Acetabular Cartilage Research Articles (Page 1)

Femoroacetabular impingement (FAI) and hip dysplasia have been shown to increase the risk of hip osteoarthritis in affected individuals. MRI with T2 mapping provides an objective measure of femoral and acetabular articular cartilage tissue quality. This study aims to evaluate the relationship between hip morphology measurements collected from three-dimensional (3D) reconstructed computed tomography (CT) scans and the T2 mapping values of hip articular cartilage assessed by three independent, blinded reviewers on the optimal sagittal cut. Hip morphology measures including lateral center edge angle (LCEA), acetabular version, Tönnis angle, acetabular coverage, alpha angle, femoral torsion, neck-shaft angle (FNSA), and combined version were recorded from preoperative CT scans. The relationship between T2 values and hip morphology was assessed using univariate linear mixed models with random effects for individual patients. Significant associations were observed between femoral and acetabular articular cartilage T2 values and all hip morphology measures except femoral torsion. Hip morphology measurements consistent with dysplastic anatomy including decreased LCEA, increased Tönnis angle, and decreased acetabular coverage were associated with increased cartilage damage (p < 0.001 for all). Articular cartilage T2 values were strongly associated with the radiographic markers of hip dysplasia, suggesting hip microinstability significantly contributes to cartilage damage. The relationships between hip morphology measurements and T2 values were similar for the femoral and acetabular sides, indicating that damage to both surfaces is comparable rather than preferentially affecting one side.

BackgroundCam morphology is associated with acetabular cartilage lesions and early-onset osteoarthritis in patients with femoroacetabular impingement syndrome. Here, we propose a novel iterative rabbit model of cam morphology to characterize the pathophysiology of femoroacetabular impingement-related cartilage lesions.MethodsWe described a repeatable method for establishing a New Zealand white rabbit model of cam morphology by interfering with the epiphyseal tubercle and evaluated the histological outcomes of acetabular cartilage lesions. Cam morphology and subchondral bone were evaluated by micro-CT scanning. The expression of anabolic and catabolic biomarkers of acetabular cartilage was investigated via western blotting and immunohistochemical staining. Chondrocyte apoptosis was detected via TUNEL staining. Kinematics of the hip joint in the sagittal plane were evaluated by a passive optical motion capture system.ResultsThere were remarkable pathological similarities between this model and human diseases. The cam morphology rabbit model exhibited early cartilage degeneration and subsequent phenotypes of hip osteoarthritis, and this pathological process is not affected by surgical trauma. Hip motion in the cam morphology models resembled that in the healthy controls, and had only a slightly lower joint angle at all phases of the half-bounding gait cycle. This model preserved the natural and predictable movement pattern.ConclusionsThis rabbit model of cam morphology replicates the disease phenotype and allows for scientifically sound evaluation of disease mechanisms. It can be employed to study human cam-type femoroacetabular impingement syndrome.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12891-025-09194-7.

BackgroundDevelopmental dysplasia of the hip (DDH) in toddlers (9–18 months) presents unique challenges due to incomplete ossification and anatomical complexity. Traditional imaging modalities, including x-ray, CT, arthrography, and ultrasonography, have limitations in assessing reduction quality. This study introduces a novel approach using only two magnetic resonance imaging (MRI) parameters-axial acetabular femoral head distance (aAFD) and coronal acetabular cartilage head index (CAHI)-to evaluate the quality of closed reduction (CR) and identify risk factors for redislocation.MethodsWe retrospectively reviewed 51 patients (58 hips) who underwent CR for DDH from June 2014 to June 2021. Pre- and post-CR pelvic radiographs assessed dysplasia grade, acetabular index (AI), and avascular necrosis (AVN). MRI, performed within three days post-CR, evaluated hip reduction quality using aAFD and CAHI. The reliability of these indices and their association with redislocation risk were analyzed.ResultsThe study cohort had a mean age of 13.7 ± 2.6 months and an average follow-up of 58.4 ± 13.5 months. CR was successful in 50 hips (86.2%), while 8 hips (13.8%) failed. Compared to failed cases, successful reductions showed significantly lower aAFD (2.4 ± 0.88 mm vs. 5.12 ± 1.70 mm, p < 0.05) and higher CAHI (83.4 ± 3.5% vs. 68.7 ± 4.9%, p < 0.05). AVN was observed in 10 hips (17.2%). Both aAFD and CAHI demonstrated strong intra- and interobserver reliability. ROC curve analysis showed excellent predictive accuracy for CAHI (AUC = 0.990) and aAFD (AUC = 0.968), with optimal thresholds aligning closely with the proposed cutoffs. Univariate analysis identified higher preoperative IHDI grade (p = 0.022) and more severe AVN (p < 0.01) as significant predictors of CR failure.ConclusionsClosed reduction with spica casting remains an effective treatment for DDH in toddlers. Postoperative MRI evaluation using only aAFD and CAHI offers a reliable and clinically applicable method for assessing reduction quality. Larger aAFD and lower CAHI values indicate a higher risk of reduction failure, making these indices valuable for postoperative assessment and decision-making.

This study investigated the effect of stride size on hip joint contact mechanics and wear using motion capture and finite element analysis. In a healthy volunteer, larger strides increased hip flexion and abduction angles, acetabular cartilage pressure (from 5.682 to 5.800 MPa), and contact area. Wear caused anterior-lateral migration and expansion of high-stress regions in both walking and running. These biomechanical changes may raise the risk of anterolateral acetabular pathology. Small strides are therefore recommended for individuals at risk of hip disease or in postoperative rehabilitation, supporting prevention, rehabilitation, and clinical treatment planning.

Background and Aims In patients with developmental dysplasia of the hip, shelf acetabuloplasty is a common surgical procedure aimed at improving the coverage of the acetabulum over the femoral head. So far, shelf acetabuloplasty has not been performed using preoperative planning, aiming to optimize morphological and biomechanical parameters and evaluate the design with finite element analysis. This study aims to conduct a finite element analysis of the hip joint before and after shelf acetabuloplasty, contingent upon optimizing biomechanical and morphological parameters during preoperative planning. In these patients, inadequate coverage can lead to stress concentration in the articular cartilage due to reduced weight-bearing area, resulting in osteoarthritis. Methods The case study is a patient with challenging right hip dysplasia whose preoperative planning was performed in a 3-D environment to optimize the morphological and biomechanical parameters of the patient’s hip joint. The joint force was calculated after extracting 3-D models, aligning the pelvis in the functional coordinate system, and registering the femur on the patient’s standing radiograph. Then, the stress distribution on the articular surface of the acetabulum before and after surgery was investigated, considering soft tissue and using the finite element method. Results Finite element analysis indicated that the maximum von Mises stress on the acetabular articular surface decreased from 4.86 MPa preoperatively to 3.17 MPa postoperatively, representing a reduction of 34.77%. Additionally, the contact pressure on the acetabular cartilage was reduced from 5.94 MPa preoperatively to 3.77 MPa postoperatively, equivalent to a decrease of 36.53%. Conclusion The results showed that preoperative planning, aimed at improving morphological and biomechanical parameters, can postoperatively reduce stress in the articular surfaces and contact pressure in the acetabular cartilage.

No Difference in Responders and Nonresponders to Preoperative Intra-articular Corticosteroid Injection Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome at 10 Years: A Matched Analysis.

Deep learning-based acceleration of high-resolution compressed sense MR imaging of the hip.

Femoro-acetabular impingement (FAI) is a possible mechanism for the development of early osteoarthritis. FAI occurs when there is a conflict between the rim of the acetabulum and the femoral neck, usually due to irregularities of the proximal femur or acetabulum. Our aims were to compare the diagnostic efficacy of computed tomography arthrography (CTA) without traction, CTA with traction, and magnetic resonance arthrography (MRA) for the detection and grading of chondral and labral lesionsin patients with a clinically positive impingement testand to determine the correlation between imaging findings and arthroscopic data in patients who had undergone surgery. This monocentric, observational, retrospective study was conductedon 95 consecutive patients referred to our imaging department with clinical symptoms suggestive of FAI between January 2012 and May 2023. A total of 21 patients underwent therapeutic arthroscopy after the failure of medical treatment. These patients underwent either CTA without traction, CTA with traction, or MRA. Chondral and labral lesions were assessed by two musculoskeletal radiologists who were unaware of the original arthroscopy findings and interpretations. The modified MAHORN (Multicenter Arthroscopy of the Hip Outcomes Research Network) classification was used for grading during imaging and surgery. There was no significant difference between the examination techniques for the diagnosis of labral lesions (p=0.1737). Cartilage lesions preferentially affected the acetabular side compared to the femoral side, with no significant difference between the examination techniques for the diagnosis of chondral lesions (p=0.1429 for femoral cartilage, p=0.0944 for acetabular cartilage). No significant difference was found between the imaging and surgical data for the diagnosis of labral and cartilage lesions, even when the three imaging techniques were combined (labrum, p=0.1797; acetabular cartilage, p=0.0588; femoral cartilage, p=0.6547). No significant difference was found between CTA without traction, CTA with traction, and MRA procedures for the detection and grading of chondral and labral lesions. Furthermore, there was no significant difference between the imaging and surgical data when the three imaging techniques were combined.

Three or More Revision Hip Arthroscopy Surgeries Is More Common in Female Patients and High-Grade Acetabular Chondral Lesions Lead to Increased Risk of Failure

BACKGROUND Developmental dysplasia of the hip (DDH; congenital dislocation of the hip, or hip dysplasia) in infants and children occurs when the joint does not properly form. The group 1 Crowe classification of DDH includes <50% subluxation. This study aimed to evaluate 26 hips in 16 adolescents and young adults aged 13-35 years with Crowe group I DDH who underwent periacetabular osteotomy, with a mean follow-up of 4.5 years. MATERIAL AND METHODS Sixteen patients (26 hips; age 13-35 years) with Crowe group I DDH underwent PAO from 2015 to 2019, with a mean follow-up of 4.5 years. Evaluations included clinical indices (Harris hip score, visual analog scale [VAS] pain scores), radiographic parameters (center-edge angle, vertical-center-anterior angle, acetabular index, Sharp angle, Shenton line continuity, acetabular sourcil length), CT angles (horizontal acetabular-sector angle [HASA], anterior acetabular-sector angle [AASA], posterior acetabular-sector angle [PASA]), and MRI measurements of acetabular cartilage length and area. RESULTS Postoperative Harris hip scores significantly improved (71.65±5.42 to 87.12±4.47, P<0.05), and VAS pain scores significantly decreased (5.12±1.33 to 2.24±0.77, P<0.05). Radiographic parameters (center-edge angle, vertical-center-anterior angle, acetabular index, Shenton line continuity), CT angles (HASA, PASA, AASA), and MRI measurements of cartilage length (25.32±8.11 mm to 29.81±8.14 mm, P<0.05) and area (613.73±119.37 mm² to 710.02±117.17 mm², P<0.01) significantly improved. CONCLUSIONS Periacetabular osteotomy significantly improved short-term clinical outcomes, acetabular coverage, and cartilage morphology in the weight-bearing region in patients with Crowe group I DDH. The observed increases in acetabular sourcil length and cartilage dimensions suggest biomechanical improvements, potentially delaying osteoarthritis progression.

Associations between hip cartilage lesions and morphologic parameters of bony structures in a cohort of Asian patients with labral tears measured using a computed tomography-based software system.

Abstract Introduction: Femoroacetabular impingement (FAI) and hip dysplasia have been shown to increase the rate of hip osteoarthritis in affected individuals. Development of T2 mapping technology on MRI allows for an objective measure of the quality of femoral and acetabular articular cartilage. This study examines the relationship between radiographic markers of FAI or dysplasia with T2 mapping values of hip articular cartilage. Methods: This retrospective study included patients with a preoperative T2 mapping MRI who underwent hip labral repair or reconstruction at a single institution between 3/2021-2/2023. As described in a prior study by the same authors, T2 mapping values were obtained by three reviewers blinded to patient information using Syngo.via software to each provide three separate sequencing analyses on each patient’s optimal T2 sagittal cut. A blinded reviewer used three-dimensional CT analysis to record lateral center edge angle (LCEA), acetabular version, Tonnis angle, acetabular coverage, alpha angle, femoral torsion, and neck-shaft angle (FNSA). Univariate Mixed Linear Models were created to evaluate the effect of the various radiographic measures on the T2 mapping values. Results: 63 hips were included in the analysis. Participants were 14-50 years-old with 35 females and 28 males. There was a correlation between nearly all radiographic parameters and the T2 mapping value for acetabular and femoral articular cartilage. Parameters that are known markers of FAI (increased LCEA, acetabular coverage, alpha angle and decreased acetabular version, Tonnis angle) resulted in lower T2 mapping values for articular cartilage on both the femoral and acetabular sides. Combined version (femoral torsion plus acetabular version) had a positive correlation with acetabular cartilage mapping values but not with the femoral cartilage values. There were no other significant differences between femoral and acetabular articular cartilage with regard to their correlation with radiographic parameters. Conclusions: There is a consistent correlation between hip articular cartilage T2 mapping values and radiographic markers of dysplasia and FAI. Markers of more severe dysplasia correlate with increased T2 mapping values, indicating more articular damage, and there is minimal difference on the impact of femoral cartilage compared to acetabular cartilage.

Abstract Background: Acetabular cartilage delamination is commonly seen in Femoroacetabular impingement (FAI) patients, especially ones with the Cam deformity. However, the definition and classification of acetabular cartilage injuries caused by FAI are still remain controversial to guide clinical treatment. Moreover, treatment of acetabular cartilage damage always puts a surgeon into a dilemma situation during surgery. We believe a reliable repair of the acetabular cartilage delamination will lead to a better long-term outcome for FAI patients. Herein, we introduce the chondral nail fixation under hip arthroscopy for treating acetabular cartilage delamination in FAI patients. This technique contributes to eliminating intra-articular unstable factors, preserving native cartilage as much as possible, and restoring cartilage surface intact at best. Video: Acetabular cartilage delamination is commonly seen in FAI patients, especially ones with the Cam deformity. The definition, classification, and treatment of acetabular cartilage injury caused by FAI still remain controversial to guide clinical work. We believe a reliable repair of the acetabular cartilage delamination will lead to a better long-term outcome for FAI patients. Here, we introduce the absorbable chondral nail fixation under hip arthroscopy for treating acetabular cartilage delamination in FAI patients. This technique contributes to eliminating intra-articular unstable factors, preserving native cartilage as much as possible, and restoring cartilage surface intact at best. In this video, we will describe the surgical procedures of the chondral nail fixation technique in detail.

Abstract Introduction: Surgical efficacy for hip labral repairs remains difficult for orthopedic hip surgeons to determine pre-operatively. Radiographic measurements may help predict which patients can benefit the most from repair before surgery. Quantitative T2 magnetic resonance imaging (MRI) has emerged as a modality to differentiate healthy tissue from damaged tissue. This study aimed to assess the correlation between T2 MRI mapping values of the labrum, acetabulum cartilage, and femoral head cartilage and patients’ iHOT-12 scores before and after labral repair or reconstruction. We hypothesized that patients with higher T2 mapping values, indicative of more soft tissue damage, would possess lower pre- and post-op iHOT-12 scores. Methods: This retrospective comparative study included patients with preoperative MRI who underwent labral repair or reconstruction at a single institution between 3/2021 and 2/2023. As described in a prior study by the same authors, T2 mapping values were obtained by three blinded reviewers providing sequencing analyses on each patient’s optimal T2 sagittal cut. Pre-op, 3-month post-op, and 6-month post-op iHOT-12 scores were collected, and Univariate Mixed Linear Models were created to evaluate the correlation between iHOT-12 scores and T2 mapping values. Results: 63 operations were included: 14 reconstructions and 49 repairs. Participants were 14-50 years old with 35 females and 28 males. Inter-rater reliability was deemed moderate for measuring the labrum, acetabulum cartilage, and femoral cartilage. A statistically significant trend emerged between lower labral and acetabulum mapping values [healthier tissue] and higher pre-op iHOT-12 scores (p = 0.015 &amp; p = 0.027, respectively). Femoral mapping values, however, did not exhibit this pre-op association. At 3-month post-op, a significant relationship was also shown between lower labral values and higher iHOT-12 scores (p = 0.005; β = - 0.0509), whereas acetabular and femoral values showed no correlation. No significant trends were identified at 6-month post-op with any T2 mapping values. Conclusions: While increased T2 mapping values are associated with worse pre-operative patient-reported outcomes, they do not seem to have the same impact in the short-term post-operative period following hip labral repair or reconstruction.

Abstract Background: Minced Cartilage is increasingly used for treating focal acetabular and femoral cartilage defects. In this procedure, autologous cartilage is harvested from the femoral neck or from the chondral flap, minced into small pieces and re-implanted into the defect. The question is whether minced cartilage is already a standardized procedure. Methods: A systematic literature review was conducted in PubMed, Embase, and Google Scholar to include all studies (clinical trials, animal studies and basic research) investigating minced cartilage for the treatment of focal cartilage defects. Subsequently, the following surgical methods were compared: cartilage harvesting, cartilage mincing, cartilage fixation, cartilage coverage using matrices, and augmentation with autologous blood products. The aim of this systematic review is to identify which surgical method has the most evidence. Results: After applying the selection criteria, the following studies were included: 6 clinical trials, 8 animal studies, and 11 studies of basic research. Only one clinical study investigated the outcome of minced cartilage for acetabular cartilage defects, while all the other studies investigated cartilage from the knee joint. Among the 6 clinical trials, one was a randomized controlled trial (minced cartilage versus microfracture), while the other 5 studies were case series with a maximum of 28 included patients. In 3 studies, a matrix was used for defect coverage. In one study, cartilage was additionally augmented with autologous blood products. All studies used fibrin glue or autologous thrombin to seal the implanted cartilage. Cartilage harvesting and mincing were the same in 5 clinical trials (Shaver (2), Scalpel (3)). In one clinical trial, cartilage was harvested using a trephine and minced with surgical scissors (no animal studies or basic research available). The harvesting and mincing of cartilage using a scalpel are currently most scientifically investigated: 3 clinical trials, 7 animal studies, 10 studies from basic research. The harvesting and mincing of cartilage using a shaver are increasingly being studied scientifically (3 studies published since 2023). So far, there are 2 clinical trials, 1 animal study, and 2 studies from basic research. Conclusion: A standardized approach of the minced cartilage procedure has not yet emerged. There are differences in the method of cartilage mincing, cartilage fixation, cartilage coverage using matrices, and augmentation with autologous blood products. Scalpel mincing has been most thoroughly researched so far, although recent studies are increasingly investigating shaver mincing.

Abstract Purpose: To analyze the relationship between alpha angle and grade of articular acetabular cartilage damage in a cohort of adolescent patients. Methods: A retrospective multicenter hip arthroscopy registry was queried for patients from January 2016 to December 2023 from the ages of 14 to 25 who underwent primary hip arthroscopy. 222 patients fit the inclusion criteria. Patient alpha angle was recorded preoperatively, and degree of acetabular cartilage damage was recorded intraoperatively using the Beck classification system. Beck grades 1 and 2 were considered low-grade damage, and Beck grades 3 and 4 were considered high-grade damage. Patients were separated into the following groups based on alpha angle: below 55°, 55°-65°, 65°-75° degree, and 75° and above. χ2 analysis was performed to measure statistical differences in cartilage damage between groups. Results: There were significant differences in grade of acetabular articular cartilage damage between groups. The below 55° group saw 5.9% of patients with high grade cartilage damage. Compared to the 55°-65°, 65°-75° degree, and 75° and above groups, this percentage was 13.5%, 23.9%, and 53.6%, respectively. These differences are statistically significant, with a p-value of less than 0.00001. Conclusions: In a cohort of adolescent patients, grade of acetabular cartilage damage was higher with increased alpha angle. Over half of adolescent patients with an alpha angle of 75° and above had high-grade acetabular cartilage damage, compared to just 5.9% of patients with alpha angles below 55°. Due to risks associated with high-grade acetabular cartilage damage, including the development of arthritis, more aggressive treatment should be considered in adolescents with high alpha angles, including arthroscopy with femoroplasty and cartilage treatment. Level of Evidence: III, retrospective cohort study.

Abstract Background: Controversy exists regarding the optimal surgical management of subjects with mild hip osteoarthritis. Hip arthroplasty is rarely indicated for patients with preserved joint space, while cartilage damage is a known risk factor for inferior outcomes following hip preservation surgery. The purpose of this study was to evaluate a standardized preoperative magnetic resonance imaging (MRI) based classification system as a decision-making tool for patients with preserved joint space undergoing hip arthroplasty or hip preservation. Methods: Consecutive patients with a preserved joint space joint space (Tonnis grade &amp;lt;2, average joint space width &amp;gt;3) undergoing primary total hip arthroplasty with a preoperative MRI were included in the study. The arthroplasty cohort was then propensity matched by Tonnis Grade (1:1) and average joint space width to a population of patients undergoing hip preservation surgery. Four fellowship trained hip surgeons reviewed patient preoperative MRIs according to the ten component Scoring of Hip Osteoarthritis in MRI (SHOMRI) grading system with grading discrepancies resolved in conference with a board-certified musculoskeletal radiologist familiar with this scoring system. Minimum two-year patient reported outcome measures (PROMs) were collected to evaluate for treatment efficacy. Results: There were 27 patients included in both the arthroplasty and hip preservation cohorts. There were no significant demographic or preoperative radiographic differences between the two groups. There was high inter-observer reliability between reviewers with ICC values greater than 0.7 for the total score as well as all component subscores. Patients undergoing arthroplasty had significantly greater acetabular cartilage, femoral cartilage, acetabular subchondral edema, and acetabular subchondral cystic change compared to patients undergoing hip preservation. Both groups had significantly improved postoperative outcomes with no differences between cohorts. Conclusion: The SHOMRI MRI based classification system demonstrated high intraobservser reliability and was successful at distinguishing treatment pathways when applied retrospectively to a cohort of patients undergoing hip preservation surgery or arthroplasty with similar appearing preoperative radiographs. Hip arthroplasty patients had significantly higher total SHOMRI scores as well as acetabular subchondral edema, subchondral cystic change, and acetabular and femoral cartilage component scores.

Abstract Introduction: Despite focus on surgical preservation of the chondrolabral junction (CLJ), the transition zone between the acetabular cartilage and labrum, the association between severity of CLJ breakdown and functional outcomes following hip arthroscopy remains unexplored. The purpose of this study was to assess the influence of CLJ breakdown on patient-reported outcome measures (PROMs) at 24-month follow-up after hip arthroscopy for symptomatic labral tears. Methods: A retrospective review of prospectively-collected data identified patients &amp;gt;18 years with minimum 24-month follow-up who underwent hip arthroscopy by a single surgeon for treatment of symptomatic labral tears secondary to femoroacetabular impingement (FAI). The Beck classification of transition zone cartilage was used to grade CLJ damage; patients with grades 0-2 were stratified into the “mild CLJ damage” cohort, and those with grades 3-4 were stratified into the “severe CLJ damage” cohort. PROMs were collected at baseline and at 3, 6, 12, and 24 months postoperatively. Linear mixed effects models were used to compare PROMs. Rates of achieving clinically meaningful thresholds and subsequent surgery rates were also compared. Results: Overall, 198 patients met inclusion criteria, with average follow-up of 3.54 ± 1.26 years. 95 patients with severe CLJ damage (age, 34.9 ± 10.5 years) were compared to 103 patients with mild CLJ damage (age, 38.2 ± 11.9 years). Hip Outcome Score-Activities of Daily Living (HOS-ADL), Non-Arthritic Hip Score (NAHS), and visual analog score (VAS) for pain were inferior in the severe CLJ group at enrollment and all time points (P&amp;lt;0.05). However, patients with severe CLJ breakdown exhibited greater improvements in HOS-ADL and NAHS at 24-month follow-up, and achieved clinically meaningful thresholds at equivalent rates to patients with mild CLJ breakdown. Subsequent surgery rates were 6.8% and 12.6% in patients with mild versus severe CLJ damage, respectively (P&amp;gt;0.05). Conclusion: Severe CLJ breakdown is associated with increased pain and decreased functional level preoperatively and up to 24 months after hip arthroscopy. Despite this, patients with severe CLJ breakdown experienced greater improvements in functional outcomes at 24-month follow-up and achieved clinical thresholds at similar rates to patients with mild CLJ damage. Thus, while worse baseline pain and functional levels may indicate severe CLJ breakdown, these patients still benefit substantially from hip arthroscopy.

Abstract Background: The optimal treatment of patients with symptomatic borderline acetabular dysplasia is a major controversy in hip preservation, as patients may have primary symptoms of impingement or instability. Intraarticular pathologies driven by these processes may differ and have not been thoroughly investigated. The purpose of this study was to investigate differences in intra-articular disease patterns between borderline hips treated with isolated hip arthroscopy (HS) compared to combined HS with periacetabular osteotomy (HS/PAO). Methods: Patients were prospectively enrolled in a multicenter cohort database. Inclusion criteria were borderline acetabular dysplasia (defined by lateral center edge angle 18-25 degrees), aged 14-40 years who failed standard conservative care. All surgeons had established teams with expertise in HS and PAO with established interobserver reliability for arthroscopic disease assessment. Treatment groups include isolated HS or HS/PAO (performed in combination on same day). Exclusion criteria were isolated PAO without arthroscopy (n=138), revision arthroscopy, and Tonnis osteoarthritis grade 2 or greater. Intraoperative labral and cartilage pathology were compared between the HS group and the HS/PAO group. Results: There were 483 hips (67.8% female) with a mean age of 24.5+7.8 years; 318 (65.8%) underwent HS and 165 (34.2%) underwent HS/PAO. Hips undergoing HS were more likely to have an abnormal labrum than those undergoing HS/PAO (6.3% vs 12.1%, p=0.027), including labral detachment (55.3% vs. 38.8%, p&amp;lt;0.001) and degeneration (28.3% vs. 17.6%, p=0.009). Hips undergoing HS had half the rate of labral hypertrophy than combined HS/PAO (21.1% vs. 44.8%, p&amp;lt;0.001). Acetabular cartilage damage was more likely to be present in isolated HS compared to HS/PAO (77.7%, vs. 64.8%, p=0.003), and higher-grade cleavage (27.7% vs. 11.5%, p&amp;lt;0.001) and chondral defects (7.9% vs. 0.6%, p&amp;lt;0.001) were more likely. Ligamentum teres pathology was similar between groups (14.6% HS vs. 10.5% HS/PAO, p=0.226). Capsular laxity was noted in fewer HS than HS/PAO hips (15.0% vs 33.1%, p&amp;lt;0.001). Conclusion: In this prospective multicenter cohort study of patients undergoing surgical treatment of borderline acetabular dysplasia, hips with impingement-predominant symptoms indicated for isolated HS were more likely to have more advanced labral and cartilage damage compared to hips with instability predominant-symptoms who were indicated for HS/PAO.

Abstract Introduction: Labral injury at the time of open and arthroscopic hip preservation surgery for symptomatic femoroacetabular impingement (FAI) is managed with debridement versus refixation by the treating surgeon based on tear pattern, tissue quality, and hip morphology. While refixation has been favored based on mid-term outcomes in some series, differences in the long-term patient reported outcomes (PROMS) have not been defined in well-designed and matched prospective series. Methods: This study consisted of a prospective, multi-center cohort that underwent primary surgical treatment for symptomatic FAI. Patients were included if they underwent corrective osteoplasty and a labral refixation or a labral debridement procedure. Using a ratio of 1:1, hips with labral refixation and labral debridement were matched by age, sex, and surgical approach. Postoperative assessments were conducted at a minimum 8 years after surgery using PROMS and assessment of reoperations. Results: A total of 237 hips (n=188 labral refixation, n=49 labral debridement) met the inclusion criteria for the current study. 48 hips from the labral refixation and 48 hips from debridement groups with mean follow-up of 10.3±1.7 years and 10.6±2.1 years respectively were included. No significant differences were observed in the femoral head, acetabular cartilage grade, or labral grade between the groups. The mHHS improved 19.8±19.6 and 23.4±16.8 from baseline to the final follow-up in the labral refixation and debridement groups, respectively (p=0.43). There were no significant differences in PROMS between the labral refixation and debridement groups. Overall, 66% and 76% of the labral refixation and debridement groups achieved the MCID for the mHHS respectively (p=0.30). There were more revision surgeries with labral refixation than with debridement (10.4% vs. 2.1%, p=0.09), but more conversions to total hip replacement in the labral debridement group (8.3% vs. 4.2%, p=0.38), but neither of these differences were statistically significant. Discussion: Both labral refixation and debridement are effective with durable improvement in PROMS at a mean of 10 years in a prospective cohort of patients treated surgically for symptomatic FAI. No significant differences in baseline or final PROMS were observed, and similar rates of revision and conversion to hip replacement were observed in the debridement and refixation groups.