM AUTHOR]

Background: The incidence of revision hip arthroscopy with labral reconstruction in athletes is increasing. However, the outcomes of revision hip arthroscopy with labral reconstruction in athletes have not been well established. Purposes: (1) To report minimum 2–year patient–reported outcome (PRO) scores and return to sports (RTS) characteristics for high–level athletes undergoing revision hip arthroscopy with labral reconstruction and (2) to compare clinical results with those of a propensity–matched control group of high–level athletes undergoing revision hip arthroscopy with labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected and retrospectively reviewed for athletes at any level who underwent a revision hip arthroscopy and a labral reconstruction between April 2010 and March 2019. Minimum 2–year PROs were reported for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score–Sport Specific Subscale (HOS-SSS), the visual analog scale (VAS) for pain, and RTS. The percentages of athletes achieving the minimal clinically important difference (MCID) and the maximum outcome improvement satisfaction threshold (MOIST) were also recorded. These patients were propensity matched in a 1: 1 ratio to athletes undergoing revision hip arthroscopy with labral repair for comparison. Results: A total of 46 athletes (N = 47 hips) were reported from 50 (n = 51 hips) athletes who underwent revision with labral reconstruction. A subanalysis of 30 propensity–matched athletes undergoing revision labral reconstruction was performed, with a mean follow–up time of 26.3 ± 2.4 months and an age of 28.5 ± 10.1 years, and compared with a revision labral repair group. Significant improvements were obtained for the mHHS, the NAHS, the HOS-SSS, and the VAS from preoperative to the latest follow–up (P <.001), with an achievement MCID rate of 61.5%, 72%, 62.5%, and 76.9% for the mHHS, the NAHS, the HOS-SSS, and the VAS, respectively. The rate for re–revision surgery (2 tertiary arthroscopy and 1 conversion to total hip arthroplasty) was 10%, and 14 patients (63.6%) were able to RTS. Improvements in PROs, rates of achieving MCID/MOIST, rate of re–revision surgery (re-revision hip arthroscopy, P =.671; conversion to total hip arthroplasty, P >.999), and RTS rate (P =.337) were similar when compared with those of the propensity–matched control labral repair group (P >.05). Conclusion: Revision hip arthroscopy with labral reconstruction, in the context of an irreparable labral tear, seems to be a valid treatment option in the athletic population, demonstrating significant improvements in all PROs and low rates of undergoing revision surgery. Athletes experienced a similar magnitude of improvement in PROs, RTS rate, and revision surgery rate to that of a propensity–matched control group of athletes undergoing revision hip arthroscopy with labral repair. [ABSTRACT FROM AUTHOR]

Background: The effect of high body mass index (BMI) on outcomes in athletes has not been established. Purpose: (1) To report minimum 2-year patient-reported outcome (PRO) scores and return to sports (RTS) for high-level athletes with high BMI undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to compare results with a propensity-matched control group of high-level athletes with a normal BMI. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all professional, collegiate, and high school athletes who had a high BMI (>30) and who had undergone primary hip arthroscopy for FAIS between January 2010 and December 2018. RTS status and minimum 2-year PROs were collected 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. The percentage of patients achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were also recorded. These patients were propensity matched in a 1:3 ratio to high-level athletes with a normal BMI for comparison. Results: A total of 30 high-level athletes with a high BMI were included with a mean follow-up of 49.4 ± 29.5 months. They demonstrated significant improvement from preoperatively to latest follow-up for mHHS, NAHS, HOS-SSS, and VAS (P <.001). When outcomes were compared with a propensity-matched control group of 90 athletes with a normal BMI, athletes with a high BMI had worse acetabular cartilage injury and were more likely to undergo acetabular microfracture (P <.001). Athletes with a high BMI demonstrated lower postoperative scores for NAHS when compared with athletes with a normal BMI (88.06 ± 9.37 [range, 60-100] and 90.25 ± 10.79 [range, 48.75-100], respectively; P =.049). Athletes with a high BMI also demonstrated worse postoperative scores for HOS-SSS when compared with athletes with a normal BMI (77.22 ± 18.31 [range, 22.22-100] and 82.38 ± 22.79 [range, 2.78-100], respectively; P =.038). Rates of achieving MCID for the high-BMI and normal-BMI groups were comparable in mHHS (90.0% and 77.8%, respectively; P =.185) and HOS-SSS (90.0% and 82.2%, respectively; P =.397). PASS rates were also comparable between the high- and normal-BMI groups for mHHS (90.0% and 87.8%, respectively; P >.999) and HOS-SSS (70.0% and 71.1%, respectively; P =.908). Athletes with a high BMI also returned to sports at a lower rate compared with athletes with a normal BMI, but this did not reach statistical significance (P =.479). Conclusion: Athletes with a high BMI undergoing primary hip arthroscopy for FAIS demonstrated significant improvement in PROs and favorable rates achieving clinically meaningful improvement. When compared with a control group of high-level athletes with a normal BMI, they exhibited similar rates of achieving psychometric thresholds and RTS rates. At short-term follow-up, high BMI did not adversely affect outcomes of high-level athletes undergoing primary hip arthroscopy. [ABSTRACT FROM AUTHOR]