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BACKGROUND: No studies have evaluated the efficacy of hyaluronic acid (HA) in reducing pain caused by osteochondritis dissecans (OCD) of the ankle. We report our initial results with this treatment. MATERIALS AND METHODS: Fifteen subjects aged 18 to 60 treated for OCD of the talus were followed for 26 weeks, in a pre- and post-treatment repeated measurements design, after receiving three weekly injections of intra-articular HA. The efficacy of HA injections in reducing pain and improving function was assessed at each visit and adverse events were recorded. Efficacy was evaluated by comparing scores determined using a Visual Analog Scale for pain, stiffness and function over time with baseline values. In addition, frequency of symptoms and global function over time were assessed using questionnaires and the AOFAS Ankle-Hindfoot Scale. Data analysis was made using ANCOVA models and paired t-tests. All statistical tests were based on an alpha level of 0.05. RESULTS: The majority of subjects were male (60%) and had Grade 3 lesions (60%). Mean VAS scores, reported on a scale from 1 (e.g., no pain) to 10 (e.g., worst pain) decreased for pain (5.6 to 3.2), stiffness (5.1 to 2.9), and function (5.9 to 3.3) from baseline to week 26. Subjective global function scores, reported on a scale from 0 to 100 (with 100 representing healthy, pre-injury function), improved on average from 57.3 at baseline to 74.3 by week 26. All of these results were statistically significant, as was the decrease in frequency of pain reported by subjects at the end of the study. CONCLUSION: OCD of the ankle treated with intra-articular injections of HA caused a decrease in pain scores and increase in global functioning over a short period of time (within 12 weeks) which then lasted for more than 6 months with minimal adverse events. [ABSTRACT FROM AUTHOR]

Abstract Background The stump impingement reflex is a subtle bounce to the knee thought to be caused by hamstring contraction when the knee is brought into extension and the torn ACL stump impinges between the distal femur and the tibial plateau. We have studied the diagnostic value of this sign. Findings From Feb 2008-Feb 2009, we audited 30 patients who underwent urgent arthroscopy for acutely locked knees. The presence of the stump impingement reflex prior to surgery was compared with the intra-operative findings. The diagnostic values of the stump impingement sign were found to be: Sensitivity 58%, Specificity 81%, Positive predictive value 70%, Negative predictive value 72% and Accuracy 71%. Conclusions We believe that the stump impingement reflex is a specific sign for ACL stump impingement as a cause of knee locking. We recommend close inspection for this sign when examining locked knees.

Abstract Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon.

Background: would patients with bilateral Femuroacetabular impingement would benefit from one surgery, addressing both hips simultaneously, compared to a staged later procedure. Methods: Group1: both hips were treated simultaneously, Group2: hips were treated few month apart, Group3: single hip control group. Outcome measures: general anesthesia, surgical times, VAS pain at post operative days 1-30, Pain killers used, time patient started: biking, driving, office work, gym, running, return to play. Long term evaluation Scores, at 6, 12, 24m. Results (interim analysis): 76 subjects (119 hips). G1 - 28 subjects (56 limbs), G2 -15 subjects (30 limbs) and, G3 - 33 subjects. No differences between groups were seen with regard to patient demographics and pre operative outcome measures. Mean general Anastasia and surgery times was 211/164 minutes for G1, 115/87 for each procedure in G2 and 107/78 for G3. Post operative VAS scores were the same for the 3 groups. The only parameters shown to influence the post op VAS pain were the subject's pre-op NAH and Womac scores (direct correlation). No difference was seen in the amount, type or days, of pain killers used. At six months, improvement in Womac and NAH scores (was filled separately for each side and averaged for the bilateral subjects) was similar for all 3 groups. Conclusions: simultaneous surgery does not lead to higher rate of complications, post-op pain, analgesic usage or side effects. Return to daily activities is similar to a single hip procedure with the advantage of a single rehabilitation. [ABSTRACT FROM AUTHOR]

Background: chronic exercise-related groin pain is a debilitating condition for athletes. Non-operative treatment has limited efficacy. We report the outcome of adductor tenotomy and hernioplasty for professional soccer players with groin pain. Methods: two groups of soccer players with persistent groin pain, with or without additional lower abdominal pain and resistance to conservative treatment were included in this retrospective analysis. Both were treated with adductor tenotomy, while in the second group, hernioplasty was added. RTP time, subjective and objective outcome measures were compared. Results: 155 professional and recreational soccer players with recalcitrant groin pain were treated. 96 patients (group 1) were treated with adductor tenotomy and additional 59 (group 2) were treated with a combination of adductor tenotomy and hernioplasty. No difference in pre- or post-operative parameters was detected between groups, apart from abdominal wall muscle defects demonstrated by ultrasound in group 2. Mean duration of pre-op symptoms was 5 months. All patients were males. Mean age was 23 years (16-36) and mean pre-op Tegner score was 8.2. Mean RTP was 11 weeks (Range 4-36). Post-op Tegner score remained 8.2. Subjective outcome was rated as 4.3 out of 5. The combined score indicated 80% of good or excellent results for both groups. Conclusions: surgical intervention has been shown to allow RTP at the same standard in professional soccer players following the failure of non-operative treatments. Athletes with an adductor syndrome and accompanying sportsman hernia might benefit from adductor tenotomy only. [ABSTRACT FROM AUTHOR]

Background: the purpose of this study is to assess the accuracy and safety of a technique utilizing an anterior approach for non-image guided intra-articular injection of the hip using anatomical landmarks. Methods: patients elected to have hip arthroscopy were positioned supine on a fracture-traction table with the hip and foot in neutral position. A point was marked by the respective crossing lines coming, distally from ASIS and horizontally from the tip of greater trochanter. A 19G spinal needle was inserted vertically down towards the femoral neck from this point. Once bony resistance was felt, the inner needle was removed and air was injected to produce an air arthrogram. The position of needle and presence of air inside the joint were confirmed with fluoroscopy and back-flow of arthroscopic fluid from the joint. Results were correlated with age, weight, height, BMI, body type, gender, femur and pelvis morphology and alignment. Results: 55 subjects enrolled in the study. There were 51 correct placements and 4 misplacements, yielding 93% success rate. Reasons for misplacements of the needle were: high riding trochanter, increased femoral version, thick adipose tissue, and lateral variant of ASIS position. Conclusions: anterior non-guided intra-articular hip injection is a safe, reproducible and easy to learn technique. The technique can be performed bedside or in the outpatient clinic negating the need for US, fluoroscopy or CT guidance, avoiding radiation exposure and reducing health care costs. [ABSTRACT FROM AUTHOR]

Introduction: the current literature shows little difference in outcome between non-operative and operative management following rupture of the Achilles tendon. Function scoring and assessment in these series is usually performed at a six monthly intervals. We report on the early outcome of a series of patients with a ruptured Achilles tendon managed by percutaneous repair followed by early functional rehabilitation. Materials and methods: seventy-five patients elected to have percutaneous surgical repair of acute Achilles tendon ruptures from April 2009 to April 2012. Results: mean ATRS scores at 3, 6, 9 & 12months were 46.1 (18-93), 74.3(26-100), 81.2(33-100) and 87.9(48-100) respectively. The number of patients who reported excellent or good scores (ATRS>84) at 3, 6, 9 & 12 months were 3%, 40%, 60% & 73%. There was 1 case of re-rupture at 8 weeks following surgery and 2 cases of DVT. In addition there was a complication rate related to surgery of 9%: superficial infection 2.6%, iatrogenic sural nerve injury 6% and one patient requested excision of the suture knot 1.3%. Conclusions: our patients report a marked improvement in function between 3 and 6 months following surgery. The majority of patients reported excellent or good scores beyond 6 months following repair. We recommend percutaneous repair followed by early functional rehabilitation to promote early recovery following rupture of the Achilles tendon. Level of evidence: level 4 case series. [ABSTRACT FROM AUTHOR]

The three primary factors involved in preservation of the hip joint include femoroacetabular impingement (FAI), hip dysplasia/instability, and femoral torsion abnormalities. Each of these factors affects the health of the acetabular labrum and femoroacetabular cartilage. The appropriate surgical treatments for each of these factors include arthroscopic or open femoroplasty/acetabuloplasty for FAI, periacetabular osteotomy for hip dysplasia/instability, and derotational femoral osteotomy for femoral torsion abnormalities. When evaluating patients with prearthritic hip conditions, orthopaedic surgeons should be aware of the various factors involved in hip joint preservation and, if surgery is indicated, the surgeon should be sure to address all factors that need surgical treatment rather than focusing on the commonly diagnosed issue or visible injury, for example, a labral tear. If any of these factors is ignored, the hip joint may not thrive. The purpose of this review was to explain the importance of the most common factors involved in hip joint preservation and the appropriate surgical treatments for pathology in these factors., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)

Purpose: To determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group., Materials and Methods: All patients aged ≥45 years old who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared to a case-matched control of younger patients. All patients underwent at least 6 months of non-operative management prior to surgery. Prior to PAO, all patients underwent hip arthroscopy to address any intra-articular pathology. The experimental group consisted of dysplastic patients >45 years of age without significant osteoarthritis who underwent PAO and reported a minimum of 1-year postoperative PROs. Patient-reported outcomes (PROs) were quantified using the International Hip Outcomes Tool (iHOT-12) and Non-Arthritic Hip Score (NAHS)., Results: The cohort consisted of 35 patients (44 hips) with a mean age of 49.4 ± 3.8 years. The lateral center edge angle significantly improved from preoperatively (20.1 ± 4.5 degrees) to postoperatively (33.2 ± 3.2 degrees) (p<0.001). Mean follow up in the PAO ≥45 cohort was 2.80 (±1.3) years postoperatively. Patients reported significant improvement of iHOT-12 (preoperative: 36.6 ± 14.1, latest follow-up: 81.2 ± 21.0; p<0.001) and NAHS scores (preoperative: 59.2 ± 15.5, latest follow-up: 87.4 ± 13.1; p<0.001). Compared to the control, the older cohort did not report significantly different iHOT-12 scores between groups at any point, and age did not significantly affect either outcome score (p>0.05)., Conclusions: Patients ≥45 years of age reported a statistically significant improvement in hip function and pain following staged hip arthroscopy and PAO, with outcome scores comparable to a younger cohort. Our findings demonstrate that appropriately selected older dysplastic patients without significant preexisting hip osteoarthritis experience clinically meaningful improvements in hip pain and function following hip preservation surgery., Level of Evidence: III, retrospective comparative case series., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: To systematically review the literature to determine potential risk factors for failure of hip arthroscopy (HA) in patients with borderline hip dysplasia (BHD)., Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify English-language clinical studies reporting on patients with BHD undergoing HA from 2003 to 2023. The search terms used were (borderline OR mild) AND hip AND (arthroscopy OR dysplasia) AND failure. The primary outcomes assessed were risk factors reported by each study for failure of a HA-only approach in patients with BHD., Results: Fourteen studies (8 Level III, 6 Level IV) met inclusion criteria, totaling 749 hips. Patient age ranged from 29.8 to 39.2 years, with a mean follow-up ranging from 24.0 to 144.0 months. The overall percentage of female patients ranged from 11.8% to 100.0%. Overall, the clinical failure rate ranged from 0 to 53.3%, and the reoperation rate ranged from 0 to 44.0%. The predominant predictors of poor outcomes after HA alone included Tönnis angle ≥15°, age ≥40 to 42 years at surgery, and female sex. Other risk factors for failure were preoperative clinical arthritis, grade 3 or 4 articular cartilage changes to the femoral head or acetabulum, an anterior wall index <0.35, and labral debridement. Revision procedures performed included revision HA (n = 88, 0-28.0%), total hip arthroplasty (n = 55, 0%-23.7%), and endoscopic shelf acetabuloplasty (n = 5, 0%-11.0%). One study included an additional 9 patients converting to either periacetabular osteotomy or total hip arthroplasty without distinguishing between the two., Conclusions: For patients with BHD, Tönnis angle ≥15°, age ≥40 to 42 years at surgery, female sex, anterior wall index <0.35, labral debridement, and pre-existing hip osteoarthritis are common risk factors for treatment failure following isolated HA., Level of Evidence: Level IV, systematic review of Level III-IV studies., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.J.K. reports consulting or advisory for Smith & Nephew and editorial board, Arthroscopy. O.M-D. has a patent with royalties paid to Stryker and stock or stock options with MITA and HeapSi. All other authors (P.M.T., M.M., J.D., K.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., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Previous studies have sought to determine the effect of inpatient ketamine therapy on postoperative pain in a variety of surgical specialties., Purpose: To determine the effects of postoperative ketamine analgesia after periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO) on opioid requirements, pain, and discharge time., Study Design: Cohort study; Level of evidence, 3., Methods: Prospective data were collected on 145 patients who underwent PAO and/or DFO by the senior author between January 2021 and December 2022. Hip arthroscopy was performed 3 to 10 days before addressing any intra-articular pathology. In 2021, patients (n = 91 procedures; control group) received a traditional postoperative multimodal pain regimen. In 2022, postoperative low-dose ketamine (0.1-1 mg/kg/h) was added to the multimodal analgesic approach until 24 hours before discharge (n = 81 procedures; ketamine group). The ketamine and control groups were matched based on procedure type. Total opioid consumption was collected using milligram morphine equivalents (MMEs) for both groups. Postoperative pain was measured using the Defense and Veterans Pain Rating Scale (DVPRS), which was analyzed as the mean score per day. Data on the mean MME and DVPRS were analyzed for up to 7 days postoperatively. Linear mixed statistical analysis was performed to determine the significance of low-dose postoperative ketamine on postoperative pain and opioid utilization., Results: Patients who did not receive ketamine after PAO and/or DFO utilized a mean of 181 ± 335 MMEs and had a mean DVPRS score of 4.18 ± 1.63. Patients who received postoperative ketamine required a mean of 119 ± 291 MMEs and had a mean DVPRS score of 4.34 ± 1.61. The ketamine group was found to consume a significantly lower total MME dose per day ( P < .001). No significant difference was found in the mean DVPRS score between the ketamine and control groups ( P = .42). Also, no significant difference was found on the day of discharge ( P = .79)., Conclusion: Patients who received postoperative ketamine after PAO and/or DFO had a significant decrease in MME dose when compared with a control group of patients who did not receive ketamine. Surgeons should consider adding ketamine to their postoperative multimodal pain control protocol to decrease opioid consumption while adequately addressing postoperative pain., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: C.Z. owns stock or stock options in AbbVie. O.M.D. holds stock or stock options in HeapSi and MITA and receives IP royalties from 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. Ethical approval for this study was obtained from the University of Colorado Denver (ref No. CRV006-1)., (© The Author(s) 2024.)

Background: Bilateral hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) has demonstrated good outcomes at short-term follow-up, with significant improvements in pain, hip function, and patient-reported outcomes, coupled with a complication rate similar to that of unilateral surgery., Purpose: To investigate whether, in patients with bilateral symptomatic FAI, simultaneous bilateral hip arthroscopic surgery is an efficacious option that produces effective midterm outcomes., Study Design: Cohort study; Level of evidence, 3., Methods: A prospective database of patients who underwent primary hip arthroscopic surgery between August 2012 and October 2020 was used to collect clinical data on 2 groups. Group 1 consisted of patients who underwent simultaneous bilateral hip arthroscopic surgery for the treatment of FAI. Group 2 represented a matched-pair control group of patients selected based on sex and age with signs and symptoms of unilateral FAI and in whom a single side was evaluated and treated. Differences in the International Hip Outcome Tool-12 and Non-Arthritic Hip Score scores were evaluated up to 5 years postoperatively., Results: In total, 171 patients (235 hips) were included, of whom 64 underwent simultaneous bilateral hip arthroscopic surgery (128 hips) and a control group of 107 patients (107 hips) underwent unilateral hip arthroscopic surgery. No significant differences were observed in International Hip Outcome Tool-12 scores between the 2 groups at 6 weeks, 3 months, 1 year, 2 years, and 5 years postoperatively. No significant differences were observed in Non-Arthritic Hip Score scores between the simultaneous bilateral and control groups at 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Overall, 18% of hips in the simultaneous bilateral group reported lateral femoral cutaneous nerve palsy at 2-week follow-up in comparison to 16% of hips in the control group., Conclusion: Simultaneous bilateral hip arthroscopic surgery for the treatment of FAI represents a safe treatment option, producing effective midterm outcomes in appropriately selected patients., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.H.L. has received hospitality payments from Smith & Nephew, Stryker, and Heraeus Medical and support for education from Gemini Mountain Medical. O.M.-D. has received royalties from Stryker and holds stock or stock options in HeapSi and MITA. 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.

Hip arthroscopy is commonly performed to treat femoroacetabular impingement syndrome. A post-assisted arthroscopic hip preservation surgery approach provides joint distraction for central-compartment access. Owing to the location, compression of the post in the perineum may cause injuries to the pudendal nerve, perineal soft tissue, or genitourinary system. A postless technique significantly reduces the risk of these complications. Postless arthroscopy uses friction between the patient's torso and the table surface to permit distraction without the post. An air arthrogram, general anesthesia with muscle paralysis, and variable degrees of Trendelenburg positioning reduce the force needed for joint distraction. Early postless literature suggested Trendelenburg angles of approximately 15°, which may be disorienting to surgeons and compromise the precision and accuracy of the surgical procedure. With the described technique, hip arthroscopy can be effectively performed with a Trendelenburg angle of less than 5° in nearly every case. Understanding the physics of postless hip arthroscopy using free-body diagrams of inclined planes with friction permits surgeons to understand the required Trendelenburg angle of the bed, the force of traction for any patient given his or her body habitus, and the coefficient of static friction of the table surface to achieve a minimum amount of joint distraction., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: M.J.K. is on the Arthroscopy editorial or governing board. J.C. is on the Arthroscopy editorial or governing board. O.M-D. receives royalties or licenses from 10.13039/100008894Stryker and owns stock or stock options in HeapSi and MITA. J.D.H. receives royalties or licenses from SLACK and Thieme Medical Publishers; receives consulting fees from Smith & Nephew; has a leadership or fiduciary role in 10.13039/100009885American Academy of Orthopaedic Surgeons, Arthroscopy, 10.13039/100011549American Orthopaedic Society for Sports Medicine, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, 10.13039/100008542Arthroscopy Association of North America, and Orthopaedic Research Society; and owns stock or stock options in PatientPop. All other authors (A.E.W., H.G.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2024 The Authors.)

Background: An everted acetabular labrum (EL) is a pathologic variant in which the labrum is flipped to the capsular side of the acetabular rim. An iatrogenic EL is a known complication of a poorly executed labral repair, and a recent study described the native acetabular EL., Purpose: To analyze surgical outcomes after advancement or reconstruction of an EL in a native hip., Study Design: Cohort study; Level of evidence, 3., Methods: This was a multicenter retrospective review of prospectively collected data on primary hip arthroscopic surgeries performed between 2013 and 2023. An EL was identified arthroscopically as a labrum-femoral head gap while off traction in the native hip. All patients with EL who were analyzed in this study underwent arthroscopic labral repair and advancement or labral augmentation or reconstruction. Patients with hip dysplasia also underwent periacetabular osteotomy with or without a derotational femoral osteotomy. Patient-reported outcomes (PROs) were assessed using the 12-item International Hip Outcome Tool (iHOT-12) and the Nonarthritic Hip Score. PROs were obtained preoperatively and up to 24 months after surgery. PROs were compared with those of a case-matched control cohort in a 1:2 ratio. Only patients with PROs available at ≥1 year postoperatively were included in the outcome analysis., Results: A total of 111 patients (129 hips) with EL during the study period were identified, with PROs available in 96 hips. The mean age of patients with EL was 30.5 years, and women made up 87% of the cohort. Of the 129 hips with an EL, an isolated diagnosis of an EL was present in 11.6% of hips. Deficient acetabular coverage (lateral center-edge angle <25°) was seen in 40.6% of EL hips. No difference was seen in iHOT-12 scores between EL and control groups at 12- or 24-month follow-up ( P = .18 and .94, respectively). Patients with EL reported a significant improvement of PROs at latest follow-up ( P < .001 for iHOT-12 and Nonarthritic Hip Score)., Conclusion: Surgical management of a native EL with restoration of the labral seal on the femoral head and correction of concomitant pathologies resulted in significant clinical improvement, with postoperative outcome scores comparable to those of patients without an EL. These findings provide evidence supporting surgical intervention for a native EL., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.H.L. has received support for education from Gemini Mountain Medical and hospitality payments from Smith & Nephew, Stryker, and Heraeus Medical. J.W.G. has received consulting fees from Pivot; IP royalties, consulting fees, and research support from Stryker; support for education from Arthrex; and hospitality payments from Smith & Nephew. L.A.V. has received support for education from ImpactOrtho, Goode Surgical, and Arthrex and hospitality payments from Stryker Corporation and Smith & Nephew. O.M-D. has received consulting fees from Stryker Corporation and holds stock or stock options in HeapSi and MITA. 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 investigate a radiographic sign believed to be indicative of hip instability and acetabular suction seal disruption in the native hip, coined the "windshield wiper" (WSW) sign., Methods: A retrospective review was performed for patients who underwent periacetabular osteotomy (PAO) with the senior author between March 2021 and September 2023. A WSW sign was identified on plain films as a concave or flat osteochondral defect on the anterolateral femoral head extending medial to the head-neck junction with resultant loss of femoral head sphericity in the native hip. Every patient underwent a standardized series of radiographs, as well as computed tomography and magnetic resonance imaging. All patients underwent arthroscopy before PAO to address intra-articular pathology and other indicated procedures. The osteochondral defect and resultant suction seal disruption were verified during arthroscopy. These patients were then compared with a control group of arthroscopically treated hips without hip instability., Results: Of 250 patients reviewed, a total of 19 hips in 17 patients (prevalence of 7.6%) demonstrated radiographic evidence of the WSW sign. All patients with a WSW sign presented with symptomatic clinical hip instability requiring a PAO. The mean patient age was 31.2 years, with a mean lateral center-edge angle (LCEA) of 14.3°. There were 13 hips (68.4%) with dysplasia, 4 (21.1%) with borderline dysplasia, and 2 (10.5%) with a normal LCEA. All patients with a WSW sign and LCEA ≥ 20° displayed significant femoral antetorsion abnormalities. All arthroscopic videos and images demonstrated a compromised suction seal. Of the 50 control group hips reviewed, the WSW sign was not identified., Conclusions: The WSW sign is an uncommon radiographic finding in patients with hip instability. When identified, it can be predictive of substantial instability, especially in cases which are otherwise considered borderline dysplasia or normal based on LCEA., Level of Evidence: Level III, retrospective comparative case control study., Competing Interests: Disclosures The authors report the following potential conflicts of interest or sources of funding: M.K.J. reports paid presenter or speaker, unrelated to this study, Medtronic, outside the submitted work. J.W.G. reports lectures, including service on speakers bureaus, royalties, research support from Stryker, outside the submitted work. O.M-D. reports royalties from Stryker and MITA and stock/stock options from Heapsi. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Case: We describe the unique case of a 20-year-old man with a history of Legg-Calve-Perthes disease, hip dysplasia, and osteochondral fragmentation of the medial femoral head. We performed arthroscopic femoroplasty and femoral head allografting, followed by a valgus-producing derotational femoral osteotomy (DFO) and periacetabular osteotomy (PAO). At 1-year follow-up, the patient achieved osseous union and complete femoral head healing with return to his active hobbies., Conclusion: We describe the successful utilization of arthroscopic allografting for medial femoral head osteochondral fragmentation. To our knowledge, this is the first report on femoral head arthroscopic allografting before DFO and PAO., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C325)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Purpose: To prospectively compare the short-term clinical outcomes of patients undergoing hip arthroscopy with versus without the use of a perineal post., Methods: A prospective, single-surgeon cohort study was performed on a subset of patients undergoing hip arthroscopy between 2020 and 2022. A post-free hip distraction system was used at 1 center at which the senior author operates, and a perineal post was used at another surgical location. An electronic survey of patient-reported outcome measures (PROMs) was completed by each patient at a minimum of 1 year postoperatively. PROMs included a visual analog scale for pain; University of California, Los Angeles (UCLA) Activity Scale; modified Harris Hip Score (mHHS); Hip Outcome Score-Sports-Specific Subscale (HOS-SSS); and a Single Assessment Numeric Evaluation. Postoperative scores and clinically significant outcomes, including the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state, for each PROM were compared between groups., Results: Sixty-nine patients were reached for follow-up (41 post, 28 postless) of 87 patients eligible for the study (79%). No significant differences were found between groups in terms of sex (post: 61% female, postless: 54% female, P = .54), age (post: 34 years, postless: 29 years, P = .11), body mass index (post: 26, postless: 24, P = .23), or follow-up duration (post: 24.4 months, postless: 21.3 months, P = .16). There was a significantly higher visual analog scale (3.1 vs 1.4, P = .01), a significantly lower UCLA Activity Scale score (7.0 vs 8.4, P = .02), and a significantly lower mHHS (73.7 vs 82.2, P = .03) in the post-assisted group. A significantly higher proportion of patients in the postless group achieved a patient acceptable symptom state for the UCLA (89.3% vs 68.3%, P = .04), mHHS (84.6% vs 61.0%, P = .04), and HOS-SSS (84.0% vs 61.0%, P = .048) and a substantial clinical benefit for HOS-SSS (72.0% vs 41.5%, P = .02). One patient (2.6%) in the post group underwent revision hip arthroscopy, and another was indicated for total hip arthroplasty by the time of follow-up., Conclusions: Postless hip arthroscopy may result in better clinical outcomes compared with post-assisted hip arthroscopy., Level of Evidence: Level III, retrospective cohort study., Competing Interests: Disclosures The authors report the following potential conflicts of interest or sources of funding: O.M.-D. holds stock or stock options in HeapSi and MITA and receives IP royalties from Stryker. A.J.S. is a paid consultant for Mitek and has stock or stock options with Biomet, ConMed, Linvatec, Johnson & Johnson, Pfizer, Smith & Nephew, and Stryker. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To determine the effects of demographic and anatomic factors on traction force required during postless hip arthroscopy., Methods: A prospectively collected database was retrospectively analyzed on patients undergoing hip arthroscopy by the senior author, including patient sex, age, body mass index (BMI), Beighton Hypermobility Score, hip range of motion in clinic and under anesthesia, hip dysplasia, acetabular version, and femoral version. All patients underwent postless hip arthroscopy under general anesthesia. At the initiation of hip arthroscopy, the traction force required to distract the hip joint was measured before and following interportal capsulotomy. Multiple regression analysis was performed to determine the effects of demographic and anatomic factors on measured distraction force., Results: In total, 352 hips (114 male, 238 female) were included with a mean age of 32.6 years and a mean BMI of 24.1 kg/m 2 . Mean initial traction force was 109 lbs and decreased to 94.3 lbs following capsulotomy (P < .0001). The starting traction force was significantly greater in male patients (P < .001), patients with a lack of hypermobility (Beighton Hypermobility Score of 0-2) (P = .026), and in patients with lower abduction (P < .001), lower internal rotation (P = .002), and lower external rotation (P = .012) on multiple regression analysis. When performing a subanalysis divided by sex, male patients with elevated BMI required significantly greater starting traction force (P = .014). Lateral center edge angle, sourcil angle, and the presence of hip dysplasia did not demonstrate a significant correlation with traction force., Conclusions: Male patients, patients with reduced preoperative hip range of motion, patients with a lack of joint hypermobility, and male patients with an elevated BMI require greater initial traction force during postless hip arthroscopy., Level of Evidence: Level IV, retrospective case series., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

As knowledge about the origin and morphologic characteristics of hip pain in the young adult has evolved, so too has the clinician's ability to assess for various pathologies of the hip on radiographs, magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA), and computed tomography (CT). Because there is no algorithm at this time directly indicating what to do in more subtle hip morphologies, such as microinstability and borderline hip dysplasia (BHD), a skilled hip preservation specialist must use multiple imaging sources and know how to interpret them correctly. Imaging parameters used in the workup for hip dysplasia and BHD include the lateral center-edge angle, Tönnis angle, iliofemoral line, and presence of an upsloping lateral sourcil or everted labrum, among many others. The purpose of this narrative review was to detail various established criteria and parameters on anteroposterior pelvis plain radiographs, MRI/MRA, and CT that assist in defining the nature and severity of instability present in a dysplastic hip, thereby aiding in the development of patient-specific surgical treatment plans., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: K.L.W. has received education payments from Smith & Nephew and hospitality payments from Stryker. T.G. and O.M.-D. have received consulting fees from 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., (© The Author(s) 2023.)

Background: Previous studies have demonstrated various groin-related nerve and soft tissue complications in patients undergoing hip arthroscopy with a perineal post., Purpose: To prospectively compare groin-related nerve and soft tissue complications between patients undergoing hip arthroscopy with and without the use of a perineal post., Study Design: Cohort study; Level of evidence, 2., Methods: A prospective single-surgeon cohort study was performed on all patients undergoing hip arthroscopy by the senior author between January 2020 and March 2022. A post-free hip distraction system was used at 1 center in which the senior author operates, and a system with a large padded perineal post was used at another surgical location. Patients completed a survey at the first postoperative visit (7-10 days) to determine if they had experienced any groin-related complications after surgery (groin numbness, sexual/urinary dysfunction, skin tears). Patients with a positive survey response repeated the survey at each follow-up visit (6 weeks, 3 months, 6 months) until the symptoms resolved. The rate and duration of groin-related complications were then compared between the groups., Results: A total of 87 patients were included in the study who underwent hip arthroscopy: 53 with a perineal post and 34 without. No differences were found between the post and postless groups in terms of age at surgery, sex, body mass index, or traction time. We found that 16 patients (30%) in the perineal post group experienced groin numbness versus 0 (0%) in the postless group ( P < .0001). On average, groin numbness lasted 5 ± 3 days (mean ± SD) in the perineal post group. Three patients in the perineal post group experienced sexual dysfunction for a mean 7 days, as compared with none in the postless group. Seventeen patients (32%) in the perineal post group experienced foot numbness versus 4 (12%) in the postless group ( P = .04). One patient in the perineal post group reported a superficial skin tear., Conclusion: Postless hip arthroscopy resulted in no risk of groin-related complications as compared with traditional hip arthroscopy with a perineal post.

Background: Previous studies have demonstrated the risks of pudendal nerve and/or soft tissue complications due to the use of a perineal post during hip arthroscopy. Recently, various postless hip arthroscopy techniques have been described in the literature., Purpose: To assess the current international trends in the use of postless hip arthroscopy among hip preservation specialists., Study Design: Cross-sectional study., Methods: An anonymous 11-item survey was sent by email to all members of the International Society for Hip Arthroscopy (ISHA) in January 2022. Surgeons were asked various questions regarding their current use of post-assisted or postless hip arthroscopy, if they had changed their setup technique during their career and the reason for that change, and their perceived rate of pudendal nerve and/or perineal soft tissue injuries using their current technique. Descriptive statistics were used to report the results of each question. The Student t test was used to compare the number of years in practice between post-assisted and postless users. Fisher exact tests were performed to compare categorical rates of pudendal nerve and soft tissue complications between post-assisted and postless users., Results: A total of 126 surveys were completed from 431 ISHA members (29.2%). Sixty-one percent of the surgeons currently use a perineal post, while 33% use a postless technique. Seventy-five percent of the perineal post users and 98% of the postless users self-reported a rate of pudendal nerve and/or soft tissue injury of <1% ( P = .015). Among 41 respondents who indicated changing their technique at some point, 59% reported doing so because of pudendal nerve and/or soft tissue complications. Among surgeons who switched from a perineal post to a postless setup, 71% indicated they have noticed a decrease in the rate of pudendal nerve and/or soft tissue complications., Conclusion: Although use of a perineal post is still a more common setup technique among hip arthroscopists, approximately one-third of surgeons use a postless technique. Surgeons who have switched to a postless technique often did so because of perineal complications, with the majority noticing a subjective decrease in these complications with the use of postless hip arthroscopy., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.D.H. has received research support from DePuy Synthes and Smith & Nephew; publishing royalties from SLACK Incorporated and Thieme Medical Publishers; consulting fees from Smith & Nephew; and speaking fees from Xodus Medical; he holds stock or stock options in PatientPop. O.M.D. has received royalties from Stryker and holds stock or stock options in HeapSi and MITA. A.J.S. has received research support from Isto Biologics; and consulting fees from Mitek, Medical Device Business Services, DePuy Synthes, and DePuy Orthopaedics; he holds stock or stock options in Biomet, CONMED Linvatec, Johnson & Johnson, Pfizer, Smith & Nephew, and Stryker., (© The Author(s) 2022.)