Faculty Bibliography

Acetabular rim fractures can accompany patients with femoroacetabular impingement. Frequently, the acetabular rim fracture is excised. However, if the osseous fragment of the acetabular rim fracture is large enough to result in instability, then the acetabular rim fracture should be reduced and secured with internal fixation. The purpose of this technical note was to describe the arthroscopic technique of internal fixation of an acetabular rim fracture.

PURPOSE/OBJECTIVE:The purpose of this study was to determine and establish the MCID for the NAHS at 2 years in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS:Patients that underwent primary hip arthroscopy for FAIS between 2010 and 2016 were analyzed for eligibility. Data were collected from a single surgeon's hip arthroscopy database. MCID was calculated for the NAHS utilizing a distribution-based method. RESULTS:. At baseline, the cohort's average NAHS score was 48.7 ± 13.6 and demonstrated an improvement of 36.5 ± 17.0 for NAHS at follow-up. This resulted in MCID values of + 8.5 for NAHS. CONCLUSION/CONCLUSIONS:This is the first study to report the MCID (+ 8.5) for NAHS following primary hip arthroscopy, and as such, is a valuable contribution to future hip arthroscopy research. LEVEL OF EVIDENCE/METHODS:IV.

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:Previous research has demonstrated that there is a statistically significant relationship between hip arthroscopy outcomes and age. The purpose of this research was to investigate the link, if any, between hip arthroscopy outcomes and intraoperative pathology as well as with both patient age and sex. METHODS:All male patients 14 years of age or older who underwent primary hip arthroscopy for femoroacetabular impingement (FAI) and who had a 2-year patient-reported outcome scores were analyzed. These patients were separated into three age-based cohorts (< 30 years old, 30 to 45 years old, and > 45 years old). These cohorts were then analyzed and compared with respect to patient demographic information, intraoperative pathology, and functional outcome scores for statistical significance, set at p < 0.05. RESULTS:At 2-year follow-up, there was a significant difference seen between the modified Harris Hip scores (mHHS) of the < 30 years old and > 45 years old cohorts with a mean difference of 10.2 (92.05 ± 10.3 and 81.89 ± 16.7, p = 0.044). The results of an ANOVA comparing 2-year non-arthritic hip scores (NAHS) were not statistically significant (p = 0.196). At 2-year follow up, the NAHS scores were 92.18 ± 10.3, 87.76 ± 15.6, and 84.63 ± 15.9 for the < 30 years old, 30 to 45 years old, and > 45 years old cohorts, respectively. When analyzing cohorts for rates of achieving a minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS), however, there were no statistically significant differences between groups. CONCLUSIONS:The results of this study suggest that males of all ages have generally good and similar outcomes following hip arthroscopy for FAI as determined by their similar rates of achieving both MCID and PASS.

Purpose/UNASSIGNED:The purpose of this study was to systematically review the evidence in the literature to ascertain whether acetabular labral repair (ALR) or debridement (ALD) resulted in superior patient outcomes. Methods/UNASSIGNED:value <.05 was considered to be statistically significant. Results/UNASSIGNED:There were 8 studies included (level of evidence [LOE] I = 1; LOE II = 2; LOE III = 5). The 7 studies compared 364 patients (369 hips) with ALR to 318 patients (329 hips) with ALD, with a mean follow-up time ranging between 32-120 months. Five studies found significantly improved patient reported outcomes with ALR (Harris Hip Score, Merle d'Aubigné, Pain, SF-12). Several studies compared the outcomes after ALR and ALD and found statistical significance in all investigated metrics in favor of ALR. One study found a significant improvement in abduction but no other study found any difference in range of motion. No study found any difference in complication rate, revision rate or conversion to total hip arthroplasty. Although, 2 studies found ALR reduced the rate of osteoarthritic progression. Conclusion/UNASSIGNED:Current literature suggests that acetabular labral repair may result in superior patient reported outcomes. However, there appears to be no significant difference in the rate of progression to total hip arthroplasty at up to 10-year follow-up. Level of Evidence/UNASSIGNED:Level III, systematic review of Level I, II, and III studies.

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/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.

PURPOSE/OBJECTIVE:To evaluate the association between postoperative cam lesion measured by the "femoroacetabular impingement resection (FAIR) arc" and 2-year patient outcomes following hip arthroscopy. METHODS:A retrospective review of prospectively gathered data from 2013-2017 was performed. All patients who underwent hip arthroscopy for FAI with ≥ 2-year follow-up were included. Cam FAIR arc measurements were made pre and postoperatively on a 45° Dunn view radiograph. The clinical effect of postoperative cam maximal radial distance (MRD) was assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Patients were divided into subgroups based on relationship to the mean and standard deviations for cam MRD. One half standard deviation above the mean was found to be 3.15 mm. RESULTS:=0.004). Subgroup analysis demonstrated that patients in the cam MRD < 3.15 mm group had significantly higher mHHS (89.7 vs 70.0 p<0.001) and NAHS scores (90.5 vs 72.9, p<0.001) than those in the >3.15 mm group. Additionally, more patients in the <3.15 mm group reached the minimal clinically important difference (MCID) (95.2% vs 78.9%, p=0.048) and were above patient acceptable symptomatic state (PASS) (95.2% vs 52.6%, p<0.001) compared to the >3.15 mm group. CONCLUSION/CONCLUSIONS:Patients with a lower postoperative cam MRD relative to the FAIR arc demonstrated significantly improved outcomes as compared to those with higher postoperative MRD at two-year follow-up.