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Background: The essential component of managing femoroacetabular impingement involves restoration of the original labral function. Circumferential labral reconstruction (CLR) has shown positive results. However, biomechanical studies of CLR are limited and have not established the efficacy of the modern knotless all-suture anchor (ASA) pull-through technique., Hypotheses: (1) CLR with knotless ASA fixation will restore native labral suction seal biomechanics; (2) tensioning the ASA to a high-tension state will increase the peak distractive force., Study Design: Controlled laboratory study., Methods: Eight fresh-frozen human cadaveric hips were dissected free of all soft tissue except the native labrum and transverse acetabular ligament. On an electromechanical testing system, the hips were compressively loaded to 250 N to initiate a suction seal and distracted at a rate of 10 mm/s until rupture of the suction seal. Hips were tested in 4 states: intact labrum, full labral removal, knotless CLR with moderate anchor tension, and CLR with high anchor tension. Peak distractive force (in newtons) was compared using repeated measures analysis of variance ( P < .05). Acetabular bevel angles (θ) were measured at labral clockface positions outside the transverse acetabular ligament using a 3-dimensional digitizer stylus after rim preparation. Linear regression plots compared θ and peak distractive force in the CLR state., Results: Peak force values were 138.5 ± 13.6 N (mean ± SE) for the intact labrum, 18.4 ± 2.79 N for labral excision, 95.4 ± 23.3 N for moderate-tension CLR, and 126.2 ± 27.3 N for high-tension CLR. Significant differences were observed only when full labral removal was compared with the other conditions: intact ( P < .001), moderate-tension CLR ( P = .016), and high-tension CLR ( P = .002). Steeper acetabular bevel angles (smaller θ) were correlated with greater suction seal restoration ( P < .05)., Conclusion: CLR restored distractive stability on average to 82.0% of the intact value after labral deficiency. Retensioning did not significantly increase peak distractive forces., Clinical Relevance: These findings provide biomechanical validation supporting CLR using knotless ASAs in an effort to minimize volumetric bone loss and provide other surgical advantages. The prepared rim's bevel angle may be an important variable to optimize for improved suction seal restoration., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was funded by Arthrex, Inc (grant AIRR-20106). A.C.L. has received consulting fees from Arthrex and Graymont Medical; research support from Arthrex and Stryker; and other financial or material support from Iroko, Medwest Associates, Smith & Nephew, Stryker, Vericel, and Zimmer Biomet. B.L.S. A.N.K., and C.A.W. are employees of Arthrex. B.G.D. is a board or committee member for the AANA Learning Center and American Hip Institution Research Foundation and has received consulting fees from Arthrex; royalties from Arthrex, DJO Global, Medacta, and Orthomerica; and research support from Arthrex, Medacta, Ossur, and Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: The growing adoption of robotic-assistance during total hip arthroplasty (THA) has provided novel means through which a patient's anatomy and dynamic spinopelvic relationship can be incorporated into surgical planning. However, the impact of enhanced technologies on intraoperative decision-making and changes to component positioning has not yet been described., Methods: A multicentre, prospective study included 105 patients (52% women) patients who underwent robotic-assisted THA with the integration of software that incorporates a patient's pelvic tilt (PT) and virtual range-of-motion (VROM) for impingement modeling. The primary outcome of the study was the percentage of patients who underwent changes to the preoperative plan for cup position after incorporating the data from the software., Results: Utilising the intraoperative VROM information, the preoperative plan for cup position was changed from the default (40° inclination and 20° anteversion) in 82/105 (78%) cases. When stratifying by spinopelvic mobility, 64% were considered normal (change ⩾ 10° and ⩽30°), 27% were stiff (change < 10°), and 9% were hypermobile (change > 30°). For all cohorts, the majority of cases (78%) deviated from the 40° inclination and 20° version target. When evaluating the proportion of cases within the Lewinnek and Callanan safe zones based on spinopelvic mobility, 19% of cases within the normal group were planned outside of both zones compared to 39% of stiff cases and 10% of hypermobile cases., Conclusions: Utilising the latest version of robotic-assisted THA software, the preoperative plan for cup position was changed in the vast majority (78%) of patients, causing substantial deviations from traditional, generic cup targets., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Arthroscopic labral repair has been shown to result in favorable short- and midterm outcomes; however, the durability of outcomes specifically in older patients remains underreported., Purpose: To (1) report prospectively collected hip preservation rates and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up in patients aged ≥40 years after primary hip arthroscopy with labral repair and (2) perform a matched analysis comparing patients aged ≥40 years with patients aged <40 years., Study Design: Cohort study; Level of evidence, 3., Methods: Data were prospectively collected and retrospectively reviewed on all patients who underwent primary hip arthroscopy between February 2008 and December 2011. Patients aged ≥40 years who underwent labral repair were included. Preoperative and minimum 10-year follow-up scores were collected for multiple PROMs. Propensity score matching was utilized to compare these patients with a cohort of patients <40 years., Results: Of the 113 hips eligible, 91 hips (80.5%) on 85 patients (6 bilateral) had a minimum 10-year follow-up. There were 58 women (68%) and 27 men (32%) with a mean age and body mass index of 47.8 years and 25.8, respectively. The hip preservation rate for patients aged ≥40 years was 78%, with 20 patients requiring arthroplasty during the study period. There was significant improvement in all PROMs from baseline to minimum 10-year follow-up with high rates of achieving the minimal clinically important difference and Patient Acceptable Symptom State clinical outcome thresholds. In total, 69 patients aged ≥40 years were propensity matched to 107 patients <40 years. Patients ≥40 tended to have a lower hip preservation rate (81.2% vs 91.6%; P = .06), while patients in the younger cohort had significantly higher rates of secondary hip arthroscopy (14% vs 3%; P = .02). Improvement in PROMs was comparable between the groups., Conclusion: Patients ≥40 years who underwent primary hip arthroscopy with labral repair demonstrated a hip preservation rate of 78%, significant and durable improvement in PROMs, and high rates of satisfaction at a minimum 10-year follow-up. Matched analysis with patients <40 years revealed comparable improvement in patient-reported outcomes between the 2 groups, with a tendency to a higher level of arthroplasty in patients ≥40 years., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by Arthrex (IIRR-01507). B.G.D. has had ownership interests in the American Hip Institute, Hinsdale Orthopaedics, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center; has received research support from Arthrex, the Kauffman Foundation, and Stryker; consulting fees from Adventist Hinsdale Hospital, Arthrex, Medacta, Stryker, and SI-BONE; educational support from Arthrex, Breg, Medacta, and Medwest Associates; speaking fees from Arthrex; honoraria from Medacta; travel and lodging payments from Arthrex, Medacta, and Stryker; food and beverage payments from Arthrex, Medacta, Stryker, DJO Global, and Zimmer Biomet; and royalties from Amplitude, Arthrex, DJO Global, Medacta, Stryker, and Orthomerica. B.G.D. is medical director of hip preservation at St. Alexius Medical Center; and board member for the American Hip Institute Research Foundation, AANA Learning Center Committee, Journal of Hip Preservation Surgery, and Journal of Arthroscopy. The American Hip Institute Research Foundation funds research and is where this study was performed. A.C.L. has received support for education from Arthrex, Medwest, and Smith & Nephew; research support from Arthrex, Stryker, and Medacta; hospitality payments from Smith & Nephew, Stryker, Zimmer Biomet, and Arthrex; and consulting fees from Arthrex, Stryker, and Graymont Medical. A.C.L. is the co–medical director of hip preservation at St. Alexius Medical Center, a clinical instructor at the University of Illinois College of Medicine, and a member of the AANA Learning Center Committee. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Purpose: To compare minimum 5-year patient-reported outcome measures after hip arthroscopy (HA) and periacetabular osteotomy (PAO) for borderline hip dysplasia., Methods: Hips with a lateral center-edge angle (LCEA) between 18° and less than 25° that underwent either PAO or HA were selected from 2 institutions. The exclusion criteria were as follows: LCEA less than 18°, Tönnis osteoarthritis grade greater than 1, prior hip surgical procedures, active inflammatory disease, Workers' Compensation, and concomitant surgery. Patients underwent propensity matching based on age, sex, body mass index, and Tönnis osteoarthritis grade. Patient-reported outcome measures included the modified Harris Hip Score, as well as calculation of the minimal clinically important difference, patient acceptable symptom state, and maximum outcome improvement satisfaction threshold. Preoperative radiographic predictors included comparison of the Femoro-epiphyseal Acetabular Roof index and ligamentum teres lesions., Results: A total of 28 PAO patients underwent propensity matching to 49 HA patients. The 2 groups were similar in terms of mean age, sex, preoperative body mass index, and LCEA. The PAO group had a longer mean follow-up period (95.8 months vs 81.3 months, P = .001). The mean Femoro-epiphyseal Acetabular Roof index was significantly lower preoperatively in the HA group (P < .001). The 2 groups showed similar and significant improvements in the mean modified Harris Hip Score from preoperatively to latest follow-up (P < .001). The relative risk of subsequent surgery in the PAO group was 3.49 (P = .024), mostly attributed to hardware removal (25%). The revision rate was 3.6% in the PAO group and 8.2% in the HA group (P = .65). One patient in the PAO group required revision HA for intra-articular adhesions. Three of the patients requiring revision in the HA group underwent PAO because of persistent pain, and one underwent revision HA alone. Conversion to total hip arthroplasty was required in 1 patient in the HA group and no patients in the PAO group., Conclusions: Both PAO and HA with capsular plication provide borderline hip dysplasia patients with clinically significant improvements and low revision rates at a minimum of 5 years postoperatively., Level of Evidence: Level III, retrospective, comparative therapeutic trial., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Arthroscopic surgery, including implants and advanced techniques, continues to advance in the field of orthopaedics. The evolution of suture anchors has undergone design changes, passing from first-generation metal anchors, biodegradable materials, different plastic polymers, to all-suture constructs. Knotless technology also has been found to be a more reproducible method and have comparable outcomes with those found using knotted anchors. This Technical Note describes the advantages and different ways this tensionable anchor can be used in arthroscopic procedures. This implant and its understanding will be useful in the sports medicine area by simplifying procedures and making them more reproducible. The aim of the present Technical Note is to detail the simplicity and versatility of the anchor and discuss different scenarios in which this technology can be used to address common hip pathologies., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was supported by 10.13039/100007307Arthrex funding (IIRR-01609). B.G.D. is supported by the American Orthopedic Foundation. B.G.D. reports a relationship with 10.13039/100007307Arthrex that includes: consulting or advisory, funding grants, nonfinancial support, and speaking and lecture fees; a relationship with 10.13039/100008894Stryker Corporation that includes: funding grants and speaking and lecture fees; a relationship with Medacta USA that includes: nonfinancial support and speaking and lecture fees; a relationship with Orthomerica that includes: nonfinancial support; a relationship with 10.13039/100016178Medwest Associates that includes: speaking and lecture fees; a relationship with HydroCision that includes: consulting or advisory; a relationship with Ossur that includes: nonfinancial support; a relationship with 10.13039/100008894Stryker Endoscopy that includes: funding grants and nonfinancial support; a relationship with the American Hip Institute Research Foundation that includes: board membership; a relationship with AANA Learning Center Committee that includes: board membership; a relationship with Journal of Arthroscopy that includes: board membership; and a relationship with American Hip Institute that includes: equity or stocks. B.G.D. has a patent, “Method and instrumentation for acetabular labrum reconstruction,” with royalties paid to Arthrex; a patent, “Knotless suture anchors and methods of tissue repair,” with royalties paid to Orthomerica; a patent, “Knotless suture anchors and methods of tissue repair,” with royalties paid to DJO Global; a patent, Adjustable multi-component hip orthosis,” with royalties paid to Arthrex; and a patent with royalties paid to Medacta. A.C.L. reports a relationship with 10.13039/100007307Arthrex that includes: consulting or advisory, nonfinancial support, and travel reimbursement; a relationship with 10.13039/100008894Stryker Corporation that includes: consulting or advisory, nonfinancial support, and travel reimbursement; a relationship with Medwest that includes: nonfinancial support and travel reimbursement; a relationship with Smith & Nephew that includes: nonfinancial support and travel reimbursement; a relationship with Vericel that includes: nonfinancial support and travel reimbursement; and a relationship with 10.13039/100012630Zimmer Biomet that includes: nonfinancial support and travel reimbursement. A.C.L. is Medical Director of Hip Preservation at St. Alexius Medical Center and a clinical instructor at the University of Illinois College of Medicine. All other authors (P.A.P., J.S.O., W.T.H., P.W.S.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objectives: Systemic strategies for combating antimicrobial resistance (AMR) currently focus on limiting antibiotic use and have been generally insufficient in preventing the rise of AMR. Additionally, they often generate other adverse incentives, such as discouraging pharmaceutical companies from investing in research and development of new antibiotics, further exacerbating the problem. This paper proposes a novel systemic strategy for tackling AMR, which we term 'antiresistics': any intervention (whether a small molecule, genetic element, phage, or whole organism) that reduces resistance rates in pathogen populations. A prime example of an antiresistic would be a small molecule that specifically disrupts the maintenance of antibiotic resistance plasmids. Of note, an antiresistic would be expected to have a population-level effect and not necessarily be useful on a time scale relevant to individual patients., Methods: We developed a mathematical model to assess the effect of antiresistics on population resistance levels and calibrated it to longitudinal data available at the country level. We also estimated potential effects on idealised rates for the introduction of new antibiotics., Results: The model shows that greater use of antiresistics allows for greater usage of existing antibiotics. This leads to an ability to maintain a constant overall rate of antibiotic efficacy with a slower rate of developing new antibiotics; subsequently, antiresistics have a positive benefit on the effective lifetime and thus profitability of antibiotics., Conclusions: By directly reducing resistance rates, antiresistics can provide clear qualitative benefits (which may be quantitatively large) in terms of existing antibiotic efficacy, longevity, and alignment of incentives., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Heterotopic ossification (HO) commonly occurs after total hip arthroplasty (THA) and can adversely impact clinical outcomes. The purpose of this study is to propose a more reliable HO grading method that is better predictive of patient-reported outcomes (PROs) after THA than the Brooker classification., Methods: 513 THAs (62 ± 10 years old) were reviewed. The incidence and grade of HO was evaluated using the Brooker grading system and a simplified biplanar classification system (grade 1: ⩾1 cm between bone on both anteroposterior and lateral views, grade 2: <1 cm between bone on either view). The modified Harris Hip Score (mHHS), Forgotten Joint Score (FJS), and visual analogue scale (VAS) for pain were collected at minimum of 2 years after surgery and were compared between HO grades using multiple regression models., Results: The incidence of HO varied by Brooker grade (grade 1, 23.4%; grade 2, 22.4%; grade 3, 7.2%; grade 4, 0%) and biplanar grade (grade 1: 45.6%; grade 2: 7.4%). The biplanar classification demonstrated higher interobserver reliability than the Brooker classification (κ = 0.95 and 0.91, respectively). Brooker grade 3 HO decreased the mHHS by 6.5 (standard error: 2.7) but did not have a significant effect on FJS or VAS. Biplanar grade 2 HO decreased the mHHS by 9.9 (standard error: 2.7), the FJS by 12.9 (standard error: 4.51) and increased the VAS pain score by 0.81 (standard error: 0.35). The Cox test was used to compare the fit of regression models and determined the biplanar classification was a significantly better predictor than the Brooker classification ( p  < 0.001)., Conclusions: Biplanar grade 2 HO had a significant negative influence on PROs. Contrary to previous literature, these results show clinical significance of non-bridging HO. Compared with the Brooker classification, the biplanar classification has greater interobserver reliability and is more predictive of outcomes after THA.

The purpose of this study was to evaluate the effectiveness of telemedicine appointments in a tertiary orthopedic hip clinic during the COVID-19 pandemic, as a substitute for traditional in-person visits. One hundred sixty-three patients had a telemedicine visit from March to September 2020. Patients were divided into two cohorts. The presurgical group included all patients who had not undergone any prior surgical hip procedures. The pre-surgical group was further subdivided into two groups based on the purpose of the visit: conservative treatment and imaging review. Patients who were indicated for surgical treatment from these two groups were identified to assess their compliance with the surgical indication. The effectiveness was measured by assessing whether patients required an in-person visit before the scheduled follow-up after the telemedicine visit for further medical assessment. Fifty (30.7%) men and 113 (69.3%) women had a telemedicine visit during the 6-month period. The mean age was 43.68 (±16.95) years. There were 92 (56.4%) patients in the presurgical group, of whom 41% followed up after indication for conservative treatment and 59% visited to review imaging. From these groups, 27% were indicated for surgical treatment. The postsurgical group contained 71 (43.6%) patients, divided into three groups based on their surgery date: 0 to 3 months (27%), 4 to 12 months (59%), and more than 12 months (14%). All patients were compliant with the scheduled follow-up after their telemedicine visit. This study showed that telemedicine can be an effective tool for patient-physician communication, obviating the need for subsequent follow-up beyond regularly scheduled visits. [ Orthopedics . 2023;46(3):e173-e178.].

Anterior iliopsoas (IP) impingement after total hip arthroplasty is an underrecognized and continued cause for postoperative pain. There are multiple etiologies for this impingement from cup positioning and sizing to changes in the leg length, and offset must be evaluated to confirm no need for implant revision. Additionally, tension of the IP tendon can be increased in patients with diminished spinal mobility, either from prior fusion or with increasing age. Managing this surgically after failing conservative treatment options is best done arthroscopically to prevent additional large, open procedures that place the arthroplasty at unnecessary risk of infection and potential instability. In this article, we describe an arthroscopic technique using fluoroscopy to guide the release of the iliopsoas tendon from the peripheral compartment., (© 2022 The Authors.)

Outcomes following total hip arthroplasty (THA) with concomitant gluteus medius (GM) repair using the direct anterior approach (DAA) are scarce. The primary purpose of this study was to report patient-reported outcome measures (PROMs) with 2-year follow-up of patients with osteoarthritis and GM tear who underwent primary THA and GM repair through the DAA. The secondary purpose was to compare these outcomes with a benchmark propensity-matched control group who underwent a DAA THA without GM tear. Patients were eligible if they received a primary THA and GM repair via the DAA between January 2015 and October 2018 and had baseline PROMs with 2-year follow-up. Patients were excluded if they had workers' compensation or were unwilling to participate. PROM subanalysis was performed between patients and a propensity-matched control group with DAA THA without GM tear. Fourteen patients were included in the study, all of whom were female. Significant improvement for all PROMs and high rate of achieving the minimal clinically important difference (MCID) at 2-year follow-up were reported. All patients were propensity-matched to 28 patients for sex, age, and body mass index. Preoperative PROMs between groups were similar, and both groups reported comparable improvement, satisfaction, and MCID achievement at 2-year follow-up. Primary THA with concomitant GM repair using the DAA yielded good functional outcomes and a high rate of MCID achievement at 2-year follow-up. Based on these results, the DAA can be used safely to address symptomatic GM tears during THA. Furthermore, these outcomes were comparable to a propensity-matched control group without GM tear. [ Orthopedics . 2023;46(1):39-46.].

Injuries to the anterolateral ligament (ALL) of the knee are commonly associated with anterior cruciate ligament (ACL) ruptures. Biomechanical studies have demonstrated conflicting results with regard to the role of the ALL in limiting tibial internal rotation. Clinically, residual pivot shift following ACL reconstruction has been reported to occur up to 25% and has been correlated with poor outcomes. As such, surgical techniques have been developed to enhance rotational stability. Recent biomechanical studies have demonstrated restoration of internal rotational control following ALL reconstruction. The purpose of our study was to understand the biomechanical effects of ACL reconstruction with an ALL internal brace augmentation. We hypothesized that (1) sectioning of the ALL while preserving other lateral extra-articular structures would lead to significant internal rotation laxity and gap formation and (2) ALL repair with internal brace augmentation would lead to reduction in internal rotation instability and gap formation. In total, 10 fresh-frozen cadaveric knees were thawed and biomechanically tested in internal rotation for 10 cycles of normal physiologic torque in the intact, ACL-deficient, ACL/ALL-deficient, ACL-reconstructed, and ALL-repaired conditions. Each condition was tested at 30, 60, and 90 degrees of flexion. Following the final ALL-repaired condition, specimens were additionally subjected to a final internal rotation to failure at 1 degree at the last-tested degree of flexion. Kinematic measurements of angle and linear gap between the femur and tibia were calculated in addition to torsional stiffness and failure torque. As hypothesized, ALL repair with internal brace augmentation significantly reduced internal rotation angular motion and gap formation at flexion angles greater than 30 degrees. Additionally, ALL sectioning produced nonsignificant increases in internal rotation laxity and gap formation compared with ACL-deficient and ACL-reconstructed states, which did not support our other hypothesis., Competing Interests: R.P.R. reports non-financial support from Arthrex, Inc. during the conduct of the study. D.P.B. reports non-financial support from Arthrex, Inc. during the conduct of the study. J.S.S. reports non-financial support from Arthrex, Inc. during the conduct of the study. A.R.M. reports non-financial support from Arthrex, Inc. during the conduct of the study. A.C.L. reports non-financial support from Arthrex, Inc., during the conduct of the study. J.R.D. reports non-financial support from Arthrex, Inc. during the conduct of the study; personal fees and non-financial support from Arthrex, Inc., personal fees from DJO, LLC, personal fees from In2Bones, outside the submitted work., (Thieme. All rights reserved.)

This study synthesizes and reports patient-reported outcomes (PROs) among athletes vs nonathletes after hip arthroscopy for femoroacetabular impingement. A systematic review was performed in November 2020 with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) process. We included studies that reported PROs for athletes vs nonathletes. We excluded articles that did not contain full text, that were not in English, and that included level IV evidence. Four studies reporting on a total of 294 athletes and 230 nonathletes were included. Of these studies, 3 found superior outcomes among athletes, and 1 found that athletes recovered faster, but nonathletes had equivalent outcomes at later follow-up. Athletes and nonathletes showed significant improvements in PROs; however, athletes showed a trend toward superior PROs. Thus, pre-operative athletic activity is associated with favorable outcomes after hip arthroscopy. [ Orthopedics . 2022;45(6):e288-e294.].

Background: Few studies have compared outcomes, return to sport (RTS), and continuation of sport (CTS) after primary hip arthroscopic surgery between matched groups of male and female athletes with a minimum 5-year follow-up., Purpose: (1) To report minimum 5-year patient-reported outcome (PRO) scores as well as RTS and CTS rates for elite female athletes undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) and (2) to compare clinical results with those of a matched control group of elite male athletes., Study Design: Cohort study; Level of evidence, 3., Methods: Data were prospectively collected and retrospectively reviewed for elite (collegiate or professional) female athletes who underwent primary hip arthroscopic surgery for FAIS between March 2009 and March 2016. Inclusion criteria were preoperative and minimum 5-year scores for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain. Exclusion criteria were Tönnis grade >1, hip dysplasia, previous ipsilateral hip surgery/conditions, and those unwilling to participate. Rates of achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) were recorded in addition to RTS. CTS was also recorded and defined as athletes reporting continued sport activity at a minimum 5-year follow-up after initially reporting returning to sport. Elite female athletes were propensity matched in a 1:1 ratio to elite male athletes for comparison., Results: A total of 81 hips in elite female athletes that underwent primary hip arthroscopic surgery met the inclusion criteria, and follow-up was available for 65 hips (80.2%) at a mean of 67.6 ± 6.5 months, with a mean age of 24.3 ± 6.8 years. Female athletes demonstrated significant improvements in all recorded PRO scores; achieved the MCID, PASS, and MOIST at high rates; returned to sport at a rate of 80.4%; and continued sport at a rate of 97.1%. Female athletes demonstrated lower preoperative PRO scores compared with male athletes, but postoperative PRO scores; improvements in scores; rates of achieving the MCID, PASS, MOIST; and RTS and CTS rates were similar between female and male athletes., Conclusion: Elite female athletes undergoing primary hip arthroscopic surgery for FAIS demonstrated favorable PRO scores and high RTS and CTS rates at a minimum 5-year follow-up. These results were comparable with those of a propensity-matched control group of elite male athletes.

Labral calcification may be part of the natural history of untreated femoroacetabular impingement syndrome (FAIS) in certain patients, making it a potential target for intervention with the goal of preserving the hip joint. The purpose of this study was to investigate if calcified labra create the appearance of lateral joint space narrowing and report minimum 2-year patient-reported outcome measures (PROMs) after treating patients with arthroscopic acetabuloplasty and labral reconstruction. Prospectively collected data on patients who underwent primary hip arthroscopy for FAIS and labral tearing from February 2015 to April 2021 were reviewed. Patients treated with primary labral reconstruction for an intraoperatively confirmed diagnosis of labral calcification were included. A sub-analysis was performed for patients with a minimum of 2-year follow-up. Preoperative and postoperative PROMs for the modified Harris hip score, nonarthritic hip score, the International Hip Outcome Tool-12 and visual analog scale for pain were recorded. Forty-six hips (46 patients) were included, with 19 hips in the sub-analysis. There was a significant increase in apparent lateral joint space width (JSW) measured on supine anteroposterior (AP) pelvis radiographs with no significant changes in medial and central JSW and significant decreases in the lateral and anterior center-edge angles and alpha angle. Patients experienced significant increases in PROMs and high rates of achieving psychometric thresholds. Patients presenting with FAIS and calcified labra may have apparent lateral joint space narrowing on pre-operative supine AP pelvis radiographs. These patients have low rates of full-thickness femoral head and acetabular cartilage pathology, this apparent narrowing can be corrected and excellent outcomes and survivorship can be achieved, with primary labral reconstruction., (© The Author(s) 2022. Published by Oxford University Press.)

Femoroacetabular impingement is recognized as a common cause of hip pain. Cam-type femoroacetabular impingement results from abnormal contact between an aspherical femoral head and the acetabular rim during hip range of motion, leading to labral tearing, cartilage damage, and, eventually, osteoarthritis. Arthroscopic correction of this bony deformity has been well described, particularly in the anterolateral quadrant of the femoral neck. Some deformities extend well beyond this quadrant, involving most or all of the circumference of the femoral neck, making arthroscopic decompression a challenge. We present a post-less, all-arthroscopic technique for performing a circumferential cam decompression using 3-dimensional preoperative planning software and interactive fluoroscopy-integrated computer vision interface., (© 2022 The Authors.)

Background: Bilateral hip symptoms from femoroacetabular impingement syndrome (FAIS) are a common finding in patients regardless of athletic involvement. Oftentimes, patients and surgeons choose to stage bilateral hip arthroscopic surgery., Purpose/hypothesis: The purpose of this study was (1) to compare minimum 2-year outcomes between patients who underwent staged bilateral hip arthroscopic surgery for FAIS to a propensity score-matched control group that underwent unilateral hip arthroscopic surgery and (2) to investigate the effect of time between bilateral procedures on patient-reported outcomes (PROs). We hypothesized that, after bilateral hip arthroscopic surgery, the improvement in outcomes would be similar to that after unilateral hip arthroscopic surgery and the time duration between bilateral procedures would not affect the final outcome., Study Design: Cohort study; Level of evidence, 3., Methods: Data were retrospectively reviewed on a consecutive series of patients who underwent primary hip arthroscopic surgery at our institution between June 2008 and November 2017. Patients who underwent bilateral hip arthroscopic surgery with minimum 2-year PROs for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score-Sports Specific Subscale (HOS-SSS), patient satisfaction, and a visual analog scale (VAS) for pain were included. The study group was matched 1:1 based on age, sex, and body mass index to a control group that only required unilateral hip arthroscopic surgery. Additionally, a subanalysis was performed on the study group to determine the effect of time between arthroscopic procedures. Rates of achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the mHHS and HOS-SSS were determined. The P value was set at <.05., Results: A total of 205 patients (410 hips) were included. The mean age and body mass index of the study group were 32.3 ± 13.2 years and 25.0 ± 5.1, respectively. All 410 hips that met the inclusion criteria were matched. There were no significant differences in patient, radiographic, or procedural data. A significant and comparable improvement was reported for all PRO measures and the VAS ( P < .0001) in both groups. Similarly, rates of achieving the MCID and PASS were comparable. After dividing the study group based on whether the contralateral procedure was performed <3 months or >3 months after the first procedure, it was determined that patients had a significant improvement and favorable outcomes regardless of time between bilateral procedures., Conclusion: Patients who underwent unilateral and bilateral hip arthroscopic surgery for FAIS had a significant and comparable improvement in PROs at a minimum 2-year follow-up. A time interval of <3 months or >3 months between bilateral procedures did not affect PROs.

Background: The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies., Methods: The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration., Results: 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801-1.256; p  = 0.489)., Conclusions: NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.

Purpose: To review short-term functional outcomes in patients who underwent hip arthroscopy and to compare their outcomes to those of a demographically similar cohort who underwent total hip arthroplasty (THA)., Methods: Data were prospectively collected and retrospectively reviewed for patients undergoing hip arthroscopy (SCOPE) between April 2008 and October 2015. SCOPE patients were included if they were ≥35 years, had preoperative and postoperative 2-year follow-up, and had no prior hip condition or ipsilateral hip surgery. SCOPE patients were matched 1:1 to a demographically similar cohort of patients who underwent THA at our institution. Matching criteria included similar age (within 5 years), gender, and body mass index (within 5). SCOPE patients were assessed with modified Harris Hip Score (mHHS), non-arthritic hip score, and visual analogue scale (VAS). THA patients were assessed with mHHS, forgotten joint score, and VAS., Results: Sixty-seven patients were included in each cohort. Patients who underwent hip arthroscopy for management of labral tears achieved nearly equivalent mHHS, Health Survey Short Form (SF-12) Mental, SF-12 Physical, Veterans RAND 12 Item Health Survey (VR-12) Mental, VR-12 Physical scores at latest follow-up compared to demographically similar patients who underwent THA. There was no significant difference in mHHS scores (SCOPE = 82.9 ± 16.4 vs THA = 87.3 ± 15, P = .095) between the 2 group groups. In addition, average patient satisfaction on a 10-point scale was 8.1 for the SCOPE cohort and 8.8 for the THA cohort (P = .052)., Conclusions: Our results show that hip arthroscopy, when performed in patients with the appropriate indications, can lead to comparably excellent outcomes as total hip arthroplasty with significant pain relief at short term follow-up., Level of Evidence: Level III, retrospective cohort study., (© 2022 The Authors.)

Purpose: To report and compare, according to sex and age, minimum 2-and minimum 5-year patient-reported outcome scores (PROs) and survivorship in a large cohort of patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS)., Methods: Data from February 2008 to September 2018 were reviewed. Patients aged 60 and younger who underwent primary hip arthroscopy with minimum 2-year follow-up were included. Exclusion criteria were Tönnis grade >1, hip dysplasia, previous hip conditions, or any labral treatment different than repair. Minimum 5-year PROs were also collected. All patients included were divided into groups by sex. For further analysis, males and females were stratified according to age: < 21 years old, 21-30 years old, 31-40 years old, 41-50 years old, and 51-60 years old., Results: In total, 1,326 hips had minimum 2-year follow-up, including 860 (64.9%) females and 466 males (35.1%), with a mean age of 31.6 years (range, 12.8-60.9 years) and a mean follow-up of 58.7 ± 28.9 months. Of those, 772 had minimum 5-year follow-up, 515 females (66.7%), and 257 males (33.3%) with a mean age of 31.7 years (range, 13.1-60.7 years) and a mean follow-up of 78.5 ± 23.0 months. All patients showed significant improvements in PROs at minimum 2-and 5-year follow-up (P < .001). Between sex analysis revealed comparable PROs at latest follow-up between females and males across any age group. Within sexes, and when sexes were combined, patients <21 years old had significantly better outcomes compared to other age groups. There were more females <21 years old that required revision arthroscopy than males <21 years old (P = .015). Conversion to total hip arthroplasty (THA) showed no significant difference between sexes (P > .05). Rates of THA were <21 years (.8%), 21-30 years (2.1%), 31-40 years (4%), 41-50 years (8.9%), and 51-60 years (14.3%)., Conclusions: Following primary hip arthroscopy for FAIS, all patients reported significant improvements in all PROs at minimum 2-and minimum 5-year follow-up, with females and males achieving similar success. Age affected outcomes, with patients under 21 years old reporting better scores regardless of sex. Although the conversion rate to THA was similar between the sexes, it was lower in the younger ages groups in both sexes., Level of Evidence: III, retrospective comparative observation trial., (Copyright © 2022 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To systematically review the evaluation, management, and surgical outcomes of arthroscopic subspine decompression in conjunction with other intra-articular hip preservation procedures., Methods: Two databases (PubMed and Embase) were searched from 2010 to 2021, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, for articles investigating arthroscopic subspine decompression using the key words: "subspine impingement", "AIIS impingement", and "extra-articular impingement." Exclusion criteria included diagnostic studies, failure to report postoperative outcomes, and case series of less than 10 hips. Studies were assessed for patient demographics, diagnostic criteria, clinical findings, concomitant procedures, outcomes, and postoperative complications. The quality of the studies was analyzed by 2 independent reviewers (A.J.C. and A.E.J.) using the Methodological Index for Non-randomized Studies (MINORS)., Results: Ten studies consisting of 438 patients (460 hips, 48.6% female) met the inclusion criteria, with average ages and follow-up ranging from 24.9 to 34.7 years and 6.0 to 44.4 months, respectively. There was 1 Level II study, 3 Level III studies, and 6 Level IV studies. The MINORS criteria yielded an average quality assessment of 13.0 (range: 7-22), with 3 methodological domains demonstrating mean scores of less than 1: unbiased assessment of the study endpoint (.25), loss of follow up less than 5% (.25), and prospective calculation of the study size (.7). The most common exam maneuver used was the subspine impingement test (9 studies). Most subspine decompressions were performed in addition to traditional femoroacetabular impingement syndrome (FAIS) procedures, with only one study (33 hips) reporting solely on isolated subspine osteoplasty. Average preoperative and postoperative modified Harris Hip Score (mHHS) values ranged from 44.93 to 75.7 and 79.5 to 98.0, respectively. Three studies noted improved hip flexion in the postoperative period. Five surgical complications were reported., Conclusions: Arthroscopic subspine decompression is commonly reported in a heterogenous patient population with intra-articular hip pathology. A combination of the subspine impingement test and anterior inferior iliac spine (AIIS) morphology on imaging is frequently used for diagnosis. While improved patient-reported outcomes (PROs) are consistently observed following arthroscopic decompression, conclusions are limited by study methodology and concurrent procedures performed at the time of surgery., Level of Evidence: IV, systematic review of Level II through Level IV studies., (Copyright © 2022 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare a minimum of two-year follow-up patient-reported outcome scores (PROs) in patients who underwent revision hip arthroscopy for acetabular circumferential labral reconstruction (CLR) and segmental labral reconstruction (SLR) using propensity-matched groups, in the setting of irreparable labral tear., Methods: Prospectively collected data were retrospectively reviewed for patients who underwent revision hip arthroscopy from April 2010 to September 2018. Patients were included if they underwent labral reconstruction and had preoperative and minimum 2-year PROs. Patients unwilling to participate, with Tönnis grade >1, or hip dysplasia were excluded. Patients in the CLR group were propensity-matched on the basis of age, sex, body mass index, and Tönnis grade to patients in the SLR group in a 1:1 ratio. The minimal clinically important difference (MCID) and the patient-acceptable symptomatic state (PASS) rates were calculated., Results: Twenty-six hips (25 patients) with CLR were propensity-matched to 26 hips (26 patients) with SRL. The mean follow-up time 25.92 and 27.78 months for the CLR and SLR, respectively (P = .845). Groups reported comparable findings for sex (P = .773), age (P = .197), body mass index (P = .124), preoperative Tönnis grade (P = .124), lateral-center edge angle (P = .144), and alpha angle (P = .264), and comparable improvement for all PROs at minimum 2-year follow-up. Patient satisfaction was similar (P = .612). Rates of achievement for the MCID and PASS were comparable., Conclusion: Following revision hip arthroscopy, patients who underwent CLR or SLR for complete and segmental irreparable labral tears, respectively, reported significant and comparable postoperative improvement for all PROs and rate of achievement for the MCID and PASS at a minimum 2-year follow-up., Level of Evidence: III, retrospective comparative therapeutic trial., (Copyright © 2022 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of the study was to analyze demographic, radiographic, and intraoperative factors that influence the time to achieve the minimal clinically important difference (MCID) and maximum outcome improvement satisfaction threshold (MOIT) after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear., Methods: Included patients had undergone hip arthroscopy with labral repair or reconstruction for FAIS with labral tear between February 2008 and October 2018. Patients were excluded if they had a prior ipsilateral hip surgery, prior hip conditions, a Tonnis grade > 1, or were unwilling to participate. Multiple demographic, radiographic, and intraoperative variables were collected. The modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) were collected before surgery and at 3 months, 1 year, and 2 years after surgery. The MCID and MOIT for the mHHS and NAHS were either calculated or determined through previously published values. A time-to-event analysis was performed to determine variables predictive of early or delayed achievement of MCID or MOIT. Early achievement was defined as achieving MCID or MOIT at the 3-month timepoint., Results: Six hundred thirty-two hips (632 patients) were included. Of those that achieved MCID and MOIT, 428 (73.0%) and 414 (73.0%) patients achieved MCID and 253 (47.9%) and 264 (52.5%) patients achieved MOIT by 3 months after surgery for mHHS and NAHS, respectively. Younger age, capsular repair, and increasing alpha angle were associated with earlier achievement for either MCID or MOIT. Increasing age, worker's compensation claims, and higher baseline patient-reported outcome measure scores were associated with delayed achievement for either MCID or MOIT., Conclusions: Most of the patients who achieved MCID and MOIT for mHHS and NAHS did so by 3 months after surgery. Younger age, capsular repair, and increasing alpha angle were associated with earlier achievement of MCID and MOIT after hip arthroscopy., Level of Evidence: Level IV, case series., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Master athletes (MAs), or athletes older than 40 years, make up a patient population whose outcomes after primary arthroscopic hip surgery are largely unknown., Purpose: To report minimum 2-year outcomes of MAs after primary hip arthroscopy and compare their results to a propensity-matched nonathlete (NA) control group., Study Design: Cohort study; Level of evidence, 3., Methods: Data were prospectively collected between February 2008 and April 2019 and retrospectively reviewed for all patients who underwent primary hip arthroscopy. Patients were included if they were older than 40 years and had preoperative data for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale score for pain. MAs reported participating in organized sports competition within 1 year before surgery and were propensity matched to a control group of patients who did not report participating in organized sports competition (NAs). Patient characteristics, radiographic and intraoperative findings, surgical procedures performed, and patient-reported outcome measures (PROMs) were reported and compared between the groups. The rates of achieving the minimal clinically important difference and maximum outcome improvement satisfaction threshold were recorded., Results: A total of 366 hips were eligible; 328 (89.6%) had adequate follow-up data. 328 patients met inclusion criteria but 88 were not included due to the restrictions of the propensity score match ratio. Of these, 80 hips (76 patients) were classified as MAs (mean age, 48.9 ± 6.2 years) and were propensity matched 1:2 to an NA control group. Groups were comparable for baseline demographic and radiographic parameters, intraoperative findings, and procedures performed. MAs had significantly better baseline and minimum 2-year PROM scores ( P < .05), higher satisfaction ( P = .01), and higher rates of achieving clinically meaningful improvement across all the outcome tools used ( P < .05). MAs, when compared with NAs, had lower rates of secondary arthroscopy (0% vs 7.5%, respectively; P = .001) and conversion to total hip arthroplasty (12.5% vs 26.9%, respectively; P = .011)., Conclusion: MAs demonstrated favorable outcomes after primary hip arthroscopy. When compared with a propensity score-matched control group of NA patients, MAs demonstrated better preoperative and postoperative PROMs, higher rates of clinically meaningful improvement, and lower rates of secondary arthroscopy and conversion to total hip arthroplasty. Absolute improvements in PROM scores were similar between the groups.

Background: The body of literature comparing hip arthroscopy between athletes and nonathletes is relatively scarce. Analyzing these groups can help to shed light on the severity of intra-articular damage and end-stage osteoarthritis that may result from participation in strenuous activities., Purpose: (1) To compare the intra-articular damage at the time of hip arthroscopy between athletes and nonathletes, and (2) to compare the pre- and postoperative outcomes between the groups., Study Design: Cohort study; Level of evidence, 3., Methods: Patients were considered eligible for analysis if they had received a primary hip arthroscopy between August 2008 and June 2018, were participating in competitive athletics, and had preoperative baseline scores and minimum 2-year follow-up for the following patient-reported outcomes: modified Harris Hip Score, Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale, and visual analog scale. Propensity score matching was used to match eligible patients in a 1:1 ratio to patients who were not participating in any sports greater than a recreational level before surgery., Results: A total of 234 patients were included. There were no significant differences in the severity of labral tears, ligamentum teres tears, or cartilage damage ( P > .05). The procedures performed between cohorts were similar ( P > .05). The athlete population had higher preoperative means scores for the modified Harris Hip Score and NAHS (each P < .001). Likewise, the athlete population had higher postoperative means scores for the NAHS, Hip Outcome Score-Sports Specific Subscale, and visual analog scale ( P = .031, P = .030, and P = .032, respectively). Additionally, the athlete cohort reported higher minimum 2-year outcomes than the nonathlete cohort for the 12-Item Short Form Health Survey (mental component; P = .003) and Veterans RAND 12-Item Health Survey (mental component, P = .032; physical component, P = .005)., Conclusion: At the time of hip arthroscopy, athletes demonstrate similar intra-articular damage to their nonathlete counterparts. Given their higher preoperative scores, it is possible that athletes better tolerate the damage to the hip joint. Despite their strenuous activities and potentially higher tolerance to pain, athletes should not necessarily be expected to have greater severity of intra-articular pathology.

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

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

Background: Personalized medicine models to predict outcomes of orthopaedic surgery are scarce. Many have required data that are only available postoperatively, mitigating their usefulness in preoperative decision making., Purpose: To establish a method for predictive modeling to enable individualized prognostication and shared decision making based on preoperative patient factors using data from a prospective hip preservation registry., Study Design: Cohort study (Prognosis); Level of evidence, 2., Methods: Preoperative data of 2415 patients undergoing hip arthroscopy for femoroacetabular impingement syndrome between February 2008 and November 2017 were retrospectively analyzed. Two machine-learning analyses were evaluated: Tree-structured survival analysis (TSSA) and Cox proportional hazards modeling for predicting time to event and for computing hazard ratios for survivorship after hip arthroscopy. The Fine-Gray model was similarly used for repeat hip arthroscopy. Variables were selected for inclusion using the minimum Akaike Information Criterion (AIC). The stepwise selection was used for the Cox and Fine-Gray models. A web-based calculator was created based on the final models., Results: Prognostic models were successfully created using Cox proportional hazards modeling and Fine-Gray models for survivorship and repeat hip arthroscopy, respectively. The Harrell C-statistics of the Cox model calculators for survivorship after hip arthroscopy and the Fine-Gray model for repeat hip arthroscopy were 0.848 and 0.662, respectively. Using the AIC, 13 preoperative variables were identified as predictors of survivorship, and 6 variables were identified as predictors for repeat hip arthroscopy. In contrast, the TSSA model performed poorly, resulting in a Harrell C-statistic <0.6, rendering it inaccurate and not interpretable. A web-based calculator was created based on these models., Conclusion: This study successfully created an institution-specific machine learning-based prognostic model for predictive analytics in patients undergoing hip arthroscopy. Prognostic models to predict survivorship and the need for repeat surgeries were both adapted into web-based tools to assist the physician with shared decision making. This prognostic model may be useful at other institutions after performing external validation. Additionally, this study may serve as proof of concept for a methodology for the development of patient-specific prognostic models. This methodology may be used to create other predictive analytics models in different realms of orthopaedic surgery, contributing to the evolution from evidence-based medicine to personalized medicine.

Purpose: To report minimum 2-year patient-reported outcome measures (PROMs) following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and painful external snapping hip (ESH) treatment and ESH resolution, and to compare these PROMs to a benchmark FAIS propensity-matched control group without ESH., Methods: Data were prospectively collected and retrospectively reviewed between November 2009 and April 2018. Patients were eligible if they were preoperatively diagnosed with FAIS and painful ESH and received primary hip arthroscopy to address these pathologies. ESH was treated with gluteus maximus and iliotibial band releases. Inclusion criteria were baseline and minimum two-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. Exclusion criteria were Tönnis grade >1 and previous hip conditions. A secondary subanalysis was performed to benchmark these outcomes to a FAIS propensity-matched control group without ESH, according to age, sex, body mass index (BMI), Tönnis grade, and preoperative lateral center-edge and α-angles using a 1:3 ratio. The minimal clinically important difference (MCID) and the maximum outcome improvement (MOI) rates were reported., Results: Twenty-two hips (21 patients) were included. The mean age, BMI, and follow-up were 31.3 years ± 14.0, 26 kg/m 2 ± 5.0, and 31.4 months ± 4.4, respectively, with 68.2% being female. ESH was resolved in 100% of patients. Significant improvement for all PROMs at a minimum two-year (P < .001) was reported. The minimum two-year PROMs and the rate of achieving the MCID and MOI threshold were comparable to the control group., Conclusion: Following primary hip arthroscopy for FAIS and painful ESH, patients demonstrated significant improvement in all PROMs, and the rate of resolution of ESH was 100% at minimum two-year follow-up: with gluteus maximus and iliotibial band releases. Functional outcomes and rates of MCID and MOI achievement were comparable to a FAIS propensity-matched benchmark control group without ESH., Level of Evidence: Level III, retrospective comparative study., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Comparable short-term outcomes have been obtained using hamstring allografts versus autografts after primary segmental labral reconstruction (SLR). Midterm results have not yet been determined., Purpose: (1) To evaluate minimum 5-year patient-reported outcome (PRO) scores in patients who underwent primary SLR with hamstring grafts in the setting of femoroacetabular impingement syndrome (FAIS) and irreparable labral tears and (2) to compare the outcomes of hamstring autografts versus allografts in a subanalysis using propensity-matched groups., Study Design: Cohort study; Level of evidence, 3., Methods: Prospectively collected data were retrospectively reviewed for patients who underwent primary hip arthroscopy between September 2010 and November 2015. Patients were included if they underwent SLR using hamstring autografts or allografts and had preoperative and minimum 5-year PROs. The exclusion criteria were previous ipsilateral hip surgery or conditions, dysplasia, or Tönnis grade >1. Patients with autograft SLR were propensity matched 1 to 1 based on age, sex, and body mass index (BMI) to patients who underwent SLR using hamstring allografts. The minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) were calculated., Results: Overall, 48 patients (N = hips 48) were eligible to be included in this study, and 41 patients (n = 41 hips [85.4%]) had a minimum 5-year follow-up reporting significant improvements in all PROs. Within the entire cohort, 9.8% required a secondary arthroscopy, with a mean time of 19 ± 1.8 months, and survivorship was 82.9%. Of the 41 included patients, 15 underwent an SLR with a hamstring autograft and were matched to 15 patients with labral reconstruction using a hamstring allograft. Groups were similar for sex ( P > .999), age ( P = .775), and BMI ( P = .486). The mean follow-up times were 80.8 ± 25.5 and 66.1 ± 8.3 months ( P = .223) for the autograft and allograft groups, respectively. Baseline PROs, preoperative radiographic measurements, surgical findings, and intraoperative procedures were similar. The groups achieved significant and comparable improvements for all PROs ( P < .0001), satisfaction ( P = .187), and the rate of achieving the MCID and the PASS. However, a tendency for higher postoperative PROs favoring allograft reconstruction was found., Conclusion: At a minimum 5-year follow-up, patients who underwent primary arthroscopic SLR in the context of FAIS and irreparable labra, with either autograft or allograft hamstring tendons, reported significant improvements and comparable postoperative scores for all PROs, patient satisfaction, MCID, and PASS.

Purpose: 1) To report minimum 2- and 5-year outcomes of high-level athletes who did not return to sport (RTS) after hip arthroscopy for reasons unrelated to their hip (T athletes) and 2) to benchmark these findings against a propensity-matched control group of high-level athletes who returned to sport (RTS athletes)., Methods: Data were prospectively collected and retrospectively reviewed for professional, collegiate, and high school athletes between April 2008 and October 2015, who underwent primary hip arthroscopy. Athletes were considered eligible if they did not return to sport for reasons unrelated to their hip such as loss of interest, graduation, or a lifestyle transition (T athletes). Inclusion criteria were preoperative and minimum 5-year postoperative patient-reported outcomes (PROs) for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and the visual analog scale (VAS) for pain. Clinical outcomes were assessed using the minimal clinically important difference (MCID) and maximum outcome improvement satisfaction threshold (MOIST). T athletes were then propensity-matched to a control group of high-level athletes who returned to sport after hip arthroscopy (RTS athletes) for comparison., Results: Twenty-seven T hips (25 patients) were included in the analysis with a mean follow-up time of 38.9 ± 16.8 and 72.1 ± 16.8 months for minimum 2- and 5-year outcomes, respectively. They demonstrated significant improvement in all measured PROs. When compared to a propensity-matched control group of RTS athletes, T athletes demonstrated similar improvement in PROs (mHHS, NAHS, and HOS-SSS) and achieved MCID at similar rates for NAHS (T: 77.8% vs RTS: 68.8%; P = .570) and HOS-SSS (T: 70.3% vs RTS: 76.6%, P = .824) compared to RTS athletes; however T athletes demonstrated higher rates of achieving MCID for mHHS (T: 88.9% vs RTS: 72.9% P = .033)., Conclusion: Athletes who did not return to sport for reasons unrelated to their hip demonstrated favorable outcomes at minimum 2- and 5-year follow-up. They had similar PROs and rates of achieving MCID for HOS-SSS compared to a propensity-matched control group of high-level athletes who returned to sport. Return to sport status may not necessarily be correlated to the patient's perception of their own outcome., Level of Evidence: III, retrospective cohort study., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Numerous studies have analyzed techniques for producing reliable and efficient arthroscopic knots. All aspects have been explored, from the biomechanics and strength to the ability to teach and replicate at all levels of training. This technique article describes an additional maneuver (X-grab) for efficiently marking the post side of the arthroscopic knot without having to do this separately outside of the joint. This is most useful for procedures such as rotator cuff repair and capsular repair or plication in hip arthroscopy in which the location of the knot (i.e., the post) is critical. The aim of this Technical Note is to describe the X-grab maneuver, which shortens this process to a single step, limiting the see-sawing of sutures and over-instrumentation of the joint seen with other techniques., (© 2022 The Authors.)

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

Background: 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.

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.

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.

Purpose: To determine the percent maximal outcome improvement willingness thresholds (MOWTs) for the Nonarthritic Hip Score (NAHS) and the visual analog scale (VAS) for pain that were associated with a patient's willingness to undergo surgery, in retrospect, given the known outcome of their primary hip arthroscopy with concomitant endoscopy for gluteus medius (GM) tear repair., Methods: An anchor question was provided to patients who underwent primary hip arthroscopy for femoroacetabular impingement syndrome with concomitant endoscopic GM tear repair between April 2008 to April 2020. Patients were included if they answered the anchor question and had baseline and postoperative minimum 1-year follow-up scores for the NAHS and VAS. Patients were excluded if they had a previous ipsilateral hip surgery, Tönnis grade >1, hip dysplasia, previous hip conditions, or a preoperative score that was already at the maximum value for the NAHS and VAS scores. Receiver operating characteristic (ROC) analysis was used to determine the MOWT. Significance was indicated by a P value <.05., Results: A total of 107 patients (107 hips) were included, with 101 (94.4%) females and 6 (5.6%) males. The average age and body mass index was 56.20 ± 9.88 years and 28.80 ± 4.92 kg/m 2 , respectively. The average follow-up time was 54.89 ± 29.52 months. The ROC analysis determined that the MOWT for the mHHS and VAS were 54.7%, and 62.6%, respectively. The probability of a patient being willing to undergo surgery again if they met the MOWT was 85.8% and 85.6% for the NAHS and VAS, respectively., Conclusion: The MOWTs that were predictive of willingness to undergo surgery again following primary hip arthroscopy with concomitant endoscopy for GM tear repair were 54.7% and 62.6% for the NAHS, and VAS, respectively., Clinical Relevance: Outcome assessment has been a point of increasing emphasis in hip preservation surgery. Having a tool to measure whether patients would go through the process of surgery again knowing their current outcome status is important to understanding outcomes after surgery., (© 2022 The Authors.)

Purpose: To identify radiographic measurements and demographics that are predictive of acetabular cartilage damage in patients with femoroacetabular impingement syndrome (FAIS) undergoing hip arthroscopy. More specifically, to compare the predictive value of alpha angle and femoral head-neck offset, as measured on Dunn view radiographs, in determining the preoperative likelihood and severity of acetabular cartilage damage., Methods: Patients were included if they underwent primary hip arthroscopy for FAIS between February 2008 and June 2020. Exclusion criteria were prior ipsilateral hip conditions, Tönnis grade of osteoarthritis >1, unwilling to participate, missing intraoperative, demographic or radiographic variables of interest, and lateral center-edge angle (LCEA) >40° or ≤25°. Fourteen variables were assessed in a bivariate comparison and analyzed in a multivariate logistic model. The Acetabular Labrum Articular Disruption (ALAD) and Outerbridge (OB) classifications were used to define acetabular cartilage defects. Those without damage or those with mild acetabular cartilage damage belonged to the ALAD/OB ≤2 group and those with severe damage belonged to the ALAD/OB ≥ 3 group., Results: A total of 1485 patients were analyzed, including 1038 patients with ALAD/OB ≤2 and 447 patients with ALAD/OB ≥3. There was a greater proportion of males in the ALAD/OB ≥3 group (64.21% vs 25.82%; P <.001). The multivariate logistic regression selected age, sex, anterior center-edge angle (ACEA), and alpha angle. Every additional degree in the alpha angle was associated with a 6% increase in the odds of severe acetabular cartilage damage (odds ratio [OR], 1.06 [95% confidence interval [CI], 0.12-8.11]). The multivariate analysis did not identify femoral head-neck offset as a predictor. The odds of severe acetabular cartilage damage were 3.73 times higher in males than females (OR, 3.73 [95% CI, 0.01-1705.96]). Higher age was found to increase the likelihood of ALAD/OB ≥3 (OR, 1.04 [95% CI, 0.13-7.75])., Conclusions: In a multivariate analysis, factors identified as preoperative predictors of acetabular cartilage damage in patients with FAIS were age, sex, ACEA, and alpha angle. Femoral head-neck offset was not predictive, suggesting that Dunn view alpha angle may take precedence as a predictor of acetabular cartilage damage., Level of Evidence: Level III, cohort study., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To identify clinical and radiographic factors that predict return to sport in athletes undergoing hip arthroscopy and to determine thresholds for significant predictors., Methods: Data were reviewed on all patients who underwent primary hip arthroscopy between November 2008 and August 2018. Patients were included if they played professional, college, or high school sports within 1 year before surgery and had preoperative, 3-month, 1-year, and 2-year postoperative patient-reported outcome scores for modified Harris Hip Score, Hip Outcome Score-Sport Specific-Subscale, and Nonarthritic Hip Score. Rates of achieving the minimal clinically important difference also were evaluated. Patients were divided into groups based on whether they returned to sport at the same or greater level. Multivariate logistic regression and receiver operator characteristic analysis were used to evaluate the correlation between significant variables and return to sport., Results: A total of 136 patients with a mean age of 20.8 ± 7.07 years were included. Among athletes who attempted to return, professional and collegiate athletes returned to sport at any level at a rate of 85.0% (51/60), and high-school athletes returned at a rate of 88.1% (52/59). Competition level, postoperative alpha angle, change in alpha angle, and postoperative patient-reported outcomes were significantly different between groups. Athletes who returned to sport achieved the minimal clinically important difference for Hip Outcome Score-Sport Specific-Subscale at significantly higher rates than athletes who did not return to sport (91.6% vs 71.7%, P = .002, S = 8.97). The multivariate logistic regression model identified postoperative alpha angle as a statistically significant predictor of return to sport (P < .001, S > 9.97 [odds ratio 0.85, 95% confidence interval 0.79-0.91]). The receiver operator characteristic curve for postoperative alpha angle demonstrated acceptable discrimination between patients returning to sport and patients not returning to sport with an area under the curve of 0.71 and a threshold value of 46°. Athletes with a postoperative alpha angle ≤46° returned to sport at significantly higher rates than those with a postoperative alpha angle >46° [(P < .001, S > 9.97 [odds ratio 6.3, 95% confidence interval 2.6-15.2])., Conclusions: Postoperative alpha angle was identified as a predictor of return to sport in athletes. The odds of returning to sport were 6.3 times greater in athletes with postoperative alpha angles ≤46° compared with athletes with angles >46°., Level of Evidence: III, retrospective cohort study., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: The workers' compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures and is usually excluded from clinical outcome studies. Therefore, comparative studies based on WC status are scarce., Purpose: (1) To determine outcomes of patients with WC claims treated with hip arthroscopy for labral tears at a minimum 5-year follow-up and (2) to compare these findings with a propensity score-matched control group without WC claims., Study Design: Cohort study; Level of evidence, 3., Methods: Patients were propensity score matched to a control group without WC claims. Data were prospectively collected for all patients undergoing hip arthroscopy. Patients were included if they received primary hip arthroscopy for labral tears in the setting of femoroacetabular impingement, had a WC claim, and had preoperative and minimum 5-year follow-up patient-reported outcomes ([PROs]; 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). Clinical outcomes were measured using the Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and maximum outcome improvement satisfaction threshold (MOI)., Results: A total of 111 from 132 (84.1%) eligible WC patients met the inclusion criteria with an average follow-up time of 80.3 ± 37.3 months. WC cases demonstrated significant improvement from preoperatively to a minimum 5-year follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain ( P < .05). WC patients returned to work at a 66% rate, with an average clearance time of 4.7 months to light duty and 9.5 months to heavy duty. When compared with the control group, the WC group demonstrated lower pre- and postoperative PROs ( P < .05); however, WC cases had a greater magnitude of improvement (ΔmHHS [ P = .0012], ΔNAHS [ P < .001], and ΔHOS-SSS [ P = .012]). Rates of achieving MCID and MOI were similar in both groups ( P > .05). The WC group went on to receive a future arthroscopy in 19 cases (17.1%), while 10 cases (4.5%) in the control group required revision arthroscopy ( P < .001). Patients in both the WC and the control groups converted to total hip arthroplasty at similar rates (13.3% and 15.4%, respectively; P > .05)., Conclusion: Patients with WC claims treated with hip arthroscopic surgery showed significant improvement and high rates of returning to work at a minimum 5-year follow-up. Although having lower scores in PROs and achieving PASS rates, no differences were found in MCID and MOI rates. Furthermore, WC patients had a greater magnitude of improvement from preoperatively to a minimum 5-year follow-up after hip arthroscopy. Therefore, even though more studies are needed to determine the causes of inconsistent outcomes in the WC population, hip arthroscopy can effectively treat labral tears in the setting of femoroacetabular impingement, regardless of the WC status.

Purpose: To evaluate the influence of baseline psychological distress on patient-reported outcomes (PROs) after arthroscopic hip surgery for femoroacetabular impingement at a minimum of 5 years., Methods: Demographic and intraoperative data were prospectively collected from patients who underwent primary arthroscopic hip surgery for femoroacetabular impingement and labral tears after failure of conservative management between June 2012 and December 2014. Included patients had preoperative and minimum 5-year postoperative PROs and visual analog scale scores for pain and satisfaction. The 12-item Short Form Health Survey (SF-12) Mental Component Summary (MCS) score was used to stratify patients into 2 cohorts: Patients with an average or above-average score (SF-12 MCS score ≥ 50) were considered psychologically non-distressed, whereas those who scored below average (SF-12 MCS score < 50) were considered to have psychological distress. Distressed patients were propensity matched by age, sex, and body mass index to an equal number of non-distressed patients., Results: Of the 153 hips that met the inclusion criteria, 117 (76.5%) had minimum 5-year follow-up. Eighty-two hips were included in the final analysis after propensity matching, with 41 in both the distressed and non-distressed cohorts. Preoperatively, patients in the distressed cohort reported inferior scores for all PROs. There was a significant difference in the SF-12 MCS score between groups at 2 years, but similar scores were observed for all other PROs. At minimum 5-year follow-up, there were no differences between groups for any PRO. There were no differences in the rates of achieving the minimal clinically important difference for all PROs or in achieving the patient acceptable symptomatic state for the modified Harris Hip Score., Conclusions: Patients with baseline psychological distress may have a lower functional status at the time of presentation but still gain meaningful clinical benefit and pain improvement from arthroscopic hip surgery, with mid-term outcomes comparable to those obtained by patients without preoperative psychological distress., Level of Evidence: Level III, retrospective comparative study., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to evaluate the total traction time and traction time as a function of anchors placed (TTAP) for primary labral repair in patients undergoing hip arthroscopy by a single surgeon., Methods: Patients were included if they received a primary labral repair with or without acetabuloplasty, chondroplasty, or ligamentum teres debridement as part of the treatment for femoroacetabular impingement (FAI). Patients were excluded if they had a previous ipsilateral hip surgery, prior hip conditions, Tönnis grade >1, open procedures, microfracture, ligamentum teres reconstruction, or labral reconstruction. TTAP was calculated by dividing total traction time by the number of anchors placed., Results: 2,350 hips met the inclusion criteria. The mean age and BMI in this cohort were 34.22 years and 25.72 kg/m 2 , respectively. A total traction time of 60 minutes was first achieved after 268 cases. Mean overall total traction time was 58.16 minutes (95% CI [57.35, 58.97]) and mean TTAP was 16.24 minutes (95% CI [15.93,16.55]) after 2,350 cases. Total traction time plateaued after 374 cases at 55.92 minutes, while TTAP plateaued after 487 cases at 14.93 minutes., Conclusion: Surgeons who introduce hip arthroscopy into their practice can expect to see improvements in traction time during the first 500 surgeries performed, as total traction time plateaued after 374 cases and TTAP plateaued after 487 cases., Level of Evidence: IV: case series., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Predictors of outcomes in adolescent athletes undergoing hip arthroscopy have not been established. The purpose of this study was to identify factors correlated with achieving the Patient Acceptable Symptomatic State (PASS) for the Hip Outcome Score-Sports Specific Subscale (HOS-SSS) at a minimum 5-year follow-up in adolescent athletes undergoing primary hip arthroscopy., Methods: Data were reviewed on adolescent (below 18 y old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between March 2008 and October 2015. Patients were included if they participated in sport within 1 year before surgery and had preoperative, 2-year, and minimum 5-year postoperative patient-reported outcome (PRO) scores for the modified Harris Hip Score, HOS-SSS, Visual Analog Scale for pain (VAS), and Non-Arthritic Hip Score (NAHS). Patients were divided into 2 groups based on whether they achieved PASS for HOS-SSS. Demographics, intraoperative findings, radiographic variables, surgical treatments, and PRO were compared. Multivariate logistic regression with corresponding odds ratios (ORs) quantified the correlation between variables and achievement of the PASS., Results: A total of 123 athletes with a mean age of 16.2±1.1 years were included. These athletes demonstrated significant imrpovement from preoperative to minimum 5-year follow-up for all recorded PROs (P<0.001). The multivariate logistic regression model identified preoperative NAHS (P=0.019, OR: 1.033), 2-year postoperative HOS-SSS (P=0.014, OR: 1.037), and 2-year postoperative VAS (P=0.003, OR: 0.590) as statistically significantly correlated with achieving the PASS. Athletes with a 2-year postoperative VAS pain score ≤2 achieved PASS at a rate of 81.9%, while those with a score >2 achieved PASS at a rate of 24.1% (P<0.001, OR: 14.2, 95% confidence interval: 5.23-38.7)., Conclusions: Favorable outcome were achieved at mid-term follow-up in adolescent athletes undergoing primary hip arthroscopy. Preoperative NAHS, 2-year postoperative HOS-SSS, and 2-year postoperative VAS pain scores were correlated with achieving the PASS for HOS-SSS at a minimum 5-year follow-up. Patients with 2-year postoperative VAS ≤2 were significantly more likely to achieve the PASS at 5-year follow-up than those with scores >2., Level of Evidence: Level III-case-control study., Competing Interests: B.G.D. reports grants and other from American Orthopedic Foundation, during the conduct of the study; personal fees from Adventist Hinsdale Hospital; personal fees and nonfinancial support from Amplitude; grants, personal fees, and nonfinancial support from Arthrex; personal fees and nonfinancial support from DJO Global; grants from Kaufman Foundation; grants, personal fees, nonfinancial support from Medacta; grants, personal fees, nonfinancial support, and other from Pacira Pharmaceuticals; grants, personal fees, nonfinancial support, and other from Stryker; grants from Breg; personal fees from Orthomerica; grants, personal fees, nonfinancial support, and other from Mako Surgical Corp.; grants and nonfinancial support from Medwest Associates; grants from ATI Physical Therapy; grants, personal fees, and nonfinancial support from St. Alexius Medical Center; grants from Ossur, outside the submitted work. In addition, He has a patent 8920497—Method and instrumentation for acetabular labrum reconstruction with royalties paid to Arthrex; a patent 8708941—Adjustable multicomponent hip orthosis with royalties paid to Orthomerica and DJO Global; and a patent 9737292—Knotless suture anchors and methods of tissue repair with royalties paid to Arthrex. B.G.D. is the Medical Director of Hip Preservation at St. Alexius Medical Center; the Clinical Instructor at the University of Illinois College of Medicine; a board member for the American Hip Institute Research Foundation, AANA Learning Center Committee, the Journal of Hip Preservation Surgery, the Journal of Arthroscopy; has had ownership interests in the American Hip Institute, Hinsdale Orthopedic Associates, Hinsdale Orthopedic Imaging, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. A.C.L. reports grants, personal fees, and nonfinancial support from Arthrex; nonfinancial support from Iroko; nonfinancial support from Medwest; nonfinancial support from Smith & Nephew; grants and nonfinancial support from Stryker; nonfinancial support from Vericel; nonfinancial support from Zimmer Biomet; personal fees from Graymont Medical, outside the submitted work. He is the Co-Medical Director of Hip Preservation at St. Alexius Medical Center; the Clinical Instructor at the University of Illinois College of Medicine; and member of the AANA Learning Center Committee. B.R.S. reports grants from Arthrex; personal fees from DJO Global, outside the submitted work. D.R.M. reports nonfinancial support from Arthrex; nonfinancial support from Stryker; nonfinancial support from Smith & Nephew; nonfinancial support from Ossur, outside the submitted work. He is an editorial board member of the Journal of Arthroscopy. The remaining authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Athletes who compete in flexibility sports (FS) place unique demands on their hip joints because of the supraphysiologic range of motion required., Purpose: To compare the pathologic features, outcomes, and return-to-sports (RTS) rates of high-level athletes participating in FS who underwent hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and labral tear against a propensity score-matched cohort of high-level athletes participating in non-flexibility sports (NFS)., Study Design: Cohort study; Level of evidence, 3., Methods: Data were prospectively collected and retrospectively reviewed for high-level athletes who underwent primary hip arthroscopy for FAIS from April 2008 to December 2018. Patients who participated in FS such as dancing, gymnastics, martial arts, figure skating, and cheerleading were propensity score matched by body mass index, age at time of surgery, sex, sports competition level, and labral treatment to a cohort of high-level athletes participating in all other sports, such as distance running, soccer, volleyball, and softball. Baseline patient characteristics, intraoperative findings, and surgical procedures were compared. Minimum 2-year patient-reported outcome measures were compared for the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sport Specific Subscale, and visual analog scale for pain and satisfaction. Rates of secondary surgery and RTS were compared., Results: A total of 47 patients (50 hips) who participated in FS were included and propensity score matched to 130 patients (150 hips) who participated in NFS. Follow-up time was 37.5 ± 10.4 months (mean ± SD). Most patients (96.0%) were female with a mean age of 19.5 ± 7.3 years. FS athletes had significantly higher rates of femoral head cartilage lesions (Outerbridge ≥2; 12.0% vs 2.0%; P = .008) and ligamentum teres tears (48% vs 26%; P = .003). FS and NFS athletes demonstrated significant clinical improvements after surgery for all patient-reported outcome measures. Of the patients who attempted, 34 (75.6%) participating in FS were able to RTS while 11 (24.4%) were not because of ongoing hip issues. This was not significantly different than the NFS group ( P = .073)., Conclusion: High-level athletes who participated in FS and were treated for FAIS with hip arthroscopy exhibited higher rates of femoral head cartilage lesions and ligamentum teres tears requiring debridement when compared with a benchmark group of athletes who participated in other sports. Despite this, both groups demonstrated similar improvements in outcome scores and comparable rates of RTS at minimum 2-year follow-up.

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

Purpose: The aims of this study were to confirm the relationship between osseous coverage and labral size and to investigate the severity of intra-articular damage in borderline dysplastic hips in correlation to labral size., Methods: Patients treated with primary hip arthroscopy for symptomatic labral tears between 2010 and 2018 were considered for this study. Patients were included if they had preoperative radiographic measures and intraoperative assessments of the labra and cartilage. The study group was divided into borderline dysplastic and nondysplastic groups via 3 measurements: lateral center edge angle (LCEA), acetabular index (Ax), and anterior center edge angle (ACEA). Undercoverage was defined as LCEA ≤ 25°, Ax ≥ 10°, and ACEA ≤ 20°. The labrum was measured in four quadrants: anterosuperior (AS), anteroinferior (AI), posterosuperior (PS), and posteroinferior (PI). Additionally, to assess cartilage damage in borderline dysplastic hips, hips with average labral size in the top quartile were compared to hips with average labral size in the bottom quartile., Results: A total of 1765 hips (1589 patients) were included in the study. The mean LCEA, Ax, and ACEA between the borderline dysplastic and nondysplastic groups were significantly different (P < .001). According to the Ax classification, there was significant evidence that borderline dysplastic hips had larger labra (P < .05). Among the dysplastic group, there was significantly more cartilage damage according to the Outerbridge classifications along both the acetabulum and femoral head in hips with labra in the upper quartile (P =.011 and .005, respectively)., Conclusion: An inverse relationship may exist between acetabular depth and labral size. Additionally, specifically in borderline dysplastic hips, a relatively large labrum correlates with worse intra-articular damage compared to borderline dysplastic hips with a relatively small labrum. Larger labral size may indicate a higher degree of instability in patients with borderline dysplasia., Level of Evidence: Level III, case-control study., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare minimum 2-year follow-up patient-reported outcome scores (PROs) in patients who underwent primary acetabular circumferential and segmental labral reconstruction for irreparable labral tears and femoroacetabular impingement syndrome (FAIS)., Methods: Data were reviewed from August 2010 to December 2017. Patients with primary labral reconstruction and minimum 2-year follow-up 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 were included. Circumferential and segmental reconstruction were selected in each case based on the extent of the labral pathology. Exclusion criteria were previous ipsilateral hip surgery/conditions, dysplasia, or Tönnis grade >1. Patients were propensity matched 1:1 based on age, sex, and body mass index. Secondary surgeries were reported. The P value was set at <.05., Results: In total, 144 hips were eligible, and 17 hips were lost to follow-up, leaving 127 hips (88.2%) for analysis. Eighty hips underwent a segmental reconstruction, and 47 hips underwent a circumferential reconstruction. Forty-seven hips with circumferential reconstruction were matched to 47 hips with segmental reconstruction. The average follow-up and age for the segmental and circumferential groups were 29.0 ± 7.8 and 27.9 ± 7.0 months (P = .732) and 43.1 ± 9.4 and 44.7 ± 10.2 years (P = .442) respectively. The segmental and circumferential groups were 48.9% and 51.1% female, respectively. The groups achieved significant and comparable improvement for all PROs and rates of secondary surgeries. No differences were found for achieving the minimal clinically important difference (MCID) and the patient acceptable symptomatic state (PASS). The MCIDs for the segmental and circumferential groups were 76.7% and 77.8% for the mHHS, 64.9% and 77.8% for the HOS-SSS, 71.1% and 68.9% for the VAS, and 68.9% and 73.9% for the NAHS, respectively. The PASSs for the segmental and circumferential groups were 78.3% and 73.3% for the mHHS, 55.3% and 55.0% for the HOS-SSS, and 75.6% and 71.1% for the International Hip Outcome Tool 12, respectively., Conclusions: At minimum 2-year follow-up, patients who underwent primary hip arthroscopy for either circumferential or segmental labral reconstruction for irreparable labra and FAIS reported significant improvement and similar postoperative scores for all PROs, with no difference in psychometric outcomes and rate of secondary surgeries. A customized approach, using the extent of the irreparable labral tear, seems to be an appropriate strategy., Level of Evidence: Level III, retrospective comparative therapeutic trial., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Labral repair is generally preferred when facing labral tears. When an irreparable labral tear in the context of femoroacetabular impingement syndrome is present, arthroscopic labral reconstruction has been proven to be a valid option for labral restoration. However, data on this procedure for the adolescent population is scarce. The purpose of the present study was to report minimum 2-year follow-up patient-reported outcome measures (PROMs) on adolescents and young adults following arthroscopic acetabular labral reconstruction., Methods: Data were prospectively collected and retrospectively reviewed on adolescents and young adults who underwent hip arthroscopy between March 2009 and June 2018. Inclusion criteria were labral reconstruction, baseline and minimum 2-year follow-up PROMs. Patients were excluded if they were unwilling to participate in the study, had Tönnis grade >1, or dysplasia., Results: Twenty-three hips (22 patients) that underwent labral reconstruction were included. Ten hips (10 patients) underwent primary labral reconstruction, and 13 hips (12 patients) underwent revision reconstruction. The mean age was 19.3 years and 56.5% of patients were males. All patients improved significantly at minimum 2 years for all PROMs (P<0.001) with high satisfaction. Patients in both groups demonstrated improvement for all PROMs, patient satisfaction, and a rate of achieving the minimal clinically important difference., Conclusion: Arthroscopic labral reconstruction in adolescents and young adults demonstrated significant improvement and high patient satisfaction at minimum 2-year follow-up in the setting of irreparable labral tear. Favorable outcomes, high patient satisfaction, and high achievement rate for the minimal clinically important difference were obtained following labral reconstruction in this population the primary and revision scenarios., Level of Evidence: Level IV, case-series., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: There is a paucity of literature evaluating the effect of low body mass index (BMI) in female patients undergoing primary hip arthroscopy., Purpose: (1) To report minimum 2-year patient-reported outcome scores for female patients with low BMI who underwent primary hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare these results with a propensity-matched control group of female patients with normal BMI., Study Design: Cohort study; Level of evidence, 3., Methods: Data were collected on all female patients who had low BMI (<18.5) and underwent primary hip arthroscopy between April 2008 and January 2019. Patients were excluded if they had a previous hip arthroscopy; had workers' compensation; were unwilling to participate in the study; or had Tönnis osteoarthritis grade >1, acetabular dysplasia, or a previous hip condition. Minimum 2-year patient-reported outcomes were collected for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, Hip Outcome Score-Sport Specific Subscale (HOS-SSS), visual analog scale for pain, and satisfaction. The percentage of patients achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) was also recorded. These patients were propensity matched in a 1:2 ratio to female patients with normal BMI for comparison., Results: A total of 43 patients (49 hips) were included with a mean ± SD follow-up of 26.9 ± 8.3 months, age of 24.1 ± 12.6 years, and BMI of 17.7 ± 0.67. These patients demonstrated significant improvement from presurgery to minimum 2-year follow-up for the mHHS, Non-Arthritic Hip Score, HOS-SSS, and visual analog scale ( P < .05). When outcomes were compared with 93 control patients (97 hips), female patients with low BMI demonstrated lower rates of achieving the PASS for the mHHS (61.2% vs 77.3%; P = .041) and HOS-SSS (39.5% vs 57.1%; P = .031). Rates of achieving the MCID and MOIST were similar between the groups ( P > .05). Female patients with low BMI also had higher rates of revision when compared with the control group, but this did not reach statistical significance (14.2% vs 7.2%; P = .171)., Conclusion: Female patients with low BMI undergoing primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes at minimum 2-year follow-up. When compared with a propensity-matched control group with normal BMI, these patients demonstrated lower rates of achieving the PASS for the mHHS and HOS-SSS. Low BMI in females undergoing primary hip arthroscopy for FAIS may adversely affect outcomes at short-term follow-up.

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.