Hip Arthroscopy For Labral Tears Research Articles

Favorable and Durable Outcomes at 10-Year Follow-Up After Endoscopic Gluteus Medius Repair With Concomitant Hip Arthroscopy

To evaluate 10-year patient-reported outcome (PRO) scores following endoscopic surgery for gluteus medius partial and full-thickness tears with concomitant hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome (FAIS). Prospectively collected data on patients followed for a minimum of 10 years after endoscopic gluteus medius repair with concomitant hip arthroscopy performed by a single surgeon were retrospectively analyzed. Patients with preoperative and 10-year follow-up for the following PROs were included: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS) score for pain. There were 13 patients eligible for inclusion, 11 (84.6%) of whom had 10-year follow up, with a mean of 127.6 months (range: 120.0-140.2 months). The group consisted of 10 females (90.9%) and one male (9.1%) with a mean age at surgery of 60.1 years (range: 46.2-74.8 years). PRO scores improved from preoperative to 10-year follow-up as follows: mHHS from 60.4 to 88.0 (P= .011); NAHS from 50.1 to 90.6 (P < .001); HOS-SS from 37.5 to 85.1 (P= .001); and VAS from 4.8 to 1.2 (P= .006). Mean patient satisfaction rating was 8.3. Patients achieved PASS and MCID for mHHS and HOS-SSS at a rate of 81.8%. There was no significant decline in PROs or satisfaction between 2, 5, and 10 years postoperatively. All patients underwent concomitant hip arthroscopy and labral treatment (debridement or repair). One patient, who had arthroscopic findings of acetabular and femoral outerbridge grade 4 lesions, subsequently underwent total hip arthroplasty; however, the GM was assessed during the THA, and it was verified that the repair was intact. There were no clinical failures, secondary operations, or complications. Endoscopic repair of gluteus medius tears is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up. Level IV, therapeutic case series.

Endoscopic Tendon Compression Bridge Technique for Repair of Partial-Thickness Gluteus Medius Tears With Concomitant Arthroscopy for Labral Tears: Minimum 2-Year Outcomes With Benchmark Control Group

Background: The transtendinous technique has been used to treat partial-thickness gluteus medius tears in the setting of concomitant arthroscopy for labral tears. The tendon compression bridge technique for gluteus medius repair has been developed as an alternative method, providing several advantages; however, comparative studies between the 2 techniques are lacking in the literature. Purpose: (1) To evaluate the short-term patient-reported outcomes (PROs) of the tendon compression bridge technique and (2) to compare these findings with short-term PROs of the transtendinous technique. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who were followed for a minimum of 2 years after an endoscopic tendon compression bridge procedure for gluteus medius repair in the setting of concomitant hip arthroscopy for labral tears. The following PROs were collected preoperatively and postoperatively: modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, visual analog scale score for pain, and the International Hip Outcome Tool. Clinical outcomes were assessed using the Patient Acceptable Symptom State, minimal clinically important difference, and maximum outcome improvement satisfaction threshold. Patients were propensity matched 1:1 to a cohort that underwent gluteus medius repair using the endoscopic transtendinous technique with concomitant hip arthroscopy. Results: A total of 48 hips (48 patients) that met inclusion criteria (age, 53.3 ± 9.8 years; 92% female; body mass index, 26.7 ± 4.6), with a mean follow-up of 38.5 ± 15.7 months, were matched to 48 hips (46 patients) that underwent gluteus medius repair using the transtendinous technique. Both groups demonstrated significant improvement from preoperative scores to latest follow-up (P < .05). Mean magnitude of improvement and latest follow-up scores were not significantly different between the tendon compression bridge group and the transtendinous group, and the groups demonstrated similar favorable rates of achieving Minimal Clinically Important Difference (79% vs 79%, respectively), Patient Acceptable Symptom State (73% vs 73%, respectively), and Maximum Outcome Improvement Satisfaction threshold (65% vs 58%, respectively) for modified Harris Hip Score (P > .05). Patient satisfaction between groups was similar (8.1 ± 2.2 vs 7.7 ± 2.7, respectively) (P = .475). Conclusion: At minimum 2-year follow-up, the endoscopic tendon compression bridge technique for partial-thickness gluteus medius tears, when performed with concomitant hip arthroscopy, was associated with significant improvement in functional outcomes. These postoperative results were comparable with those of a matched cohort that underwent the endoscopic transtendinous technique for partial-thickness gluteus medius tears, suggesting that the tendon compression bridge technique for gluteus medius repair is an effective treatment option for partial-thickness gluteus medius tears.

Paper 12: Elite Female Athletes Demonstrate Comparable Improvement in Midterm Patient Reported Outcome Scores and Rate of Return to Sport Compared to Elite Male Athletes After Hip Arthroscopy: A Sex-Based Comparison in Professional and Collegiate Athletes

Objectives: (1) To report minimum 5-year patient reported outcome scores (PROs) and continuation of sport for elite female athletes undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and (2) to compare clinical results with a matched control group of elite male athletes. Methods: Data on all consecutive elite female athletes who underwent primary hip arthroscopy performed by the senior author (X.X.X.) between March 2009 and March 2016 were collected. Patients were eligible if underwent hip arthroscopy for labral tears or FAI and participated at a collegiate or professional level within 1 year of surgery. Minimum 5-year PROs were collected for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain. The rates of patients achieving minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were also recorded. These athletes were propensity-matched to elite male athletes for comparison. Results: Sixty-five elite female athlete hips were included in the study. Elite female athletes had an average follow-up time of 67.6 ± 6.5 and age of 24.3 ± 6.8. When propensity-matched to a control group of elite male athletes, female athletes demonstrated lower preoperative PRO scores and comparable minimum 5-year post-op scores, improvement between preoperative and minimum 5-year scores, and continuation of sport rate. Conclusions: Elite female athletes undergoing primary hip arthroscopy for FAI demonstrated significant improvement in PROs and high rates of CTS which were similar to a propensity-matched group of elite male athletes. [Figure: see text][Table: see text] [Table: see text]

Paper 48: Elite Female Athletes Demonstrate Greater Improvement in Patient Reported Outcome Scores and Equal Rate of Return to Sport Compared to Elite Male Athletes After Hip Arthroscopy: A Sex-Based Comparison in Professional and Collegiate Athletes *ACCEPTED TO AJSM*

Objectives:(1) To report minimum 2-year patient reported outcome scores (PROs) and return to sport for elite female athletes undergoing hip arthroscopy for femoroacetabular impingement (FAI) and (2) to compare clinical results with a matched control group of elite male athletes.Methods:Data on all consecutive female athletes who underwent primary hip arthroscopy performed by the senior author (X.X.X.) between March 2009 and July 2018 were collected. Patients were considered eligible if they underwent hip arthroscopy for labral tears or FAI and participated in collegiate or professional athletics within 1 year of surgery. Minimum 2-year PROs were collected for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and RTS status. The percentage of patients achieving minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were also recorded. These patients were then matched to elite male athletes for comparison.Results:Seventy-three female athlete hips were included with a mean follow-up of 65.1 ± 27.9 months. They demonstrated significant improvement from preoperative to latest follow-up for mHHS, NAHS, HOS-SSS, and VAS (P < .05). When outcomes were compared to a control group of male athletes, female athletes demonstrated lower preoperative scores, similar postoperative scores, and significantly greater magnitude of improvement (delta value) for mHHS, NAHS, and VAS. Female athletes also achieved MCID at higher rates than male athletes for HOS-SSS (85.1% vs 70.0%, P = .035) and NAHS (79.1% vs 62.9%, P = .037). RTS rates were similar between the two groups (Females: 67.1%, Males: 67.1%, P > 0.999).Conclusions:Elite female athletes undergoing primary hip arthroscopy for FAI demonstrated significant improvement in PROs and high rates of return to play, which were similar to a matched group of male athletes. Female athletes exhibited greater improvement in PROs (mHHS, NAHS, VAS) and achieved MCID (HOS-SSS, NAHS) at higher rates when compared to a control cohort of male athletes.Figure 1.Patient Selection FlowchartFigure 2.Return to sport rate comparison between males and females. (Lifestyle transition: did not return to sport due to a lifestyle transition; Hip pain: did not return to sport due to hip pain)Table 1.Rate of MCED and PASS achievement between the male and female cohorts at minimum 2 years.

Workers’ Compensation Patients Improved After Hip Arthroscopy for Labral Tears: A 5-Year Outcome Propensity Score–Matched Study

Background: The workers’ compensation (WC) status has been associated with inferior outcomes in orthopaedic procedures and is usually excluded from clinical outcome studies. Therefore, comparative studies based on WC status are scarce. Purpose: (1) To determine outcomes of patients with WC claims treated with hip arthroscopy for labral tears at a minimum 5-year follow-up and (2) to compare these findings with a propensity score–matched control group without WC claims. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were propensity score matched to a control group without WC claims. Data were prospectively collected for all patients undergoing hip arthroscopy. Patients were included if they received primary hip arthroscopy for labral tears in the setting of femoroacetabular impingement, had a WC claim, and had preoperative and minimum 5-year follow-up patient-reported outcomes ([PROs]; modified Harris Hip Score [mHHS], Non-Arthritic Hip Score [NAHS], Hip Outcome Score–Sports Specific Subscale [HOS-SSS], and visual analog scale [VAS] for pain). Clinical outcomes were measured using the Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and maximum outcome improvement satisfaction threshold (MOI). Results: A total of 111 from 132 (84.1%) eligible WC patients met the inclusion criteria with an average follow-up time of 80.3 ± 37.3 months. WC cases demonstrated significant improvement from preoperatively to a minimum 5-year follow-up for mHHS, NAHS, HOS-SSS, and VAS for pain (P < .05). WC patients returned to work at a 66% rate, with an average clearance time of 4.7 months to light duty and 9.5 months to heavy duty. When compared with the control group, the WC group demonstrated lower pre- and postoperative PROs (P < .05); however, WC cases had a greater magnitude of improvement (ΔmHHS [P = .0012], ΔNAHS [P < .001], and ΔHOS-SSS [P = .012]). Rates of achieving MCID and MOI were similar in both groups (P > .05). The WC group went on to receive a future arthroscopy in 19 cases (17.1%), while 10 cases (4.5%) in the control group required revision arthroscopy (P < .001). Patients in both the WC and the control groups converted to total hip arthroplasty at similar rates (13.3% and 15.4%, respectively; P > .05). Conclusion: Patients with WC claims treated with hip arthroscopic surgery showed significant improvement and high rates of returning to work at a minimum 5-year follow-up. Although having lower scores in PROs and achieving PASS rates, no differences were found in MCID and MOI rates. Furthermore, WC patients had a greater magnitude of improvement from preoperatively to a minimum 5-year follow-up after hip arthroscopy. Therefore, even though more studies are needed to determine the causes of inconsistent outcomes in the WC population, hip arthroscopy can effectively treat labral tears in the setting of femoroacetabular impingement, regardless of the WC status.

Multicenter Outcomes After Revision Hip Arthroscopy: Comparative Analysis of 2-Year Outcomes After Labral Repair Versus Labral Reconstruction

Background: There is a paucity of literature evaluating patient outcomes in patients undergoing revision labral repair and labral reconstruction. Purpose: To compare outcomes in patients undergoing revision hip arthroscopy for treatment of labral tears by labral repair or labral reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of a prospectively maintained multicenter database of patients undergoing hip arthroscopy was performed. An a priori power analysis determined that a total of 62 patients were required. Patients undergoing revision hip arthroscopy for labral tears with completed 2-year outcome scores were included. Patients undergoing primary hip arthroscopy, labral debridement, concomitant gluteal repair, and patients with hip dysplasia (lateral center-edge angle <20°) were excluded. Patients were grouped into revision labral repair and labral reconstruction groups. Patient demographics and patient-reported outcomes (PROs) including Hip Outcome Score – Activities of Daily Living, Hip Outcome Score – Sport Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, visual analog scale for pain and satisfaction, and achievement of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were analyzed. Results: A total of 40 patients underwent revision labral repair and 55 patients underwent labral reconstruction. Patients undergoing revision labral repair were younger (mean age, 30.0 ± 10.7 years vs 34.4 ± 9.7 years; P = .048), had lower rates of labral degeneration (25.0% vs 62.7%; P = .004), and had lower rates of severe complexity of tears (21.1% vs 66.0%; P = .003). However, the labral repair group had higher rates of articular cartilage damage (62.5% vs 33.3%; P = .009). There were no differences in any preoperative or 2-year postoperative PROs. Furthermore, no differences were seen in achievement of MCID or PASS in any PRO. Conclusion: In this multicenter study on revision hip arthroscopy, patients undergoing revision labral repair were younger and had better labral characteristics but greater cartilage damage compared with patients undergoing labral reconstructions. Despite these differences, patients who underwent labral repair reported similar outcomes to those undergoing labral reconstruction.

Approach to the Patient With Failed Hip Arthroscopy for Labral Tears and Femoroacetabular Impingement.

There has been an exponential increase in the diagnosis and treatment of patients with femoroacetabular impingement, leading to a rise in the number of hip arthroscopies done annually. Despite reliable pain relief and functional improvements after hip arthroscopy in properly indicated patients, and due to these increased numbers, there is a growing number of patients who have persistent pain after surgery. The etiology of these continued symptoms is multifactorial, and clinicians must have a fundamental understanding of these causes to properly diagnose and manage these patients. Factors contributing to failure after surgery include those related to the patient, the surgeon, and the postoperative physical therapy. This review highlights common causes of failure, including those related to residual bony deformity as well as capsular deficiency, and provides a framework for diagnosis and treatment of these patients.

Clinical Outcomes of Hip Arthroscopy in Patients With Systemic Inflammatory Diseases Compared With Matched Controls at a Minimum of 2-Year Follow-Up

To evaluate postoperative outcomes and preoperative risk factors for patients with underlying systemic inflammatory disorders after hip arthroscopy. A retrospective analysis of patients who had undergone hip arthroscopy, with a history of systemic inflammatory disease, was performed. This included patients with a diagnosis of lupus, a positive antinuclear antibody test, rheumatoid arthritis, psoriatic arthritis, sarcoidosis, inflammatory bowel disease, Reiter syndrome, and mixed connective tissue disease. These cases were 1:2 matched to a control group of patients with no history of systemic inflammatory disease based on age and sex. An a priori power analysis was conducted and A 1:2 case-control ratio was selected to increase study power. Inclusion criteria included all skeletally mature patients with hip pain refractory to nonoperative management who underwent hip arthroscopy for labral tears and femoroacetabular impingement. Skeletally immature patients, those with Tönnis grades of 2 or more (less than 2 mm of joint space), hip dysplasia, patients undergoing revision hip arthroscopy, and patients whose pain failed to improve after intra-articular injection were excluded. The primary outcome was rate of revision hip arthroscopy or total hip arthroplasty 24 months after surgery. Secondary outcomes included 2 patient-reported outcome scores, the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Twenty patients (21 hip arthroscopy procedures) and 42 controls were included. There was no significant difference in proportion of patients who met failure criteria (28.6% vs 16.7%, P=.271) or 2-year survivorship (76.2% vs 83.3%, P= .496) between the systemic inflammatory disorder and control groups, respectively. Both groups had a significant improvement in mHHS and NAHS at 24 months compared with baseline; however, there was no significant difference in mHHS (P= .28) or NAHS (P= .22) at 24 months between the 2 groups. Patients with underlying inflammatory conditions have similar 2-year outcomes after hip arthroscopy for intra-articular pathology compared with patients with no history of inflammatory disease. III, retrospective comparative study.

What Is the Association Between Articular Cartilage Damage and Subsequent THA 20 Years After Hip Arthroscopy for Labral Tears?

Few studies have examined long-term outcomes for patients after arthroscopic treatment for intraarticular hip conditions, and none have done so beyond 10 years postarthroscopy. Examining outcomes beyond 10 years is necessary to determine factors that contribute to conversion to THA in patients undergoing hip arthroscopy for labrochondral damage. (1) What is hip survivorship free from THA in patients who underwent arthroscopic labral débridement, with or without chondroplasty at least 15 years before? (2) What factors are associated with conversion to THA after arthroscopic labral débridement, with or without chondroplasty? (3) Can these data be used to estimate the risk of conversion to THA based on patient- and hip-related factors? Between 1989 and 2000, one surgeon performed 552 arthroscopic hip procedures for symptomatic labral tears, with or without associated articular cartilage damage. Of these, the hip status was known in 404 hips (73%) at a minimum of 15 years after the index procedure, with 20 of those patients having died during the followup period. During the study period, patients were offered hip arthroscopy for labral tears with mechanical symptoms, with or without underlying articular cartilage damage. Patient age, sex, acetabular and femoral head Outerbridge grade at surgery, and presence of labral tear were recorded. We determined survivorship free from THA using a Kaplan-Meier survivorship estimator. A stepwise multivariable logistic regression analysis was conducted to determine factors associated with the eventual conversion to THA after hip arthroscopy for labrochondral injuries. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for all significant independent factors. Odds ratios for combinations of significant factors were used to create a risk assessment. The survivorship free from conversion to THA at 20 years was 59% (95% CI, 53-64. Factors that affected survival included age ≥ 40 years and the presence of combined femoral head and acetabular chondral damage. After controlling for confounding factors, we found that age ≥ 40 years (OR, 2.0; 95% CI, 1.2-3.4; p = 0.011), the absence of all chondral damage (OR, 0.1; 95% CI, 0.03-0.32; p < 0.001), the presence of acetabular damage with severe femoral head damage (OR, 5.0; 95% CI, 2.4-10.3; p < 0.001), and the presence of severe acetabular damage with femoral head damage (OR, 3.7; 95% CI, 2.0-6.8; p < 0.001) were associated with conversion to THA at long-term followup. Based on the calculated ORs, the probability of conversion to THA by 20 years postarthroscopic treatment for labrochondral injuries ranged from 12% (95% CI, 8-17) for a patient younger than 40 years with a Grade 0-II femoral and acetabular Outerbridge grade to 92% (95% CI, 86-95) for a patient older than 40 years with a Grade III-IV femoral and acetabular Outerbridge grade. Our study revealed that survivorship free from THA at 20 years after arthroscopic labral débridement was associated with both patient age at time of index procedure and, more importantly, the presence of combined femoral head and acetabular chondral damage. Patients should be counseled as to the increased probability of conversion to THA, depending on the health of their articular cartilage after surgery. Future studies should examine survivorship free from THA or clinical symptoms in patients undergoing hip arthroscopy with bone reshaping procedures or with labral repair or reconstruction up to and exceeding 20 years. Level III, therapeutic study.

Five-Year Outcomes and Return to Sport of Runners Undergoing Hip Arthroscopy for Labral Tears With or Without Femoroacetabular Impingement

Background: Recent evidence has demonstrated a high rate of return to running after hip arthroscopy for femoroacetabular impingement at short-term follow-up. The midterm outcomes and rates of continued running of these patients are unknown. Purpose: To evaluate midterm rates of return to running and outcomes after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected for patients who underwent hip preservation surgery between July 2008 and November 2011. Patients were excluded for preoperative Tönnis osteoarthritis grade ≥2, previous ipsilateral hip conditions or hip surgery, or workers’ compensation status. All patients who participated in mid- to long-distance running before their surgery and intended on returning after their operation were considered for inclusion. Preoperative and minimum 5-year postoperative measures for the following patient-reported outcome scores (PROs) were necessary for inclusion in the final cohort: the modified Harris Hip Score, Non-arthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, and visual analog scale (VAS) for pain. All patients were counseled about the risks of continued running after hip arthroscopy. Results: Sixty patients (62 hips) were eligible for inclusion, of which 50 (83.3%; 52 hips) had minimum 5-year follow-up. There were 10 male hips and 42 female hips. Mean ± SD age at surgery was 32.4 ± 12.4 years (range, 14.9-62.4), and mean body mass index was 22.9 ± 3.2 (range, 17.7-30.1). Latest follow-up was recorded at a mean 69.3 ± 8.5 months (range, 60.0-92.1 months). Level of competition included 39 recreational, 7 high school, 4 collegiate, and 2 professional athletes. There were significant improvements in all PROs and VAS scores preoperatively to latest follow-up. Mean modified Harris Hip Score improved from 67.5 to 88.2; mean Non-arthritic Hip Score, from 65.9 to 88.3; mean Hip Outcome Score–Sports Specific Subscale, from 49.5 to 81.0; and mean VAS, from 5.2 to 1.5. At latest follow-up, patient satisfaction was 8.4. Thirty-nine patients (78.0%, 41 hips) had returned to running postoperatively. When stratified by level of competition, 79% (31 of 39) of recreational, 100% (7 of 7) of high school, 50% (2 of 4) of collegiate, and 50% (1 of 2) of professional athletes returned to running. Conclusion: Hip arthroscopy for all levels of runners is associated with a significant increase in PROs and a low risk of complications. The rate of return to running is moderately high after hip arthroscopy at midterm follow-up. Hip arthroscopy may be considered for runners presenting with symptoms of femoroacetabular impingement that fail nonoperative treatments. Patients should be educated on the rate of return to running over time and the risks of continued running after hip arthroscopy.

Do Femoral Head Osteochondral Lesions Predict a Poor Outcome in Hip Arthroscopy Patients? A Matched Control Study With Minimum 5-Year Follow-Up

To determine whether the presence of femoral head (FH) lesions affects patient-reported outcomes (PROs) of patients undergoing hip arthroscopy for labral tears. Data were prospectively collected and retrospectively reviewed for all patients who underwent hip arthroscopy for labral tears at our institution from April 2008 to March 2011. Patients with FH lesions were matched to those without (control) for age, body mass index, sex, and lateral center-edge angle. The inclusion criteria were FH lesions, labral tears, and minimum 5-year follow-up. The exclusion criteria were previous hip surgery, prior hip conditions, inflammatory arthritis, Workers' Compensation claims, and Tönnis grade greater than 1. PRO scores, including the modified Harris Hip Score, Non-Arthritic Hip Score, and Hip Outcome Score-Sports Specific Subscale, were collected preoperatively and postoperatively. Visual analog scale (VAS) scores for pain and patient satisfaction were recorded. We matched 96 hips with FH lesions to 96 control hips. The FH group had slightly longer follow-up (71.4months vs 67months, P= .004). Patients with FH lesions tended to have higher-grade acetabular lesions (grade 4 acetabular labrum articular disruption and Outerbridge grade 4 acetabular lesions). All PRO scores, VAS scores, and patient satisfaction ratings were statistically improved at latest follow-up in both groups. No statistical difference in improvement (ΔPRO and ΔVAS scores) was noted between groups. However, patients with FH lesions had a higher rate of conversion to arthroplasty (32% vs 16%, P= .0027). Patients in the control group underwent more secondary arthroscopies (14% vs 5%, P= .05). Finding an FH chondral lesion at arthroscopy does not necessarily portend a worse clinical outcome or conversion to total hip arthroplasty, when controlling for other variables. Patients with FH lesions were, however, found to have worse intra-articular hip pathology. When combined with these factors, patients with FH lesions had lower outcome scores and double the rate of conversion to arthroplasty than patients without them. Level III, case-control study.

Acetabular Labral Tears Are Common in Asymptomatic Contralateral Hips With Femoroacetabular Impingement.

The number of patients undergoing hip arthroscopy for labral tears has increased, but labral tears are sometimes seen in asymptomatic patients with femoroacetabular impingement (FAI). The frequency of this finding, however, has not been well characterized nor is the proportion of patients with previously asymptomatic labral tears who may later become symptomatic. The purpose of this study was to determine (1) the prevalence of labral tears and other intraarticular pathology in the asymptomatic contralateral hip of patients undergoing surgery for symptomatic FAI; (2) the likelihood that the asymptomatic hip had become symptomatic at latest followup; and (3) any association between MRI findings and age, sex, and body mass index (BMI) in both symptomatic and asymptomatic sides. This study included patients who were diagnosed with unilateral symptomatic FAI between 2013 and 2015 and who had an available MRI of both hips. The study included 100 patients (47 females, 53 males) with a mean age of 33 years (range, 17-57 years). Patients with a symptomatic contralateral hip (n = 56) or an unsuitable MRI for review based on both reviewers' consensus (n = 344) were excluded. The MRI of both hips was independently evaluated by two orthopaedic surgeons and interobserver reliability tested. The interobserver reliability for the two surgeons' MRI ratings was almost perfect (κ ≥ 0.85). The presence of a labral tear, an acetabular chondral lesion, subchondral acetabular cysts, and fibrocystic changes in the femoral head-neck junction was documented for both hips. At latest followup, asymptomatic hips were investigated for any symptomatic labral tears or surgical procedures resulting from FAI. A labral tear was recorded in 97 (97%) and 96 (96%) of symptomatic hips, respectively, for each surgeon's evaluation. A labral tear was also detected in 41 (41%) and 43 (43%) of asymptomatic hips. In addition, an acetabular chondral lesion was detected in 32 (32%) and 35 (35%) of the symptomatic hips and 15 (15%) and 17 (17%) of the asymptomatic hips. At latest followup, nine of the patients were diagnosed with symptomatic labral tears in the contralateral asymptomatic hip and were treated. None of the radiologic parameters examined demonstrated an association with patient age, sex, or BMI in either symptomatic or asymptomatic hips. Labral tears and acetabular chondral lesions are common in the asymptomatic contralateral hip of patients undergoing surgery for FAI. The incidence of a symptomatic labral tear in these asymptomatic hips was 9% during 2 years of followup. We suggest that the decision to perform chondral or labral surgery in patients with FAI should be made with caution considering the relatively high prevalence of labral tears in asymptomatic hips and the low chance of development of symptoms. Level IV, case-series study.

Assessing the Outcome of Hip Arthroscopy for Labral Tears in Femoroacetabular Impingement Using the Minimum Dataset of the British Non-arthroplasty Hip Register: A Single-Surgeon Experience

The aim of this study was to assess changes in British Non-arthroplasty Hip Register (NAHR) minimum dataset (MDS) patient-reported outcome measures (PROMs) after hip arthroscopy for femoroacetabular impingement (FAI) and define the relation between these and patient satisfaction. Secondary aims included exploring the impact of patient characteristics (age, sex, and social deprivation status) on MDS PROMs and satisfaction and determining the Net Promoter Score for hip arthroscopy for FAI. Preoperative data were collected from the NAHR, and postoperative data were collected through the NAHR, by mail, and by telephone survey. Correlations between satisfaction, International Hip Outcome Tool 12 (iHOT-12), and EQ-5D scores were explored. A consecutive series of 89 primary hip arthroscopy procedures for FAI in 88 patients is reported. Patients reported improvements in the iHOT-12 score (mean, 34.08; 95% confidence interval [CI], 27.88 to 40.28; P < .001), EQ-5D index score (+0.124; 95% CI, 0.063 to 0.185; P<.001), and EQ-5D visual analog scale (VAS) (+4.49; 95% CI, -1.56 to 10.54; P= .061) after hip arthroscopy for FAI. Satisfaction was predicted by both change in iHOT-12 score (Spearman r [rs]= 0.54, P < .001) and absolute postoperative iHOT-12 score (rs= 0.78, P < .001), change in EQ-5D index score (rs= 0.42, P < .001) and absolute postoperative EQ-5D index score (rs= 0.70, P < .001), and change in EQ-5D VAS score (rs= 0.30, P= .012) and absolute postoperative EQ-5D VAS score (rs= 0.59, P < .001); and the strength of correlation was greater with the absolute postoperative score than with the change in score for all 3. Sex, age, and social deprivation status did not predict postoperative PROMs (P ≥ .15) or satisfaction (P ≥ .32). The postoperative iHOT-12 score correlated strongly with EQ-5D index (rs= 0.90, P < .001) and EQ-5D VAS (rs= 0.81, P < .001) scores. The Net Promoter Score for hip arthroscopy for FAI was 70.31. This study showed significant improvements in hip-specific function (iHOT-12) and health-related quality of life (EQ-5D), as measured by the NAHR MDS, in patients undergoing hip arthroscopy for FAI. Satisfaction rates were high (75.7%) and correlated strongly with hip-specific and general health PROMs. Satisfied patients were more likely to be willing to undergo similar surgery in the future. Self-reported postoperative hip function correlated very strongly with general health-related quality of life. Level IV, case series.

Central Acetabular Impingement Is Associated With Femoral Head and Ligamentum Teres Damage: A Cross-Sectional Matched-Pair Analysis of Patients Undergoing Hip Arthroscopy for Acetabular Labral Tears

The primary purpose of this study was to report the prevalence of femoral head articular damage in patients with a central acetabular osteophyte (CAO) that was identified during hip arthroscopy and compare it with that in a matched control group without a CAO. A secondary purpose was to identify rates of coexisting intra-articular pathology in both patient groups. Intraoperative data were collected prospectively on all hip arthroscopy patients at our institution between 2008 and 2015. The inclusion criteria for this study were CAOs identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement. The exclusion criteria were Tönnis grade greater than 0, previous hip conditions, and prior surgical interventions. The matched control group was selected based on sex, age ± 5years, body mass index, and Workers' Compensation claim at a 3:1 ratio and comprised patients who underwent hip arthroscopy for a labral tear and/or femoroacetabular impingement without a CAO. The size and location of labral tears and chondral lesions were recorded in square millimeters with a 5-mm probe and by the clock-face method. The CAO group consisted of 126 patients, who were matched to 378 patients in the control group. Femoral and acetabular chondral damage grades were significantly different between the 2 groups (P < .001). Of patients with CAOs, 55% had femoral head chondral damage compared with 24% of the control patients. The mean size of femoral chondral damage was 3.2cm2 in the CAO group and 1.7cm2 in the control group. The mean size of acetabular chondral damage was 1.7cm2 in the CAO group and 1.2cm2 in the control group. Both femoral and acetabular chondral damage sizes were significantly larger in the CAO group (P ≤ .007). The prevalence of ligamentum teres tears was significantly different between the 2 groups (P < .001). There were no statistically significant differences in the types of labral tears between the 2 groups (P=.625). This study showed that patients with CAOs had a significantly higher prevalence of femoral chondral damage and ligamentum teres tears than matched controls. Level III, comparative study.

Endoscopic Gluteus Medius Repair With Concomitant Arthroscopy for Labral Tears: A Case Series With Minimum 5-Year Outcomes

To report the minimum 5-year outcomes of endoscopic gluteus medius repair for partial- and full-thickness tears with concomitant hip arthroscopy. Data for all patients who underwent hip arthroscopy between February 2009 and September 2011 were prospectively collected. We included patients who underwent endoscopic gluteus medius repair with concomitant arthroscopic labral treatment and for whom the following measures were obtained preoperatively and at a minimum of 5years' follow-up: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale score for pain. For included patients, the International Hip Outcome Tool-12 (iHOT-12) score and satisfaction rating were also available at latest follow-up. Patients with at least 1 of the following criteria were excluded: preoperative Tönnis osteoarthritis grade of 2 or greater, previous hip conditions, severe dysplasia, and Workers' Compensation claims. There were 16 patients eligible for inclusion, 14 (87.5%) of whom had minimum 5-year follow-up, with a mean of 68.8months (range, 60.1-79.6months). The study group consisted of 13 women (92.9%) and 1 man (7.1%) with a mean age at surgery of 57.4years (range, 46.3-74.8years). Outcome scores improved as follows: modified Harris Hip Score, from 52.4 to 81.2 (P= .004); Non-Arthritic Hip Score, from 48.0 to 82.5 (P= .002); Hip Outcome Score-Sports Specific Subscale, from 30.1 to 66.4 (P < .001); and visual analog scale score, from 6.2 to 2.6 (P= .001). At minimum 5-year follow-up, the mean iHOT-12 score was 73.8 and the mean patient satisfaction rating was 8.4. Survivorship was 92.9%, with 1 patient who underwent conversion to total hip arthroplasty. There was no deterioration in patient outcomes and satisfaction between 2 and 5years postoperatively. There were no clinical failures of gluteus medius repair and no complications. Endoscopic gluteus medius repair with concomitant hip arthroscopy for labral tears is safe and shows favorable outcomes at minimum 5-year follow-up. Patient outcomes were as favorable at 5years as they were at 2years postoperatively. Level IV, therapeutic case series.

Does duration of symptoms affect clinical outcome after hip arthroscopy for labral tears? Analysis of prospectively collected outcomes with minimum 2-year follow-up.

Limited research exists on the possible association between duration of symptoms and clinical outcomes following hip arthroscopy for labral tears. The purpose of this study was to evaluate whether duration of symptoms affected clinical and patient-reported outcome (PRO) scores following hip arthroscopy for labral tears. From 2008 to 2011, data were collected prospectively on all patients undergoing primary hip arthroscopy for labral tears. Workers’ compensation cases, dysplasia cases and patients with previous ipsilateral hip surgeries were excluded. A total of 738 patients were identified with a minimum of 2-year follow-up, and clinical and PRO data were available for 680 patients. Uni- and multivariate analyses were performed to determine the relationship between duration of symptoms along with other variables and PROs. Overall, patients experienced significant improvements in all clinical and PRO scores. Results of univariate analysis revealed that all PROs were negatively associated with increasing Log10 months of symptoms as were pain and satisfaction scores. During multivariate analyses, increasing Log10 months of symptoms, age, body mass index and trauma were all negatively associated with PROs (P < 0.05). Our study demonstrates that clinical and PRO scores were negatively associated with increasing duration of symptoms prior to hip arthroscopy for treatment of labral tears. Although this implies that delay in treatment may adversely affect outcome, conservative treatment remains the gold standard first line of treatment. Surgeons should incorporate this information into their treatment algorithm to maximize patient outcomes following treatment for labral tears. Level of evidence: Level IV, prospective case series.

Arthroscopic Treatment of Labral Tears of the Hip in Adolescents: Patterns of Clinical Presentation, Intra-articular Derangements, Radiological Associations and Minimum 2-Year Outcomes

To report on patterns of clinical presentation, intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopy (HA) in patients 18years or younger. This study was a retrospective case series on patients 18years or younger who had undergone HA for labral tears that had failed nonoperative management from April 2008 to April 2013 with a minimum 2-year follow-up. Exclusion criteria were previous hip conditions or surgery. The following were recorded: demographic, examination, radiological and intraoperative findings, intraoperative procedures performed, patient-reported outcomes (PROs), and patient satisfaction. The PROs reported included the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sport-Specific Subscale, Hip Outcome Score-Activities of Daily Living, and Visual Analogue Score for pain. One hundred and two patients satisfied the inclusion criteria, of whom 90 (88.2%, 77 females and 13 males) had minimum 2-year follow-up. Females had increased external rotation in flexion (58.9° vs 50.0°, P= .041). Sixty-eight females had a Beighton's score of >4 compared to 6 males (P < .001). There was no distinct pattern within the group or between genders for radiological markers of acetabular coverage, depth, or version and femoral cam size. Mean femoral anteversion for females was 15.7° and for males 11.3°. Females had significantly smaller labral tears (1.73hours vs 2.34hours on the acetabular clock face, P=.028). Females were more likely to require a capsular plication and iliopsoas fractional lengthening (88.3% vs 46.2%, and 77.9% vs 38.5%, respectively). There was a significant improvement in all PRO measures in both males and females (P < .01), but females had lower preoperative and postoperative scores. Mean preoperative and postoperative PROs for males and females were as follows: modified Harris Hip Score 71.0/94.3 and 63.4/88.8, Hip Outcome Score-Activities of Daily Living 78.1/93.4 and 64.0/91.8, Hip Outcome Score-Sport-Specific Subscale 51.7/91.0 and 45.7/78.6, Non-Arthritic Hip Score 78.1/94.5 and 63.1/89.2, and visual analog score 4.77/1.85 and 6.29/2.21. The mean patient satisfaction score was 8.29 out of 10. Five patients (5.56%) required a revision procedure. HA is associated with improved outcomes and pain and high satisfaction scores at minimum 2-year follow-up in adolescent population. The pattern of labral injury is different in males and females and dictates the arthroscopic approach. Females are likely to require a capsular plication and iliopsoas release to address soft-tissue laxity and impingement. Level IV, therapeutic case series.

Arthroscopic Treatment of Labral Tears in Patients Aged 60 Years or Older

The purpose of this study was to (1) evaluate the clinical outcomes of a series of patients aged 60 years or older who underwent hip arthroscopy for labral tears with minimum 2-year follow-up and (2) identify risk factors for conversion to total hip arthroplasty (THA). Outcome data were prospectively collected and retrospectively reviewed in patients aged 60 years or older who underwent hip arthroscopy between April 2008 and May 2012. Four patient-reported outcome (PRO) scores, pain scores, and satisfaction ratings were collected. Conversion to THA andrevision surgery rates were recorded. A subgroup analysis compared survivors with patients requiring THA. Minimum 2-year follow-up was available for 30 patients with a mean age of 63.9 years. The 2-year survivorship rate was 70%, with 9 patients undergoing conversion to THA at a mean of 1.1 years after hip arthroscopy. Two patients required additional surgery during the study period, for a reoperation rate of 37% (11 of 30 patients). The remaining cohort showed mean improvements in all PRO scores. All scores, except the sports-related PRO (P= .12), improved significantly from the preoperative baseline scores. Visual analog scale scores for pain decreased from a mean of 5.0 preoperatively to 2.7 postoperatively (P= .003). Patients who required conversion to THA had lower preoperative modified Harris Hip Scores (P= .015), lower preoperative Hip Outcome Score-Activity of Daily Living values (P= .01), higher pain scores (P= .05), greater acetabular inclination (P= .023), and more severe chondral damage (P= .033). Arthroscopic treatment of labral tears in patients aged 60 years or older should be approached with caution. Patients in this age group had an overall 2-year survivorship rate of 70% and should be counseled before surgery on the possibility of subsequent conversion to THA. Patients aged 60 years or older with poor preoperative PRO scores, high pain scores, radiographic evidence of borderline dysplasia, and severe chondral damage may be poor candidates for hip arthroscopy. Level IV, therapeutic case series.

Patient-Centered Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Labral Tears Are Not Different in Patients With Normal, High, or Low Femoral Version

The purpose of this study was to determine whether outcomes after hip arthroscopy were different based on femoral version. The inclusion criteria were diagnosis of femoroacetabular impingement (FAI) based on clinical examination and/or imaging findings and preoperative measurement of femoral version by magnetic resonance imaging. For this study, the definition of FAI was a positive impingement sign, a positive flexion-abduction-external rotation examination finding, or radiographic signs of impingement. A query of a prospective data registry identified 180 patients who matched the inclusion and exclusion criteria. Group 1 had version of less than 5° (n = 48), group 2 had version of 5° to 15° (n = 84), and group 3 had version greater than 15° (n = 48). The mean age of the patients was 35 years (range, 18 to 61 years). On radiographic examination, the mean alpha angle for all patients' injured hips was 63° (range, 42° to 88°). The mean center-edge angle was 30° (range, 20° to 43°), and mean femoral version was 9.9° (range, -16° to 29°). There was no significant difference in age, alpha angle, or center-edge angle among the 3 version groups. A significant difference in psoas release procedures (psoas impingement) was seen with increasing femoral version. The mean follow-up period was 30 months (range, 18 to 47 months). Patient-reported functional outcomes were not statistically different among the groups. Patient-reported functional outcomes after hip arthroscopy for labral tears and FAI were not different based on femoral version in this population. Although some differences were observed regarding intraoperative findings, these also did not result in differences in patient outcomes reported at a mean follow-up of 2 years. Level IV, therapeutic case series.

Clinical Results of Hip Arthroscopy for Labral Tears: A Comparison Between Intraoperative Platelet-Rich Plasma and Bupivacaine Injection

The purpose of this prospective comparative study was to evaluate the effect of intraoperative platelet-rich plasma (PRP) injection on the outcomes of patients undergoing hip arthroscopy for labral treatment. During the period from November 2010 through March 2012, all patients undergoing hip arthroscopy for labral tears were considered for this study. The study group received intra-articular PRP at the end of the operation, and the control group received an intra-articular injection of 0.25% bupivacaine. Selection for the study group was based on the day of the week on which the patient underwent surgery. The protocol included administration of 4 hip-specific patient-reported outcome tools. Patients also reported their pain score on a visual analog scale from 0 to 10. Scores were recorded at the preoperative visit and at 3 months and 2 years postoperatively. A minimum of 2 years' follow-up was available for 306 patients. Thirteen patients (4.2%) underwent conversion to total hip arthroplasty and 24 patients (7.8%) underwent revision hip arthroscopy, which left 91 patients in the study group and 180 patients in the control group. The study group had slightly higher pain scores than the control group (3.4 v 2.5) 2 years after surgery (P = .005). No difference in pain scores was identified at 3 months postoperatively. The 2-year modified Harris Hip Score was slightly lower in the study group (78.6) than in the control group (82.6) (P = .049). No significant difference was observed for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, or Non-Arthritic Hip Score at any time point. There was no significant difference between groups for conversion to total hip arthroplasty or revision surgery. On the basis of the results of this study, intraoperative PRP injection does not appear to improve the clinical results of patients undergoing hip arthroscopy for labral treatment. Level II, prospective comparative study.