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Background: Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function, assisting in clinical decision making, and quantifying outcomes of surgical and nonsurgical management. However, PROMs are often designed using patients with preexisting pathology and typically assume that a patient without the pathology would have a perfect or near perfect score. This may result in unrealistic expectations or falsely underestimate how well a patient is doing after treatment. The influence of age on PROMs about the hip of healthy individuals has not been studied. Hypothesis: We hypothesize that in asymptomatic individuals hip-specific PROM scores will decrease in an age-dependent manor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In this multicenter survey study, volunteers who denied preexisting hip pathology and previous hip surgery completed 3 PROMs online or as traditional paper questionnaires. The International Hip Outcome Tool (iHOT), the modified Harris Hip Score (mHHS), and the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and HOS—Sport were completed. Analysis of variance with a Tukey post hoc test was used to analyze differences in PROMs among subgroups. An independent-samples Student t test and a χ2 test were used to analyze differences in continuous and categorical data, respectively. Results: In total 496, 571, 534, and 532 responses were collected for the iHOT, mHHS, HOS-ADL, and HOS–Sport, respectively. Respondents' PROMs were scored and arranged into 3 groups by age: <40 years, 40 to 60 years, and >60 years. The iHOT, mHHS, HOS-ADL, and HOS–Sport of these asymptomatic respondents all decreased in an age-dependent manner: iHOT (<40, 94.1; 40-60, 92.4; >60, 87.0), mHHS (<40, 94.8; 40-60, 91.3; >60, 89.1), HOS-ADL (<40, 98.4; 40-60, 95.0; >60, 90.9), and HOS–Sport (<40, 95.7; 40-60, 82.9; >60, 72.9) (analysis of variance between-group differences, P <.05). Conclusion: This study demonstrated that the iHOT, mHHS, and HOS-ADL and HOS–Sport scores in asymptomatic people decrease in an age-dependent manner. It is important to compare a patient's outcome scores with the age-normalized scores to establish an accurate reference frame with which to interpret outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to (1) evaluate the clinical outcomes after arthroscopic subspinal decompression in patients with hip impingement symptoms and low AIIS, and to (2) assess the presence of low anterior inferior iliac spine on the pre-operative radiographs of patients with established subspinal impingement diagnosed intra-operatively. Methods: Retrospective analysis of patients who underwent arthroscopic subspinal decompression has been performed. The indications for surgery were femoroacetabular impingement (FAI), or subspinal impingement. Pre-operative radiographs were assessed for anterior inferior iliac spine type. Intra-operative diagnosis of low anterior inferior iliac spine was based on the level of anterior inferior iliac spine extension relative to the acetabulum and the presence of reciprocal labral and chondral lesions. In patients where low anterior inferior iliac spine was not diagnosed on pre-operative radiographs, the pre-operative radiographs were re-read retrospectively to assess missed signs of low anterior inferior iliac spine. Results: Thirty-four patients underwent arthroscopic subspinal decompression between 2012 and 2015. The patients were followed for a median of 25 months (13–37 months). Intra-operatively, grade 2 anterior inferior iliac spine was found in 27 patients and grade 3 anterior inferior iliac spine was found in 7 patients. MHHS, HOS, and HOSS scores increased from median (range) pre-operative scores of 55 (11–90), 48 (20–91) and 20 (0–80) to 95 (27–100), 94 (30–100) and 91 (5–100), respectively (p < 0.0001, p = 0.001, p < 0.0001, respectively). Pre-operative diagnosis of low AIIS was made in 6/34 patients via AP radiographs. On retrospective analysis of pre-operative radiographs, signs of low AIIS were still not observed in 21/34 (61.8%) patients. Conclusions: Arthroscopic subspinal decompression of low AIIS yielded significantly improved outcome measures and high patient satisfaction at a minimum of 13 months follow-up. Low AIIS is often under-diagnosed on AP pelvis and lateral frog radiographs and if left untreated, may result in unresolved symptoms and failed procedure. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Proximal hamstring avulsion is an uncommon injury which usually requires surgical intervention. When possible, primary surgical fixation is recommended. In chronic hamstring avulsion with significant retraction of the tendon, hamstring reconstructions using an autograft or allograft are required in order to bridge the gap. This is mainly performed using an open surgical technique. We describe a combined endoscopic and open surgical approach to hamstring reconstruction surgery. [ABSTRACT FROM AUTHOR]

Capsulotomy is necessary to facilitate instrument manoeuvrability within the joint capsule in many arthroscopic hip surgical procedures. In cases where a clear indication for capsular closure does not exist, surgeon's preference and experience often determines capsular management. The purpose of this study was to assess the influence of capsular closure on clinical outcome scores and satisfaction in patients who underwent hip arthroscopy surgery for femoroacetabular impingement (FAI) and labral tear. Data were prospectively collected and retrospectively analysed for hip arthroscopy surgeries with a minimum 2 years follow-up. Patients with developmental dysplasia of the hip, previous back or hip surgeries, and degenerative changes to this hip and secondary gains were excluded. Demographic data, intraoperative findings and patient-reported outcome scores were recorded, including the Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). A total of 29 and 35 patients were included in the non-closure and closure groups, respectively. The mean follow-up time was over 3 years for both groups. The mean pre-operative and post-operative HOS scores and MHHS scores did not significantly differ between groups (pre-operative HOS: 65.6 and 66.3, P = 0.898; post-operative HOS: 85.4 and 87.2, P = 0.718; pre-operative MHHS: 63.2 and 58.4, P = 0.223; post-operative MHHS: 85.7 and 88.7, P = 0.510). Overall patient satisfaction did not differ significantly between groups (non-closure 86.3%, closure group 88.6%; P = 0.672). Capsular closure did not significantly influence satisfaction or clinical outcome scores in patients who underwent arthroscopic hip surgery for FAI or labral tear. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze dynamic patterns for scanning femoroacetabular impingement (FAI) radiographs in orthopedics, in order to better understand the nature of expertise in radiography. Seven orthopedics residents with at least two years of expertise and seven board-certified orthopedists participated in the study. The participants were asked to diagnose 15 anteroposterior (AP) pelvis radiographs of 15 surgical patients, diagnosed with FAI syndrome. Eye tracking data were recorded using the SMI desk-mounted tracker and were analyzed using advanced measures and methodologies, mainly recurrence quantification analysis. The expert orthopedists presented a less predictable pattern of scanning the radiographs although there was no difference between experts and non-experts in the deterministic nature of their scan path. In addition, the experts presented a higher percentage of correct areas of focus and more quickly made their first comparison between symmetric regions of the pelvis. We contribute to the understanding of experts’ process of diagnosis by showing that experts are qualitatively different from residents in their scanning patterns. The dynamic pattern of scanning that characterizes the experts was found to have a more complex and less predictable signature, meaning that experts’ scanning is simultaneously both structured (i.e. deterministic) and unpredictable. [ABSTRACT FROM AUTHOR]

Purpose: Femoroacetabular impingement (FAI) has been well described in recent years as one of the major causes of hip pain potentially leading to acetabular labral tears and cartilage damage, which may in turn lead to the development of early degenerative changes. More recently, extra-articular patterns of impingement such as the anterior inferior iliac spine (AIIS)/subspine hip impingement have gained focus as a cause of hip pain and limitation in terminal hip flexion and internal rotation. The purpose of this study was to evaluate the prevalence of low AIIS in patients undergoing hip arthroscopy and to characterize the concomitant intra-articular lesions. Methods: Between November 2011 and April 2013, 100 consecutive patients underwent hip arthroscopy for various diagnoses by a single surgeon. After intra-operative diagnosis of low AIIS was made, a comprehensive review of the patients' records, preoperative radiographs, and intra-operative findings was conducted to document the existence and location of labral and chondral lesions. Results: Twenty-one (21 %) patients had low AIIS. There were 13 males (mean age 38.4 years) and eight females (mean age 35.5 years). Eight patients had pre-operative radiographic evidence of low AIIS. All patients had a labral tear anteriorly, at the level of the AIIS; 17 had chondrolabral disruption and 17 had chondral lesions in zone two (antero-superior); and four patients had lesion in zones two and three. Conclusions: Low AIIS is a common intra-operative finding in hip arthroscopy patients. Characteristic labral and chondral lesions are routinely found in a predictable location that effaces the low AIIS. Level of Evidence-Level IV, Case Series [ABSTRACT FROM AUTHOR]