Faculty Bibliography

PURPOSE/OBJECTIVE:To determine if early PRO improvements in the 6 months after surgery are predictive of achieving a patient acceptable symptomatic state (PASS) at 2 years. METHODS:A prospectively collected database was retrospectively reviewed. Inclusion criteria included patients ≥ 18 years of age, Tonnis grade 0 or 1 changes, radiographic imaging consistent with FAI or labral pathology, a primary diagnosis of symptomatic FAI for which they underwent primary hip arthroscopy and had baseline, 6 month and 2 year modified Harris Hip Score (mHHS) scores. Revision cases were excluded. ROC curve analysis was conducted to determine if 6month changes in mHHS was a predictor for achieving PASS at 2 years. RESULTS:There were 173 patients (mean age: 39.8, 61.8% females) included within the study. Patients who do not achieve the minimal clinically important difference (MCID), defined as a change of 8 points in mHHS, by 6 months (n = 21) tended to have significantly lower mHHS scores at 1 year and 2 years compared to those that did (n = 152). Only 52% of patients that did not achieve MCID by 6 months achieved MCID by 2 years (vs. 98% for those that did) and only 24% achieved PASS by 2 years (vs. 88% that did). Using the MCID as a cutoff for improvement in mHHS at 6 months results in a 96% sensitivity but 47% specificity for predicting PASS achievement at 2 years. Using 24 points of improvement in mHHS as a cutoff at 6 months improves sensitivity and specificity to 81% and 80%, respectively. CONCLUSIONS:Early improvement in mHHS scores are associated with 2 year outcomes. Patients who do not achieve MCID within 6 months of surgery have a high rate of not achieving PASS at 2 years.

BACKGROUND/UNASSIGNED:Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. PURPOSE/UNASSIGNED:To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. STUDY DESIGN/UNASSIGNED:Systematic review; Level of evidence, 4. METHODS/UNASSIGNED:A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. RESULTS/UNASSIGNED:Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. CONCLUSION/UNASSIGNED:The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

PURPOSE/OBJECTIVE:The purpose of this study was to assess the prognostic effect of lumbar spinal stenosis on clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAI). METHODS:Patients undergoing hip arthroscopy between September 2009 to December 2015 for FAI with concomitant lumbar spinal stenosis (central/neuroforaminal) and a 2-year follow-up were identified (hip-spine). A 1:1 case-matching query using pre-operative modified Harris Hip Score (mHHS) within 3 points, body mass index (BMI) within 3 points, age within 5 years, and gender identified a control cohort without spinal pathology. Follow-up patient reported outcomes and clinical failure rates to revision procedure were compared using analysis of variance (ANOVA) and Kaplan-Meier survival analysis. RESULTS:, P=0.61; baseline mHHS: 44.27±2.82, P=0.98). ANOVA analysis demonstrated that all PROs improved from baseline to 2-year outcomes (P<0.001). The hip-spine versus control had lower 1-year (mHHS: 65.97±5.64 versus 85.04±3.09, P=0.006; nonarthritic hip score (NAHS): 70.26±5.71 versus 87.89±2.65, P=0.010) and 2-year (mHHS: 69.72±4.92 versus 84.71±2.56, P=0.007; NAHS: 72.23±5.18 versus 87.14±2.23, P=0.008) outcomes. While there was no difference in Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) rates at 1-year follow-up, the hip-spine group demonstrated lower PASS (42% versus 81%, P =0.004) and MCID (58% versus 88%, P=0.027) rates at 2 years. Although susceptible to type II error, there was no difference in clinical failure rates to revision procedure (P=0.13). CONCLUSION/CONCLUSIONS:While net PROs from baseline improve after hip arthroscopy for FAI, the presence of concomitant lumbar spinal stenosis negatively affects post-operative PROs. FAI patients with spinal stenosis should be counseled accordingly. LEVEL OF EVIDENCE/METHODS:III, case-control study.

Purpose/UNASSIGNED:To explore the relationship between generalized joint hypermobility and hip labrum width. Methods/UNASSIGNED:and Fisher exact testing as well as linear regression. Results/UNASSIGNED: = .004). Conclusions/UNASSIGNED:Patients with a BTS ≥4 were found to have significantly thinner labra than those with a BTS of <4. Level of Evidence/UNASSIGNED:III, retrospective comparative trial.

Symptomatic femoroacetabular impingement is one of the most common hip pathologies in young athletes. Intraoperative fluoroscopy is commonly used during hip arthroscopy to aid with portal placement and resection of the cam and pincer lesions. However, there are currently no universally agreed-on tools to allow for the assessment of adequacy of femoral and acetabular osteoplasty. Despite the general lack of consensus among hip arthroscopists, the senior author recommends using the femoroacetabular impingement resection arc to guide the adequacy of cam and pincer resection in hip arthroscopy. Using intraoperative fluoroscopy, one should aim to create a continuous "Shenton's line"-type arc along the inferior aspect of the anterior-inferior iliac spine and superolateral femoral neck base by resecting any bone that causes a break in the continuity of this arc.

PURPOSE/OBJECTIVE:To determine if any association exists between physical examination and/or imaging findings [ultrasound (US) and magnetic resonance imaging (MRI)] and IPT in order to characterize the reliability of these diagnostic modalities. METHODS:Patients who had undergone US-guided iliopsoas tendon sheath injection (of lidocaine and a corticosteroid agent) as well as MRI performed within one year of injection between 2014-2019 were retrospectively reviewed. Demographic data, response to physical exam maneuvers, and response to injection were queried from patient records. US and MRIs were reviewed by 2 independent musculoskeletal-trained radiologists. Response to injection was considered positive if the patient improved by >2 points on a 0-10 VAS score. Chi-square and Fischer exact testing was utilized to assess for any associations. Sensitivities, specificities, positive predictive values, and negative predictive values were calculated. RESULTS:Sixty-three patients, with mean age 52.3 years +/- 17.3, with average BMI 27.4 +/- 4.3, and average follow-up was 33.6 months +/- 20.6 met inclusion criteria. No physical exam maneuvers, sonographic features, or MRI findings were significantly associated with response to iliopsoas tendon injection (p>0.05). Groin pain had a sensitivity of 100%, though a specificity of 7%. Snapping hip had a specificity of 82%, though a sensitivity of 24%. Pain with resisted SLR (sensitivity 62%, specificity 25%), and weakness with resisted SLR (sensitivity 15%, specificity 71%) both were non-reliable. Sonographic bursal distension and tendinosis had low sensitivities (67% and 63%, respectively) and specificities (35% and 32%, respectively). Bursal distension on MRI had sensitivity and specificity of 64% and 45% respectively. Tendon thickening had sensitivity and specificity of 55% and 60%, respectively, while heterogeneity had sensitivity and specificity of 52% and 65%, respectively. CONCLUSION/CONCLUSIONS:Neither physical examination, nor US, nor MRI findings were associated with a positive response to peritendinous iliopsoas corticosteroid injections in patients with suspected IPT.

PURPOSE/OBJECTIVE:The purpose of the study is to determine if patients with coexisting lumbar back pain experience back pain improvement after undergoing hip arthroscopy for femoroacetabular impingement (FAI). METHODS:An IRB approved retrospective chart review compared patients undergoing hip arthroscopy for FAI with lumbar spine back pain to patients solely reporting hip pain. The modified Harris Hip Score (MHHS) and Nonarthritic Hip Score (NAHS) were recorded preoperatively and at 1-year follow up . The Oswestry disability score, which quantifies disability from lower back pain, and visual analog scale (VAS) were recorded from the Hip-Spine (HS) cohort alone. Statistical analysis was performed using paired sample t-tests with p≤ 0.05 considered significant. RESULTS:Sixty-eight patients who underwent hip arthroscopy between November 2016 and October 2018 were enrolled. Thirty-four patients with a mean age of 48.2 ± 14.0 years and BMI of 26.6 ± 6.6 had a history of back pain and 34 patients were age- and sex-matched for the Matched-Control (MC) cohort. The MC cohort had lower MHHS and NAHS scores preoperatively. The MC cohort reported a larger increase in the MHHS (p= 0.01) and NAHS scores (p= 0.01) postoperatively. More patients in the MC cohort reached MCID with MMHS (p=0.003) and NAHS (p=0.06). Following surgery, the HS cohort reported a lower Oswestry Disability score, indicating minimal disability (p= 0.01). CONCLUSION/CONCLUSIONS:Surgical intervention for FAI can lead to improvements in hip and back pain in patients with co-existing lumbar pathology.

Purpose/UNASSIGNED:To correlate patient-reported outcomes (PROs) and minimal clinically important difference (MCID) achievement rates after hip arthroscopy for femoroacetabular impingement syndrome (FAI). Methods/UNASSIGNED:linically diagnosed FAI who underwent primary hip arthroscopy from September 2012 to March 2014 with a minimum of 5-year outcomes were identified. Patients undergoing labral debridement, microfracture, bilateral procedures, with evidence of dysplasia, Tönnis grade >1, and joint space <2 mm were excluded. Analysis of variance was used to compare PROs. Survival rates were determined using Kaplan-Meier analysis. Regression analysis identified associations with modified Harris Hip Scores (mHHS), minimal clinically important difference (MCID) rates, and Nonarthritic Hip Scores (NAHS). Results/UNASSIGNED: = .010) with 5-year outcomes. Conclusions/UNASSIGNED:There is a decline in MCID at 5-year follow-up after hip arthroscopy for FAI. Lower BMI, younger age, and cam resection are associated with positive outcomes. There is excellent index procedure survivability and excellent total hip arthroplasty prevention rate. Level of Evidence/UNASSIGNED:Level IV.

Purpose/UNASSIGNED:To investigate what effect decreased opioid prescribing following hip arthroscopy had on Press-Ganey satisfaction survey scores. Methods/UNASSIGNED:A retrospective review of prospectively collected data was conducted on patients who underwent primary hip arthroscopy for femoroacetabular impingement between October 2014 and October 2019. Inclusion criteria consisted of complete Press-Ganey survey information, no history of trauma, fracture, connective tissue disease, developmental hip dysplasia, autoimmune disease, or previous hip arthroscopy. Groups were separated based on date of surgery relative to implementation of an institutional opioid reduction policy that occurred in October 2018. Prescriptions were converted to milligram morphine equivalents (MME) for direct comparison between different opioids. Results/UNASSIGNED:> .05). Conclusions/UNASSIGNED:A reduction in opioids prescribed after a hip arthroscopy is not associated with any statistically significant difference in patient satisfaction with pain management, as measured by the Press-Ganey survey. Level of Evidence/UNASSIGNED:Level III, retrospective comparative study.

Intraarticular corticosteroid injections are commonly administered by physicians to provide analgesia for acute athletic injuries, though there is an increasing body of literature that has illuminated substantial risks to the soft tissues. A review of Clinical Key, MEDLINE, and PubMed databases from 2012 to 2020 was performed using search terms, including corticosteroid, shoulder arthroscopy, knee arthroscopy, hip arthroscopy, intraarticular, and injections. The references of pertinent articles were reviewed for other relevant sources. Corticosteroid injections can provide reliable pain control in athletes for various pathologies affecting the shoulder, knee, and hip. The use of these medications has demonstrated efficacy in some disorders, whereas the clinical benefit for others remains questionable. Intraarticular injections to the shoulder, knee, and hip are all associated with increased risks to the soft tissues, which must be considered and weighed heavily, especially in an athlete. Perioperative corticosteroids confer an increased risk of surgical site infection after knee, shoulder, and shoulder arthroscopy. Subacromial injections confer an increased risk for revision rotator cuff repair if given within 6 months of surgery, but are safe if given at least 1 month postoperatively. Hip injections for chondral pathology perform significantly better than those for labral injuries.
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