Faculty Bibliography

BACKGROUND/UNASSIGNED:Arthroscopic-assisted lower trapezius tendon transfer (SALTT) utilizes an interpositional graft between the lower trapezius tendon and the greater tuberosity. We hypothesized that SALTT with achilles allograft or semitendinosus autograft would result in similar patient outcomes and complication rates. METHODS/UNASSIGNED:Patients undergoing SALTT with semitendinosus autograft from 2019 to 2023 were case matched to patients with achilles allograft based on age, preoperative subjective shoulder value (SSV), and sex. Active forward elevation (aFE), external rotation (ER) lag, and SSV were assessed pre- and postoperatively. RESULTS/UNASSIGNED:Sixteen patients (17 shoulders) with semitendinosus autograft (Auto) were case matched to 17 patients with achilles allograft (Allo). SSV improved with no significant difference between groups (Auto: 71.8 ± 7.3, Allo: 72.5 ± 19.4, P = 0.9). ER lag also improved, with a similar rate of a persistent ER lag (Auto: 5.9%, Allo: 11.8%, P = 1). aFE was greater in the Allo cohort (151 ± 16°, 135 ± 20°, P = 0.015). On linear regression analysis, a subscapularis tear requiring repair (β = -0.61, P = 0.008) and male sex (β = -0.48, P = 0.032) were negatively associated with final SSV. There was one surgical site infection in the Auto cohort and one traumatic graft rupture in the Allo cohort. CONCLUSION/UNASSIGNED:SALTT with either achilles allograft or semitendinosus autograft delivers similar improvements in SSV and ER lag with minimal complication rates. LEVEL OF EVIDENCE/UNASSIGNED:Level III, case-controlled study.

PURPOSE/OBJECTIVE:To determine the clinical outcomes of hip arthroscopy for anterior inferior iliac spine subspine impingement (SSI). LEVEL OF EVIDENCE/METHODS:Case Series; level IV. METHODS:Patients who underwent unilateral, primary hip arthroscopy for SSI from February 2015 to December 2017 with minimum 3-year follow-up data were identified (SSI). Analysis of variance, Kaplan-Meier analysis, and regression modeling were used to analyze outcomes. RESULTS:Of 23 eligible, 19 (83% inclusion) patients (mean [standard error of the mean]: age: 45.9 [3.1]; body mass index, 26.3 [0.9]; 79% female, 53% right side) had a minimum of 3-year follow-up (48.3 [2.2] months). The estimated mean survival time of index procedure across the whole cohort was 64.9 ± 3.1 months. One patient underwent total hip arthroplasty. Patients improved from baseline modified Harris Hip Score (62.7 [5.1]) to follow-up (75.1 [4.3]; P = .014). Twelve patients (63%) met minimal clinically importance difference criteria while 7 (37%) met patient acceptable symptomatic state criteria. Linear regression modeling demonstrated lower postoperative lateral center edge angle (beta = -2.1, 95% confidence interval: -0.5 to -2.9, P = .035) and presence of labral repairs (beta = 46.1, 95% confidence interval: 24.8-67.4, P = .003) were associated with higher follow-up modified Harris Hip Score. CONCLUSION/CONCLUSIONS:In conclusion, patients undergoing anterior inferior iliac spine decompression during hip arthroscopy for SSI in the setting of femoroacetabular impingement syndrome have acceptable, improved clinical outcomes at minimum 3-year follow-up. Labral repair and decreasing postoperative lateral center edge angle were predictive of improved patient-reported outcomes. Hip arthroscopy remains a viable successful treatment options in the treatment of concomitant SSI during femoroacetabular impingement syndrome surgery.

PURPOSE/OBJECTIVE:To quantify the improvement of patients undergoing scope-assisted lower trapezius tendon transfer (SALTT) for irreparable rotator cuff tears (IRCTs) and whether intraoperative subscapularis management affected these outcomes. METHODS:From 2015 to 2023, patients undergoing primary SALTT for IRCTs without osteoarthritis or brachial plexopathy with serial follow-up at 6 months and a minimum of 12 months postoperatively were identified. Subjective shoulder value (SSV) scores, active forward elevation (FE), external rotation (ER) lag, and cuff strength were recorded. Continuous variables were analyzed with 1-way or repeated-measures analysis of variance, and a multivariate linear regression was performed evaluating demographic, radiographic, and intraoperative variable effects on SSV and ER lag. RESULTS:Seventy-six (mean age: 56.5 ± 8.1 years; body mass index: 29.0 ± 4.3; 73% male) patients, operated on by 4 surgeons (A: 66%; B: 15%; C: 13%; D: 4%), had significant improvement in baseline SSV scores (mean: 23.9 ± 13.1) to 6-month (mean: 73.5 ± 10.6, 91% minimal clinically important difference achievement, P < .001) and final (mean: 43.5 ± 29.5 months) follow-up scores (mean: 79.9 ± 16.5, 92% minimal clinically important difference achievement, P < .001; n = 45/122: 37% 2-year inclusion rate). Regression analysis for final SSV showed age (β: 0.8, P = .017) to have a positive effect and subscapularis fatty infiltration (β: -10.6, P < .001) to have a negative effect. Active FE improved from 6-month (139° ± 23.8°) to final (146° ± 23.0°, P = .013) follow-up while ER lag (17° ± 17°) improved as well (6-month mean: 3° ± 7.8°, P < .001; final: 3° ± 5.6°, P < .001). Regression analysis revealed subscapularis fatty infiltration (β: -11.6, P = .003) had a negative effect on final active FE, while infraspinatus fatty infiltration (β: -1.2, P = .048) and concomitant subscapularis repair (β: -5.0, P = .023) had a negative effect on final ER lag. Presence of subscapularis tears alone (β: 4.5, P = .030) had a positive effect on ER lag. Overall, 5 (7%) patients underwent reoperations. CONCLUSIONS:Patients with IRCT undergoing SALTT with or without subscapularis tears requiring repair achieve excellent short-term clinical outcomes while improving from an examination standpoint. LEVEL OF EVIDENCE/METHODS:Level III, retrospective case series.

Para-labral cysts in the acetabulum often occur in the setting of labral tears. While labral tears are commonly identified in femoroacetabular impingement syndrome, developmental dysplasia of the hip is also a cause of chondrolabral pathology. Our understanding of para-labral cysts has encouraged addressing the concomitant labral pathology, as this has been shown to result in cyst resolution. However, recent evidence suggests in the setting of hip dysplasia, addressing the bony pathology of the acetabulum with an isolated acetabular re-orientation osteotomy allows for cyst resolution and significant improvement in clinical outcomes despite persistent labral tears post-operatively. While further investigation is needed to delineate the effects of persistent labral tears after isolated peri-acetabular osteotomy, addressing the acetabular undercoverage remains critical in the treatment of these patients.

PURPOSE/OBJECTIVE:The aim of this study was to assess the inter-rater reproducibility and inter-method comparability of hip alpha angle measurements on magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA) and plain radiographs in patients with femoroacetabular impingement syndrome (FAIS). METHODS:A cross-sectional study of patients who were diagnosed with symptomatic FAIS underwent preoperative MRI/MRA with axial oblique and/or radial plane imaging and had preoperative radiographs with anterior-posterior (AP), 45° Dunn and 90° Dunn views. Alpha angle measurements were performed independently by two musculoskeletal radiologists. Inter-rater reproducibility and inter-method comparability between MRI/MRA images and radiographic views were assessed using the intraclass correlation coefficient (ICC) with 95% confidence interval (CI). RESULTS:Ninety-seven patients were included of whom 93 (95.8%) received axial oblique plane images and 54 (55.6%) had radial plane MRI/MRA images. Inter-rater reproducibility was excellent (ICC > 0.9) for all planes on MRI/MRA and radiographs. MRI/MRA axial oblique images had poor (ICC 0.39, 95% CI [0.09, 0.59]), moderate (ICC 0.57, 95% CI [0.18, 0.75]) and moderate (ICC 0.64, 95% CI [0.20, 0.81]) comparability with AP, 45° Dunn and 90° Dunn, respectively. MRI/MRA radial plane images had equivocal (0 included in all CIs) comparability with AP (ICC 0.66), 45° Dunn (ICC 0.35) and 90° Dunn (ICC 0.14) radiographs. On average, alpha angle measurements were significantly higher with radial images and lower with axial oblique images, when compared to all radiographic views (p < 0.05), except axial oblique versus 45° Dunn views, where angles measured on axial oblique were significantly larger. CONCLUSION/CONCLUSIONS:Alpha angle measurements taken on axial oblique MRI/MRA images show moderate comparability to radiographic 45° Dunn and 90° Dunn views despite negative bias to measurements taken on radiographic AP and 45° Dunn view. Larger alpha angles were appreciated on MRI/MRA radial and axial oblique views compared to radiographic views supporting the inclusion of MRI/MRA alpha angle measurements to properly identify deformity. LEVEL OF EVIDENCE/METHODS:Level II.

Patients undergoing endoscopic gluteus medius and/or minimus repair with concomitant arthroscopic labral management have been reported to achieve excellent improvement in symptoms and outcome at as far as 5- to 10-year long-term follow-up. Although clinical outcomes at 2 years and onward are successful, few studies investigate how quickly patients improve after surgery. Most patients undergoing gluteus medius and/or minimus for predominantly partial-thickness tears achieve minimal clinically important differences as early as 6 months postoperatively, and a minimum of 1 year is needed for most patients to achieve a patient acceptable symptomatic state. From a patient counseling and satisfaction standpoint, time to recovery is of high importance.

Diminished hip labral size and tissue quality may be a predictor of poor patient outcomes when a non-augmented primary labral repair is performed. Labral augmentation is an option for patients with hypoplastic or degenerative labral tissue. The optimal graft for augmentation has yet to be identified, and biomechanical research shows no difference in force to suction-seal disruption between dermal allograft and iliotibial band allograft when used to augment the labrum. However, time-zero biomechanical studies do not reflect the biological ability of the graft to heal to surrounding structures, revascularization of the graft, durability of the graft, hip capsular status, and response to functional demands of the patient.

PURPOSE/OBJECTIVE:To examine the associations between hip labral width and patient-reported outcomes, clinical threshold achievement rates, and rate of reoperation among patients with femoroacetabular impingement syndrome (FAIS) who underwent hip arthroscopy and labral repair at minimum 5-year follow-up. METHODS:Patients were identified from a prospective database who underwent primary hip arthroscopy for treatment of labral tears and FAIS. Modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) were recorded preoperatively and at 5-year follow-up. Achievement of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptom state (PASS) was determined using previously established values. Labral width MRI measurements were performed by two independent readers at standardized "clockface" locations. Patients were stratified into three groups at each position: lower-width (<½ SD below mean), middle-width (within ½ SD of mean), and upper-width (>½ SD above mean). Multivariable regression was used to evaluate associations of labral width with patient-reported outcomes and reoperation rate. RESULTS:Seventy-three patients (age: 41.0±12.0 years; 68.5% female) were included. Inter-rater reliability for labral width measurements was high at all positions (ICC: 0.94-0.96). There were no significant inter-group differences in mHHS/NAHS improvement (p>0.05) or in achievement rates of MCID/SCB/PASS at each clockface position (p>0.05). Eleven patients (15.1%) underwent arthroscopic revision and four patients (5.5%) converted to THA. Multivariable analysis found lower-width groups at 11:30 (OR: 1.75, p=0.02) and 3:00 (OR: 1.59, p=0.04) positions to have increased odds of revision within 5 years, however, labral width was not associated with 5-year improvement in mHHS/NAHS, achievement of MCID/PASS/SCB, or conversion to THA (p>0.05). CONCLUSION/CONCLUSIONS:Hip labral width <½ SD below the mean measured on preoperative MRI at 11:30 and 3:00 clockface positions was associated with increased odds of reoperation after arthroscopic labral repair and treatment of FAIS. Labral width was not associated with 5-year improvement of mHHS, NAHS, achievement of clinical thresholds, or conversion to arthroplasty. LEVEL OF EVIDENCE/METHODS:Level IV, case series.

PURPOSE/OBJECTIVE:To compare hip survivorship and patient-reported outcomes after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients with versus without comorbid borderline hip dysplasia (BHD) at 2-year follow-up. METHODS:A retrospective matched-cohort study was conducted involving patients who underwent primary hip arthroscopy for FAIS with a single surgeon from 2010 to 2019. BHD was defined as lateral center edge angle (LCEA) of 20 to 25°. Subjects with BHD were matched 1:2 to controls without BHD on age, sex, body mass index, and preoperative modified Harris Hip Score (mHHS). Alpha angle, LCEA, Tönnis angle, and acetabular retroversion signs were measured on preoperative and/or postoperative hip radiographs. Patient-reported outcomes were assessed using the mHHS and the Non-Arthritic Hip Score. Hip survivorship, outcome scores, and achievement of the minimum clinically important difference were compared between groups using the Mann-Whitney U test or Fisher exact test, as appropriate. P values <.05 were considered significant. RESULTS:Thirty-one BHD subjects (mean age 36.8 years, 71.0% female) and 62 controls (mean age 38.0 years, 71.0% female) were included. There were no significant intergroup differences in demographics or preoperative radiographic measurements besides LCEA and Tönnis angle (all P > .05). Intraoperatively, subjects with BHD were found to have significantly shorter labral tears (mean 2.6 vs 2.8 clock-face hours, P = .048), but there were no significant intergroup differences in acetabular or femoral cartilage status (all P > .05). Postoperatively, there were no significant intergroup differences in rates of revision arthroscopy (BHD 6.5% vs control 11.3%) or conversion to total hip arthroplasty (BHD 9.7% vs control 1.6%), in 2-year improvement of the mHHS and Non-Arthritic Hip Score, or in minimum clinically important difference achievement rates (all P > .05). CONCLUSIONS:BHD is not associated with a significant difference in hip survivorship or patient-reported outcomes following primary hip arthroscopy for FAIS. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative study.

PURPOSE/OBJECTIVE:The purpose of our study was to evaluate the impact of age, body mass index (BMI), and symptom duration on 5-year clinical outcomes among females following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS:We conducted a retrospective review of a prospectively collected database of hip arthroscopy patients with a minimum 5-year follow-up. Patients were stratified by age (<30, 30-45, ≥45 years), BMI (<25.0, 25.0-29.9, ≥30.0), and preoperative symptom duration (<1 vs ≥1 year). Patient-reported outcomes were assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Pre- to postoperative improvement in mHHS and NAHS was compared between groups using the Mann-Whitney U test or Kruskal-Wallis test. Hip survivorship rates and minimum clinically important difference (MCID) achievement rates were compared with Fisher exact test. Predictors of outcomes were identified using multivariable linear and logistic regression. P values <.05 were considered significant. RESULTS:In total, 103 patients were included in the analysis with a mean age of 42.0 ± 12.6 years (range, 16-75) and mean BMI of 24.9 ± 4.8 (range, 17.2-38.9). Most patients had symptoms of duration ≥1 year (60.2%). Six patients (5.8%) had arthroscopic revisions, and 2 patients (1.9%) converted to total hip arthroplasty by 5-year follow-up. Patients with BMI ≥30.0 had significantly lower postoperative mHHS (P = .03) and NAHS (P = .04) than those with BMI <25.0. Higher BMI was associated with reduced improvement in mHHS (β = -1.14, P = .02) and NAHS (β = -1.34, P < .001) and lower odds of achieving the mHHS MCID (odds ratio [OR] = 0.82, P = .02) and NAHS MCID (OR = 0.88, P = .04). Older age was predictive of reduced improvement in NAHS (β = -0.31, P = .046). Symptom duration ≥1 year was predictive of higher odds of achieving the NAHS MCID (OR = 3.98, P = .02). CONCLUSIONS:Female patients across a wide range of ages, BMIs, and symptom durations experience satisfactory 5-year outcomes following primary hip arthroscopy, but higher BMI is associated with reduced improvement in patient-reported outcomes. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative prognostic trial.