Arthroscopic Treatment Of Femoroacetabular Impingement Research Articles

PREDICTING MINIMAL CLINICALLY IMPORTANT DIFFERENCE USING IHOT-12 AT ONE YEAR FOLLOWING ARTHROSCOPIC TREATMENT FOR FEMOROACETABULAR IMPINGEMENT USING MACHINE LEARNING

Femoroacetabular Impingement (FAI) syndrome, characterised by abnormal hip contact causing symptoms and osteoarthritis, is measured using the International Hip Outcome Tool (iHOT). This study uses machine learning to predict patient outcomes post-treatment for FAI, focusing on achieving a minimally clinically important difference (MCID) at 52 weeks.A retrospective analysis of 6133 patients from the NAHR who underwent hip arthroscopic treatment for FAI between November 2013 and March 2022 was conducted. MCID was defined as half a standard deviation (13.61) from the mean change in iHOT score at 12 months. SKLearn Maximum Absolute Scaler and Logistic Regression were applied to predict achieving MCID, using baseline and 6-month follow-up data. The model's performance was evaluated by accuracy, area under the curve, and recall, using pre-operative and up to 6-month postoperative variables.A total of 23.1% (1422) of patients completed both baseline and 1-year follow-up iHOT surveys. The best results were obtained using both pre and postoperative variables. The machine learning model achieved 88.1% balanced accuracy, 89.6% recall, and 92.3% AUC. Sensitivity was 83.7% and specificity 93.5%. Key variables determining outcomes included MCID achievement at 6 months, baseline iHOT score, 6-month iHOT scores for pain, and difficulty in walking or using stairs.The study confirmed the utility of machine learning in predicting long-term outcomes following arthroscopic treatment for FAI. MCID, based on the iHOT 12 tools, indicates meaningful clinical changes. Machine learning demonstrated high accuracy and recall in distinguishing between patients achieving MCID and those who did not. This approach could help early identification of patients at risk of not meeting the MCID threshold one year after treatment.

Association Between Chondrolabral Junction Breakdown and Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Symptomatic Labral Tears: Minimum 8-Year Follow-up.

Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied. To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture). Cohort study; Level of evidence, 3. This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion. In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ (P < .001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators (P < .001 for all). Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors.

Comparison of Gait and Functional Outcomes Between Open and Arthroscopic Treatment of Adolescent and Young Adult Femoroacetabular Impingement.

Management of femoroacetabular impingement (FAI) through an arthroscopic or surgical hip dislocation (SHD) approach has been shown to have similar clinical success and patient-reported outcomes. However, there are limited data comparing functional outcomes. The purpose of this study was to compare gait and functional outcomes of adolescent/young adult patients with FAI treated by either an arthroscopic or open SHD approach. We identified prospectively enrolled adolescent/young adult patients (≤20 years old) who underwent surgical treatment for FAI through an SHD or arthroscopic approach. Participants were evaluated in a movement science lab preoperatively and postoperatively (minimum 8 months postoperatively) with barefoot walking and a 30-second single-limb balance trial on the affected side. Participants also completed the Harris Hip Score at the same timepoints. Differences from preoperative to postoperative were determined using a paired-samples t test for each surgical technique, and differences between the SHD and arthroscopic groups were determined using an independent samples t test (α=0.05). Fifty-five participants (42F, 16.2±1.4y) were tested and grouped by surgical intervention. The SHD and arthroscopy groups consisted of 28 and 27 participants, respectively, with no significant difference between the SHD and arthroscopic cohorts in age (16.4±1.2 vs. 15.9±1.5y, respectively, P=0.218) or sex distribution (78.6% vs. 74.1% females, respectively, P=0.75). Each group demonstrated significant postoperative improvement in Harris Hip Score (SHD: 64.8±16.4 to 81.8±17.8; arthroscopy: 57.0±16.7 to 84.7±19.7; preoperatively to postoperatively, respectively, both P<0.001). During gait, increased maximum hip flexion was observed following surgical intervention for the SHD group (32.3±5.7 vs. 36.1±5.2, P=0.003). No other clinically significant changes were detected in the SHD or arthroscopic groups preoperatively to postoperatively in trunk, pelvis, or hip kinematics in the coronal plane. During the balance task, neither cohort demonstrated markers of clinically significant abductor dysfunction. However, post operatively, the arthroscopy group was able to balance longer than the SHD group (18.8±7.8 vs. 14.2±2.7s, respectively, P=0.008), although no differences were detected in trunk or pelvis position in the coronal plane during balance. Both open SHD and arthroscopic treatment of FAI resulted in improved clinical outcomes with no clinically significant abductor dysfunction 1 year post operatively. However, further study is needed to determine whether more dynamic tasks can potentially elicit subtle differences between the groups. Level II-prospective study.

Poster 114: Viability and Expression of Chondrocytes Harvested During Arthroscopic Treatment of Femoroacetabular Impingement

Poster 114: Viability and Expression of Chondrocytes Harvested During Arthroscopic Treatment of Femoroacetabular Impingement

Paper 12: Severity of Chondrolabral Junction Degeneration Predicts Conversion to Total Hip Arthroplasty after Arthroscopic Femoroacetabular Impingement Treatment at Minimum 10-Years Follow-Up

Objectives: To identify location and severity of intraoperative pathology at time of arthroscopic surgery for femoroacetabular impingement (FAI) as risk factors for conversion to total hip arthroplasty (THA) utilizing long-term follow-up (minimum 10 years). Methods: Retrospective study of prospectively collected data of adult patients (≥ 18 years) who underwent hip arthroscopy for FAI between 1998 and 2011 with minimum follow-up of 10 years. Location and severity of pathology at time of arthroscopic surgery were assessed as risk factors for later conversion to a primary outcome of THA. Patients with radiographic evidence of hip dysplasia and previous history of hip surgery were excluded. Patients were then grouped according to whether they had underwent THA. Differences in continuous variables including age, BMI, and center edge angle (CEA) were analyzed with independent t tests. Differences in categorical variables including type of treatment (debridement or repair), deformity (CAM vs pincer vs combined), Outerbridge grade, location of most severe chondral wear (anterosuperior acetabulum, posterosuperior acetabulum, femoral head), presence of chondral flap, and degree of chondrolabral degeneration (as measured by Beck classification) were analyzed with the Pearson’s Chi-squared test. For variables with greater than two levels (chondrolabral degeneration, etc.) adjusted residuals were calculated to determine which comparisons were statistically different, with a value of &gt;2 indicating a lack of fit with the null hypothesis of difference. A multivariable logistic regression model was constructed to estimate the influence of the exact location and severity of pathology on risk for conversion to THA. Model results are reported as odds ratios (OR) with corresponding 95% confidence intervals. Results: A total of 109 patients with a mean age of 39.41 ± 11.43 years and minimum follow-up of 10 years were eligible for inclusion in this study. The average follow-up was 12.29 ± 2.53 years. Average body mass index (BMI) was 26.19 ± 4.07 while average center edge angle (CEA) was 39.53 ± 7.24. 67 (61.5%) patients underwent debridement while 42 (38.5%) patients underwent labral repair. 32 (29.4%) patients subsequently converted to THA. BMI (1.7% difference, p = 0.072), CEA (0.3% difference, p = 0.832), sex (0.2% difference, p = 0.991), procedure type (11.8% difference, p = 0.565), and presence of a chondral flap (6.3% difference, p = 0.685) were not significantly associated with conversion to THA. FAI type, Outerbridge grade, chondrolabral junction degeneration, and location of most severe degenerative change were statistically significant, with adjusted residuals greater than 2 (Table 1). A multivariable logistic regression model demonstrated age (OR=1.08, 95% CI 1.03-1.14, p = 0.002), Grade 4 chondrolabral degeneration (OR = 3.26, 95% CI 1.16-9.17, p = 0.025) and combined FAI type (OR = 4.32, 95% CI 1.38 – 13.56, p = 0.012) as significant risk factors for conversion to THA. Conclusions: Grade 4 degeneration of the chondrolabral junction as well as combined FAI type and older age are significant risk factors for conversion to THA after arthroscopic treatment of FAI at minimum 10-years of follow-up. [Table: see text][Table: see text]

How Long Do Patients Take To Regain Their Baseline Strength Following Arthroscopic Treatment For Femoroacetabular Impingement?

How Long Do Patients Take To Regain Their Baseline Strength Following Arthroscopic Treatment For Femoroacetabular Impingement?

Postoperative alpha angle seems to be important for the achievement of clinical significance at a minimum 5-year follow-up after primary hip arthroscopy.

The purpose of the present study was to clarify whether there is an association of postoperative alpha value with functional scores or progression of osteoarthritis at X-rays at the midterm after arthroscopic treatment of femoroacetabular impingement (FAI) syndrome with femoral osteoplasty, labral repair or debridement and rim trimming. A retrospective review of prospectively gathered data from 2013 to 2017 was performed. All patients who underwent first-time unilateral hip arthroscopy for FAI resection with 5-year follow-up were included. Patient-reported outcomes included the modified Harris Hip Score (mHHS) and Visual Analog Scale for Pain (Pain VAS). The progression of osteoarthritis (Tönnis grade) and radiological parameters (alpha angle, lateral center-edge angle [LCEA] and head-neck offset) were evaluated. A receiver operating characteristic (ROC) analysis was used to evaluate the correlation between significant variables and achievement of patient-acceptable symptomatic state (PASS) and degree of osteoarthritis. We identified 52 patients with a minimum 5-year follow-up (average, 6.7 years). The average patient age was 33.9 ± 11.5 years. There were 19 (36.5%) female patients. The mHHS improved from 60.1 ± 13.4 before surgery to 86.8 ± 14 after surgery (P < 0.001). The Pain VAS decreased from 6.21 before surgery to 2 after surgery (P < 0.001). Overall, 69% achieved the PASS for mHHS. The ROC curve for postoperative alpha angle demonstrated acceptable discrimination between patients achieving a fifth-year PASS value and those who did not have an area under the curve of 0.72. Patients having a postoperative alpha angle of ≤48.3° achieved the fifth-year PASS value at a significantly higher rate than patients having a postoperative alpha angle of >48.3° (P = 0.002). The postoperative alpha angle is a predictor of the achievement of the fifth-year PASS value for the mHHS. A threshold of ≤48.3° had a sensitivity of 0.75 and a specificity of 0.69 to predict positivity. Level of evidence IV.

Ultrasound Assessment of Hip Subspine Bone Morphology Soft-tissue Correlates with Clinical Diagnosis of Impingement

To determine the ultrasound imaging manifestations associated with subspine impingement (SSI), including the osseous and soft-tissue injuries adjacent to anterior inferior iliac spine (AIIS) and to investigate the diagnostic value of ultrasound for SSI. We retrospectively evaluated patients who attended the sports medicine department of our hospital and underwent arthroscopic treatment for femoroacetabular impingement (FAI) between September 2019 and October 2020, with preoperative hip joint ultrasound and computed tomography (CT) examination within 1 month before surgery. All of the FAI patients were divided into the SSI group and non-SSI group, according to the clinical and intraoperative findings. The preoperative ultrasound and CT findings were assessed. The sensitivity, specificity, and positive predictive value (PPV) of some indicators were calculated and compared. Multivariable logistic regression and receiver operating characteristic curve (ROC) were also used. A total of 71 hips were included, with a mean age of 35.4 ± 10.4 years, 56.3% were women. Of these, 40 hips had clinically confirmed SSI. The bone morphology type III, heterogeneous hypoecho in anterosuperior joint capsule and the direct head of rectus femoris (dRF) tendon adjacent to AIIS on the Standard Section of the dRF in ultrasound were associated with SSI. Among them, the heterogeneous hypoecho in the anterosuperior joint capsule had the best diagnostic value for the SSI (85.0% sensitivity, 58.1% specificity, AUC= 0.681). The AUC of the ultrasound composite indicators was 0.750. The AUC and PPV of CT low-lying AIIS for the SSI diagnosis was 0.733 and 71.7%, which could be improved when CT was combined with the ultrasound composite indicators with AUC= 0.831 and PPV= 85.7%. Bone morphology abnormalities and soft-tissue injuries adjacent to the AIIS through sonographic evaluation were associated with SSI. Ultrasound could be used as a feasible method to predict SSI. The diagnostic value for SSI could be improved when ultrasound is combined with CT. Level IV, case series.

Long-term Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement for Patients With Borderline Dysplasia

Background: Outcomes after isolated hip arthroscopic surgery for patients with dysplasia have been unfavorable. Results have included iatrogenic instability and conversion to total hip arthroplasty at a young age. However, patients with borderline dysplasia (BD) have shown more favorable results at short- and medium-term follow-up. Purpose: To assess long-term outcomes after hip arthroscopic surgery for femoroacetabular impingement in patients with BD (lateral center-edge angle [LCEA] = 18°-25°) compared with a control group of patients without dysplasia (LCEA = 26°-40°). Study Design: Cohort study; Level of evidence, 3. Methods: We identified a group of 33 patients (38 hips) with BD who were treated for FAI between March 2009 and July 2012. An age- and sex-matched control group of 83 patients (96 hips) was also identified. Patient-reported outcome scores were collected preoperatively and subsequently at a mean of 9.6 years postoperatively. Results: The mean LCEA and Tönnis angle were 22.42°± 2.02° and 6.27°± 3.23° in the BD group, respectively, and 31.71°± 3.52° and 2.42°± 3.02° in the control group, respectively (P < .001). At a mean follow-up of 9.6 years (range, 8.2-11.6 years), there was a significant improvement in all patient-reported outcome scores in both groups (P < .001). There were no significant differences between preoperative and postoperative scores or rates of achieving the minimal clinically important difference between the BD and control groups. Bilateral surgery was noted to be a risk factor for any revision during the follow-up period (P < .001). There were 2 hips (5.3%) that underwent revision surgery in the BD group and 10 hips (10.4%) in the control group; of these, 1 patient in the BD group underwent total hip arthroplasty, and 1 patient who had undergone bilateral surgery in the control group underwent bilateral hip resurfacing. Conclusion: Durable outcomes (>9 years) with low revision rates can be expected after hip arthroscopic surgery with an approach that involves labral preservation where possible and careful attention to capsular closure in patients with BD. The observed outcomes were similar to those of a femoroacetabular impingement group with normal coverage. These results highlight the importance of classifying patients into impingement or instability categories and tailoring treatment appropriately with arthroscopic surgery or periacetabular osteotomy, respectively.

Validation of the Brazilian version of the Hip Sports Activity Scale (HSAS) for patients with femoroacetabular impingement: a cross-sectional study.

The Hip Sports Activity Scale (HSAS) is a hip-specific instrument for assessing the present levels of physical activity among patients with femoroacetabular impingement (FAI) syndrome. When evaluating treatment outcomes in patients with FAI syndrome, it is necessary to use joint-specific instruments and ones that can evaluate the levels of physical activity in these patients, such as the HSAS-Brazil. To validate the HSAS-Brazil among a group of physically active patients after arthroscopic treatment of FAI syndrome. Cross-sectional research of quantitative and qualitative types using data obtained from July 2018 to October 2019. A total of 58 patients of both genders diagnosed with FAI syndrome and who had undergone hip arthroscopy participated in this research. To establish reliability and validity, patients first answered the Brazilian versions of the 12-Item Short-Form Health Survey (SF-12), Nonarthritic Hip Score (NAHS), and HSAS; after a 48-hour interval, they answered the HSAS-Brazil again. For test-retest reliability, the interclass correlation was 0.908 (P < 0.001). The HSAS-Brazil correlated to the NAHS-Brazil (r = 0.63, P < 0.001), as well as the SF-12 (Physical Health) (r = 0.42, P = 0.001). The HSAS-Brazil was validated and proved to be a reliable and valid scale to assess sports activity levels in physically active patients with FAI syndrome after arthroscopic treatment.

Results of Arthroscopic Treatment for Femoroacetabular Impingement

Background. Femoroacetabular impingement (FAI) is one of the most frequent causes of hip pain and limited hip mobility in young and middle-aged patients. It is a result of repeated injury of hip structures, that leads to degenerative changes in hip labrum, cartilage and subchondral bone and provokes progressive development of hip osteoarthritis.&#x0D; Aim of study to analyze own experience of treating patients with femoroacetabular impingement and identify factors affecting its outcomes.&#x0D; Methods. Retrospective, uncontrolled, single-center clinical study included 128 patients with FAI which had 150 surgeries on 149 joints in in the period from 2013 to 2021. All patients underwent physical examination and X-ray diagnostics, their FAI type was identified. The alpha angle of external part of femoral head in anterior-posterior position and in the modified Dunn 45 position, as well as Tonnis angle, lateral central-marginal angle in Ogata modification and the height of articular gap along the lateral (LS) and medial edges (MS) of sclerosed acetabulum part were calculated. The i-HOT-33 and HOS scales were used to assess preoperative status and postoperative results.&#x0D; Results. The average follow-up period was 3.9 years (SD 1.71; min 1.05 and max 8.16). The study included 55 (43.0%) women and 73 (57.0%) men which underwent 64 (42.7%) and 86 (57.3%) surgeries respectively. The most common types of FAI, according to our data, were mixed type (53% of joints) and сam type (27.5% of joints). Insufficient coverage of the femoral head by the acetabulum (borderline dysplasia) in combination with the сam deformity of the femoral head was observed in 18.1%. Pincer-type FAI was observed in 1.4% of joints. We obtained the worst results with a combination of сam deformity and borderline dysplasia in comparison with cam- and mix-type FAI according to the i-HOT-33 and HOS scales. Patients age, deep cartilage damage, irreparable labrum damage and height decrease of the lateral part of the articular gap determined negative effect on treatment results according to the i-HOT-33 and HOS scales.&#x0D; Conclusion. Hip arthroscopy showed good short- and midterm outcomes in patients with FAI. Pain syndrome is most often manifested in patients with pathology of hip soft tissue structures concomitant to FAI. The combination of сam deformity and insufficient femoral head coverage, deep cartilage damage and a height decrease of the articular gap are important predictors of poor treatment results.

Superior outcomes after arthroscopic treatment of femoroacetabular impingement and labral tears with closed versus open capsule.

The purpose of the study was the clinical evaluation of the capsular management with arthroscopic treatment of femoroacetabular impingement and labral tears by comparing the functional outcomes of closed versus open capsule. Patients with a median age of 38years (18-55), clinical and radiological features of FAI and/or labral tear, and non-arthritic non-dysplastic hips were selected for arthroscopic treatment. Capsulotomy was performed primarily as an interportal section, then a distal extension preserving the zona orbicularis was added. The study compared two matched groups: patients with open capsule versus patients with closed capsule. Clinical outcomes were assessed by Non-Arthritic Hip Score, hip outcome scores of daily living activities and sports-specific scales. Scores were collected preoperatively and 6months, 2years and 5years postoperatively. Rate of revision arthroscopy and conversion to total hip arthroplasty were used for comparing groups. Minimal clinically important differences were calculated for both groups. The study included 42 patients in the OC group and 44 patients in the CC group. Significant improvement of postoperative PROMs was recorded in both groups compared to preoperative scores. CC group significantly improved more than the OC group based on NAHS, HOS-ADL and HOS-SSS over all check points except for NAHS and HOS-ADL at 6months, which were statistically non-significant. A non-significant difference was observed in the percentage of patients who met the MCID for all reported outcome scores at 5years in both groups. The rate of reoperation was similar in both groups, but with different indications. Arthroscopic treatment of FAI and labral repair with complete closure of the hip capsule led to significantly improved functional outcomes after 5years follow-up compared with open capsule. Closed capsule can provide greater improvement in the sports-specific outcomes at early follow-up. Controlled capsulotomy limited by zona orbicularis did not produce instability at any postoperative stage. Similar proportions of patients achieved minimal clinically important difference, and similar rates of reoperation were reported in both groups. III.

The narrow subspine space and relatively large labrum are radiographic features of subspine impingement: a case-control study

BackgroundSubspine impingement is considered a source of residual hip symptoms after primary hip arthroscopy, and the role of the subspine space and soft tissue is not clear. The purpose of this study was to analyze the relationship between the subspine space and labrum size in subspine impingement patients.MethodsWe performed a retrospective study of patients with femoroacetabular impingement between July 2016 and July 2020. Sixteen patients without hip symptom relief after primary hip arthroscopic treatment of femoroacetabular impingement and undergoing revision surgery for anterior inferior iliac spine compression were included as the study group. Forty-eight matched patients who underwent only primary surgery and whose hip discomfort was relieved without a diagnosis of subspine impingement were included as the control group. The patients’ preoperative computerized tomography data were reviewed, and the anterior inferior iliac spine dimensions and the size of the subspine space were measured. The size of the labrum at the 11:30, 1:30, and 3 o’clock positions was measured with the use of magnetic resonance imaging. The ratio of the subspine space to the labrum was also calculated.ResultsThere was no significant difference in anterior inferior iliac spine dimensions between these two groups (p > 0.05). A relatively narrow subspine space was found in the study group, especially in the direction of the anterior inferior iliac spine. Compared with the control group, subspine impingement patients were identified with larger labrums at 11:30 (8.20 ± 1.95 mm vs. 6.81 ± 0.50 mm, p = 0.016), 1:30 (7.83 ± 1.61 mm and 6.25 ± 0.78 mm, p = 0.001) and 3:00 (9.50 ± 1.73 mm vs. 7.48 ± 0.99 mm, p = 0.001). A relative mismatch between the subspine space and the labrum was also identified in the study group. The ratios of the labrum width to the subspine area were significantly larger in the study group than in the control group.ConclusionThis study reported potential additional criteria for subspine impingement—a large labrum and a relatively narrow subspine space—instead of abnormal anterior inferior iliac spine dimensions. For those with a large labrum and narrow subspine space, the diagnosis of subspine impingement should be carefully made, and arthroscopic anterior inferior iliac spine decompression may be important.

Arthroscopic Treatment of Femoral Neck Impingement Cysts Using Biocomposite Anchors in the Setting of Femoroacetabular Impingement

Background: There is no established superior treatment for femoral neck impingement cysts, which may be symptomatic and can create a challenge in the arthroscopic treatment of femoroacetabular impingement. Isolated decompression of these cysts may lead to biomechanical compromise and an increased risk of femoral neck fracture similar to that associated with cortical perforation in osteoplasty of cam lesions, given the remaining focal osseous disruption and cortical discontinuity analogous to a burr perforation. Indications: In patients undergoing arthroscopic treatment of femoroacetabular impingement and found to have femoral neck impingement cyst warranting decompression, occlusion of the remaining defect with a biocomposite anchor may improve symptoms related to the impingement cyst as well as reduce the risk of femoral neck fracture. Technique Description: This surgical technique video demonstrates the filling of a femoral neck impingement cyst using a case example of a very active middle-aged woman undergoing arthroscopic treatment of femoroacetabular impingement. During cam osteoplasty in the peripheral compartment phase, the cyst is decompressed using a curette. An appropriately sized bioabsorbable suture anchor is secured into the defect and the sutures removed. The osteoplasty is resumed over the screw to achieve contouring of the femoral neck commensurate with an adequate head-neck offset confirmed by dynamic intraoperative hip examination. Results: Postoperative imaging from this procedure reveals bony in-fill with gradual dissolution of the biocomposite anchor. In our cohort of patients treated with biocomposite anchors concomitant to arthroscopic treatment of femoracetabular impingement with follow-up ranging from 2 to 12 years, there were no self-reported femoral neck fractures. Discussion/Conclusion: We expect that treatment of femoral neck impingement cysts with biocomposite anchors will stimulate bony in-fill of the defect stimulated by the anchor, with a decrease in the risk of femoral neck fracture as compared with an untreated cyst. Further research is needed to strengthen the evidence surrounding comparative treatment of impingement cysts as well as the optimal choice of material in the case of occlusion with a biocomposite anchor.

Hip arthroscopy for femoroacetabular impingement is associated with significant improvement in early patient reported outcomes: analysis of 4963 cases from the UK non-arthroplasty registry (NAHR) dataset

PurposeResults from recent randomised controlled trials demonstrate the superiority of surgery over physiotherapy in patients with femoroacetabular impingement (FAI) of the hip in early follow-up. However, there is paucity of evidence regarding which factors influence outcomes of FAI surgery, particularly notable is the lack of information on the effect of impingement subtype (cam or pincer or mixed) on patient reported outcomes measures (PROMs). This study aims to evaluate the early outcomes of hip arthroscopy for FAI, and their determinants.MethodsThis is a retrospective analysis of prospectively collected data from the UK Non-Arthroplasty Hip Registry (NAHR) of patients undergoing arthroscopic intervention for FAI between 2012 and 2019. The null hypothesis was that there is no difference in PROMs, based on morphological subtype of FAI treated or patient characteristics, at each follow-up timepoint. The outcome measures used for the study were the iHOT-12 score and the EQ5D Index and VAS 6- and 12-month follow-up.ResultsA cohort of 4963 patients who underwent arthroscopic treatment of FAI were identified on the NAHR database. For all FAI pathology groups, there was significant improvement from pre-operative PROMs when compared to those at 6 and 12 months. Overall, two-thirds of patients achieved the minimum clinically important difference (MCID), and almost half achieved substantial clinical benefit (SCB) for iHOT-12 by 12 months. Pre-operatively, and at 12-month follow-up, iHOT-12 scores were significantly poorer in the pincer group compared to the cam and mixed pathology groups (p < 0.01). Multivariable analysis revealed PROMS improvement in the setting of a higher-grade cartilage lesion.ConclusionThis registry study demonstrates that hip arthroscopy is an effective surgical treatment for patients with symptomatic FAI and results in a statistically significant improvement in PROMs which are maintained through 12 months follow-up.Level of evidenceIII.

Two-Tiered Resection of Cam Lesions in Hip Femoroacetabular Impingement: Optimizing Femoral Head Sphericity

Hip arthroscopy is one of the most rapidly growing fields in orthopaedic surgery. One of the most frequent pathologies treated with hip arthroscopy remains femoroacetabular impingement, which is addressed by labral repair and femoral osteoplasty. The most commonly cited reason for failure of arthroscopic treatment of femoroacetabular impingement is under-resection of the cam lesion. Surgeons frequently use evaluations of preoperative images, intraoperative fluoroscopy, and dynamic range of motion to ensure adequate resection. In this article, we describe a reproducible and standardized technique to assist in appropriate resection. This is achieved by a 2-tiered resection technique: Tier 1 aims to set the depth of resection and restore the head-neck offset. Tier 2 then matches the depth of the resection set by tier 1 and allows for retention of appropriate transition of the proximal convexity to the distal concavity seen in more ideally shaped femoral heads. With this technique, we offer a tool to avoid under-resection in the area of maximal conflict while simultaneously minimizing the risk of proximal over-resection and thus compromising the fluid seal dynamics of the joint in deeper flexion angles.

Predictive radiological parameters of failure following surgical management of femoroacetabular impingement associated with borderline acetabular dysplasia

IntroductionThe role of arthroscopic treatment of femoroacetabular impingement (FAI) in mild or borderline hip dysplasia (lateral center edge angle=18–25) is controversial. It is recommended to combine capsular plication with femoral neck osteoplasty and suture repair of the labrum. Few studies have investigated which radiological parameters are associated with failure of this procedure. HypothesisA larger number of radiological signs of mild or borderline hip dysplasia than radiological signs of FAI negatively influence the outcomes of arthroscopic treatment. MethodsThis was a retrospective study done with data collected prospectively after a minimum of 2 years’ follow-up in patients who underwent arthroscopic treatment of FAI due to cam impingement combined with mild to moderate hip dysplasia. Patients with hip osteoarthritis graded as ≥ Tönnis 2 were excluded. Functional outcome scores (mHHS and NAHS) were determined along with the need for reoperation. Three groups were defined based on the outcomes: success (mHHS ≥ Patient Acceptable Symptomatic State [PASS]); moderate improvement (improvement in mHHS + mHHS<PASS) and failure (worsening of the mHHS). Demographic data, radiographic parameters (LCEA, Tönnis angle, alpha angle, offset, FEAR index, Shenton's line, Cliff sign, anterior wall index [AWI], posterior wall index [PWI]) and intraoperative findings were compared between these three groups. The area under the curve (AUC) for the most relevant data identified during the univariate analysis were then modeled to define which factors were the best at predicting failed arthroscopic treatment a posteriori. ResultsThe study analyzed 39 patients. The mean mHHS was 76±15 [40–92]. The “success” group consisted of 21 patients (56%, 21/39), the “moderate improvement” group of 12 patients (31%, 12/39) and the failure group of 6 patients (13%, 6/39) (2 subsequently underwent total hip replacement, 4 underwent shelf acetabuloplasty). The FEAR index was significantly higher and the AWI and VCE were significantly lower in the “failure” group. The FEAR index was the best predictive factor; an index ≥ 4° detected 100% of failures with 96% specificity. The patients in the “moderate improvement” group were significantly older (37 years±8 [18–45]<p= 0.04) with a significantly higher offset (2mm±3 [−5–5]<p=0.004); an offset ≥ 2mm could detect 73% of them with a specificity of 72%. ConclusionA FEAR index ≥ 4° and offset ≥ 2mm is best able to detect patients at risk of failure and unsatisfactory results, respectively, in the mild clinical cam-type impingement in a population of FAI patients. Level of evidenceIV, retrospective series.

Paper 23: Long Term Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement for Patients with Borderline Dysplasia

Objectives:Outcomes following isolated hip arthroscopy for patients with dysplasia have been unfavorable, results have included iatrogenic instability and conversion to total hip arthroplasty (THA) at a young age. However, patients with borderline dysplasia have portended more favorable results at short and medium term follow-up. The purpose of this study was to assess long term outcomes after hip arthroscopy for femoroacetabular impingement (FAI) in borderline dysplasia (BD) patients (LCEA, 18°-25°) compared to a control cohort of nondysplastic patients (LCEA, 25°-40°).Methods:Between March 2009 and July 2012, a BD group of 33 patients (38 hips) was identified. An age- and sex-matched control group of 83 patients (96 hips) was also identified. Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT-33), were collected preoperatively and subsequently at an average of 9.6 years post-operatively.Results:The mean LCEA and Tönnis angle was 22.4° ± 2.02° and 6.2° ± 3.23° in the BD group and 31.7° ± 3.52° and 2.42° ± 3.02° in the control group, respectively (P <0.001). A labral repair was performed in 78.9% and 76% of the BD and control groups, respectively, all patients underwent capsular closure as part of routine hip arthroscopy. A cam decompression was performed in 97.4% of the BD patients and 99.0% of the control patients. At mean follow-up of 9.6 years (range, 8.2-11.6 years) on average there was significant improvement in all patient-reported outcomes scores in both groups (P<0.001). There were no significant differences between pre and post-operative scores between BD and control groups. Two hips (5.2%) underwent revision surgery in the BD group and 10 hips (10.4%) in the control group, of these one patient in the BD group underwent THA and one patient who underwent bilateral hip arthroscopies in the control group underwent bilateral hip resurfacing.Conclusions:Durable outcomes (>9 years) with low revision rates can be expected after isolated hip arthroscopy that includes cam resection, labral refixation and capsular closure in BD patients with equivalent outcomes to a nondysplastic cohort.

Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears.

Background:The cleft sign (CS) and bone marrow edema (BME) are considered magnetic resonance imaging (MRI) findings signifying a pubic pathology, which is associated with groin pain; however, their relationship with bony morphology related to femoroacetabular impingement (FAI) has not been established.Purpose:To investigate the prevalence of CS and BME in symptomatic patients with acetabular labral tears and assess their possible association with bone morphology and sport-specific activities.Study Design:Cross-sectional study; Level of evidence, 3.Methods:This study enrolled 418 patients (469 hips) undergoing hip arthroscopic surgery for labral tears. Also included were patients with labral tears in the setting of either hip dysplasia or borderline hip dysplasia who were undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic labral repair, cam osteoplasty, and capsular plication. All patients were screened for superior CS (SCS), inferior CS (ICS), and BME of the ipsilateral side of the pubis using 3-T MRI. We measured the following angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior, and alpha. Then, we evaluated the relationship between patient characteristics and abnormal findings on MRI scans (preoperatively vs 1 year postoperatively).Results:An overall 397 hips were included: 200 in men and 197 in women (mean ± SD age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in 183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18 (4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings at the pubis were seen more often in athletes than nonathletes (23.8% vs 3.3%), and contact sports athletes had the most frequent abnormalities. There was no SCS in patients with an LCE angle <22°. SCS was more frequently seen in those who had an alpha angle ≥71°. More than 60% of abnormal findings at the pubis diminished after arthroscopic surgery that included FAI correction and labral repair.Conclusion:In patients with labral tears, CS and BME were seen more frequently in athletes versus nonathletes, especially contact athletes with FAI-related bony abnormalities. More than 60% of abnormal MRI pubis findings resolved after arthroscopic treatment of FAI.

Rehabilitation and Return to Sport After Arthroscopic Treatment of Femoroacetabular Impingement: A Review of the Recent Literature and Discussion of Advanced Rehabilitation Techniques for Athletes

The purpose of the article is to present an updated literature review, as well as describe our approach to rehabilitation and return to sports following hip arthroscopy for femoroacetabular impingement (FAI) with labral repair. A literature review was performed to identify articles published within the last 10 years that were focused on this topic. Relevant articles were reviewed, and reference lists were searched to identify additional articles. Findings were summarized for rehabilitation phases and return-to-sports assessment. Additionally, advanced rehabilitation topics are reviewed. Several systematic reviews and individual case series were identified. There is relative uniformity concerning the use of a four-phase approach for rehabilitation. However, there is inconsistency in terms of timing and criteria for ultimate return to sport. Advanced rehabilitation topics were reviewed, and description of their relevance at various rehabilitation phases was provided. A four-phase approach to rehabilitation following hip arthroscopy for FAI is widely used with general uniformity, although the timing and level of detail concerning assessment and readiness for return to sport are variable. Advanced rehabilitation techniques may be used in select patients returning to high-level activities.