Faculty Bibliography

Purpose: Though Femoroacetabular impingement (FAI) is thought of as primarily a hip condition an increasing body of evidence has demonstrated the existence of a relationship between the hip joint and lumbopelvic spine, termed the hip-spine syndrome (HSS). This review will provide an overview of the relevant pelvic parameters, proper HSS patient evaluation, describe how lumbar pathology may mechanistically affect the hip, provide a literature review of biomechanic and outcome papers exploring the subject, and finally investigate potential interventions that can be considered in these challenging patients. Recent Findings: Deviations from normal ranges in pelvic parameters have been shown in biomechanical studies to worsen FAI by decreasing the range of impingement free motion. The clinical relevance of this is still being determined. Patients with concomitant lumbar spine pathology may significantly improve after hip arthroscopy, though they may have a lower ceiling than comparable patients without lumbar spine pathology. Summary: Surgeons and patients should be aware of the HSS. Alterations in pelvic parameters may affect outcomes, though this still has to be determined. Patients with lumbar spine pathology and FAI can still be treated successfully with hip arthroscopy, though should be counseled appropriately.

Osteotomies around the knee-including distal femoral osteotomies, high tibial osteotomies, and tibial tubercle osteotomies-are technically demanding procedures that are generally safe, with relatively low overall complication rates. However, complications do occur and can pose significant challenges, with substantial implications for patient outcomes. Awareness of potential complications and meticulous surgical technique are, therefore, essential to minimizing risk. This review highlights the most clinically relevant complications unique to knee osteotomies. These include vascular injury, hinge and shingle fractures, delayed union or nonunion, femur and tibia fractures, and infection. For each complication, contributing patient and surgical factors are examined, along with an emphasis on strategies for prevention and proposed treatment management algorithms. By combining preventive strategies with structured management guidance, this review aims to serve as a practical reference for optimizing outcomes and reducing the morbidity associated with knee osteotomies.

Hip arthroscopy has grown exponentially over the past decade, with a parallel rise in revisions, underscoring the importance of refined patient selection and diagnostic accuracy. This review outlines the most common causes of failure after primary hip arthroscopy and provides a framework for evaluation, imaging, and management. Notably, differentiating between impingement and instability is crucial, as misclassification can worsen outcomes. Revision procedures may provide clinically meaningful improvement in patient-reported outcomes and delay total hip arthroplasty in well-selected patients. However, recognizing when to shift from preservation to replacement is key to optimizing outcomes.

PURPOSE/OBJECTIVE:To systematically review and meta-analyze cadaveric studies quantifying the medial patellofemoral ligament (MPFL) femoral attachment site using radiopaque markers on radiographs to evaluate the accuracy of Schöttle's point as a radiographic landmark for MPFL attachment. METHODS:A systematic review and meta-analysis was performed of the PubMed, EMBASE, and Scopus databases to identify cadaveric studies reporting the radiographic position of the MPFL femoral attachment. Included studies reported attachment location relative to the posterior cortical extension line in the anterior-posterior direction and to either the posterior point of Blumensaat's line or another radiographic landmark in the proximal-distal direction. The distance between Schöttle's point and other mean radiographic locations were calculated; distances greater than 3 mm, the radius of a femoral surgical tunnel, represented substantial variation. RESULTS:Nine studies of 94 cadaveric knees were included in the final analysis with a mean age of 62.45 ± 11.64 years. The average distance from the posterior cortical extension line to the MPFL insertion was 1.04 ± 10.09 mm anterior [95% CI: 0.40, 2.28, range: 4.80 mm posterior to 8.80 mm anterior] (n = 94). The average distance from Blumensaat's line was 2.07 ± 5.06 mm proximal [95% CI: 1.12, 2.00, range: 0.90 mm distal to 4.70 mm proximal] (n = 77). Three studies reported mean distance from the condylar transition line, averaging 2.88 ± 6.02 mm distal [95% CI: -5.04, -0.54, range: 0.50-5.70 mm distal] (n = 25). CONCLUSIONS:There was substantial heterogeneity in the radiographic location of the MPFL attachment, which suggests that relying solely on Schöttle's point risks nonanatomic tunnel placement. CLINICAL RELEVANCE/CONCLUSIONS:Although Schöttle's point is commonly used as a radiographic landmark during MPFL reconstruction, its variability suggests that the utilization of additional methods of assessment such as clinical palpation and graft isometry evaluation may enhance surgical precision and outcomes.

OBJECTIVE:We assembled a workgroup within the Pediatric Research Collaborative on Critical UltraSound (PeRCCUS), a subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), to define early guidance for point-of-care ultrasound (POCUS) institutional practice and foster future comprehensive guidelines for its broad adoption in pediatric critical care medicine. DESIGN/METHODS:A modified Delphi method was used for creating the statements. The first meeting was an open proposal session for workgroup members to suggest items for consideration. This was followed by a cycle of voting for levels of agreement along a 7-point Likert-type scale. Items were reviewed, with only items receiving a score of greater than or equal to 6 progressing to the next stage of voting and lower-scoring items reconsidered, with only consensus items proceeding to the next stage for additional rounds of voting until consensus was reached. SETTING/METHODS:Multi-institutional, multidisciplinary, workgroup of experts on POCUS organized within PeRCCUS as a subgroup of PALISI. INTERVENTIONS/METHODS:None. MEASUREMENTS AND MAIN RESULTS/RESULTS:Consensus was obtained for 25 recommendations across five domains: clinical application, quality assurance, equipment, education, and research. CONCLUSIONS:We report consensus recommendations for institutions on clinical use, educational programs, quality assurance, technical requirements, and future research opportunities for the adoption of pediatric critical care medicine POCUS.

Hip arthroscopy femoroacetabular impingement syndrome continues to evolve, changing trends and constant pendulum swinging. While hip arthroscopy initially was performed with a capsulectomy, fastidious capsular management has became the norm over the last decade. Recently, the utility of routine capsular closure has again been called into question, with several studies finding minimal differences between repaired and unrepaired cohorts. Like most controversies in orthopaedics, the answer is likely nuanced, and a one-size-fits-all approach should be spurned in favor of patient-specific and capsulotomy technique-specific considerations. However, while capsule repair may not be required in every patient, the downside of closure is minimal and our understanding of the hip imperfect. Select patients that receive interporal capsulotomies may do well with an unrepaired capsule, but a high degree of caution should be used if considering this.

BACKGROUND:Inflammatory biomarkers in an injured knee have been shown to predict outcomes, yet the role of the subsequent systemic inflammatory response to injury remains poorly understood. PURPOSE/OBJECTIVE:To investigate whether synovial fluid (SF) biomarkers from the contralateral uninjured knee could predict long-term patient-reported outcomes (PROs) for the operative knee in patients undergoing arthroscopic knee surgery. STUDY DESIGN/METHODS:Case series; Level of evidence, 4. METHODS:This retrospective analysis included patients undergoing knee SF aspiration before arthroscopy with ≥8 years of follow-up. SF was aspirated from both the injured and healthy contralateral knees, and concentrations of 10 pro- and anti-inflammatory biomarkers were quantified. Patients completed visual analog scale (VAS) for pain score, Lysholm, Tegner, and Knee injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS) surveys preoperatively and at the final follow-up. Stepwise linear regression was performed to identify the most significant predictor(s) of PRO scores utilizing log-normalized contralateral biomarker concentration, age, body mass index, injury type, and Outerbridge grade as covariates. Concentrations from the contralateral knee were also compared with the injured knee to assess for correlations. RESULTS:= .006) score at the final follow-up. Contralateral concentrations of monocyte chemotactic protein 1, macrophage inflammatory protein 1β, vascular endothelial growth factor, and TIMP-1 were correlated with levels in the operative knee but at significantly lower concentrations. CONCLUSION/CONCLUSIONS:SF biomarker levels in the contralateral uninjured knee at the time of arthroscopy were predictive of long-term outcomes for the operative knee. Increased levels of pro-inflammatory biomarkers were predictive of worse outcomes, while anti-inflammatory cytokines predicted improved scores. These results suggest that unilateral knee injury can result in a broader systemic inflammatory response that influences long-term outcomes in patients.

BACKGROUND:Hip arthroscopy has demonstrated favorable short- and mid-term outcomes for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD). However, long-term outcomes in patients with FAIS and BHD treated with hip arthroscopy remain understudied. PURPOSE/OBJECTIVE:To evaluate hip survivorship and patient-reported outcomes (PROs) in patients with FAIS and BHD compared with those without BHD at a minimum 10-year follow-up. STUDY DESIGN/METHODS:Cohort Study; Level of evidence, 4. METHODS:A retrospective matched-cohort study was conducted on patients undergoing primary hip arthroscopy for FAIS by a single surgeon (2012-2024). BHD was defined as a lateral center-edge angle (LCEA) of 20° to 25°. Patients with BHD were matched 1 to 2 to controls without BHD based on age, sex, body mass index, and preoperative modified Harris Hip Score (mHHS). Radiographic parameters (eg, alpha angle, LCEA) were assessed pre- and postoperatively. PROs-including mHHS, Non-Arthritic Hip Score (NAHS), and hip survivorship (revision arthroscopy, conversion to total hip arthroplasty [THA])-were compared. RESULTS:= .01). CONCLUSION/CONCLUSIONS:At a minimum 10-year follow-up, patients with BHD who underwent hip arthroscopy for FAIS achieved comparable PROs and hip survivorship to those without BHD. These findings support the use of hip arthroscopy as a durable and effective treatment for FAIS in this population.

PURPOSE:Though Femoroacetabular impingement (FAI) is thought of as primarily a hip condition an increasing body of evidence has demonstrated the existence of a relationship between the hip joint and lumbopelvic spine, termed the hip-spine syndrome (HSS). This review will provide an overview of the relevant pelvic parameters, proper HSS patient evaluation, describe how lumbar pathology may mechanistically affect the hip, provide a literature review of biomechanic and outcome papers exploring the subject, and finally investigate potential interventions that can be considered in these challenging patients. RECENT FINDINGS:Deviations from normal ranges in pelvic parameters have been shown in biomechanical studies to worsen FAI by decreasing the range of impingement free motion. The clinical relevance of this is still being determined. Patients with concomitant lumbar spine pathology may significantly improve after hip arthroscopy, though they may have a lower ceiling than comparable patients without lumbar spine pathology. SUMMARY:Surgeons and patients should be aware of the HSS. Alterations in pelvic parameters may affect outcomes, though this still has to be determined. Patients with lumbar spine pathology and FAI can still be treated successfully with hip arthroscopy, though should be counseled appropriately.