Routine Capsular Closure Outperforms Incomplete Capsular Closure After Hip Arthroscopy: A Meta-analysis and Expected-Value Decision Analysis.

Purpose: To determine the optimal treatment decision for capsular management after primary hip arthroscopy for femoroacetabular impingement syndrome.

Methods: An expected-value decision analysis was performed (1) organizing the decision problem, (2) determining outcome probabilities, (3) determining outcome utilities, (4) performing fold-back analyses, and (5) performing sensitivity analyses. A decision tree was constructed (complete capsule closure vs incomplete closure) and a meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, a systematic review was conducted to determine outcome probabilities.

Editorial Commentary: Microfracture Remains a Foundational Tool for Cartilage Restoration During Hip-Preservation Procedures: Defying the Odds.

A comprehensive approach to arthroscopic hip preservation in patients whose pathology includes cartilage defects may include microfracture; microfracture has been shown to have long-lasting positive effects in most patients treated for femoroacetabular impingement plus full-thickness chondral pathology. Although modern cartilage treatment alternatives such as autologous chondrocyte implantation, autologous matrix-induced chondrogenesis scaffolds, allograft or autograft particulate cartilage graft, and others have been described for the treatment of high-degree cartilage acetabular lesions, microfracture remains a foundational tool in cartilage restoration procedures. That said, when determining outcome, comorbidity must be considered, and, moreover, it is difficult to determine whether outcomes are only attributable to the microfracture versus concomitant procedures or changes in postoperative activity of operated patients.

Clinical presentation, imaging findings, and arthroscopic features in skeletally immature and mature adolescent hip patients: a comparative double-cohort retrospective study.

The purpose of this study was to evaluate differences in clinical presentation and extent of surgery required based on skeletal maturity between two cohorts of adolescent hip arthroscopy patients. We hypothesized that skeletal immaturity would be associated with a lower frequency of pincer impingement and a decreased need for surgical acetabuloplasty. A database of 1481 hip arthroscopies performed by a single orthopaedic surgeon between 2008 and 2016 was queried.

Allocation of Anchors During Labral Repair: A Multicenter Cohort Analysis of Labral Treatment in Hip Arthroscopy.

Background: While previous studies have established several techniques for suture anchor repair of the acetabular labrum to bone during arthroscopic surgery, the current literature lacks evidence defining the appropriate number of suture anchors required to effectively restore the function of the labral tissue.

Purpose/hypothesis: To define the location and size of labral tears identified during hip arthroscopy for acetabular labral treatment in a large multicenter cohort. The secondary purpose was to differentiate the number of anchors used during arthroscopic labral repair.

Reliability of hip range of motion measurement among experienced arthroscopic hip preservation surgeons.

The aim of this study was to determine (i) the reliability of hip range of motion measurement among experienced arthroscopic hip preservation surgeons and (ii) the magnitude of hip flexion change with posterior pelvic tilt. Five experienced arthroscopic hip preservation surgeons (5-18 years of hip surgery experience) performed passive hip range of motion (internal and external rotation), flexion (contralateral hip extended) and flexion with posterior pelvic tilt (contralateral hip maximally flexed) on five young healthy asymptomatic volunteers (three males, two females; 34.4 ± 10.

Travel Distance Does Not Affect Outcomes in Hip Preservation Surgery: A Case for Centers of Excellence.

Background: Previous studies have evaluated the effect of distance to high-volume centers on outcomes after joint replacement. However, there is limited evidence on whether this distance has an effect on outcomes after undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS).

Purpose: To determine whether increased distance from a patient's home to his or her primary orthopaedic clinic has an influence on the ability to achieve the minimal clinically important difference (MCID) on outcome measures after surgery for FAIS.

Best Practice Guidelines for Hip Arthroscopy in Femoroacetabular Impingement: Results of a Delphi Process.

Background: Treatment algorithms for the arthroscopic management of femoroacetabular impingement (FAI) syndrome remain controversial because of a paucity of evidence-based guidance. Consequently, notable variability in clinical practice exists between different practitioners, necessitating expert consensus. The purpose of this study is to establish best practice guidelines (BPG) using formal techniques of consensus building among a group of experienced hip arthroscopists driven by the results of a systematic review and meta-analysis.

Diabetic hip arthropathy is associated with a higher prevalence of femoral head chondromalacia: a case-controlled study.

Introduction: No previous studies have characterised hip joint disease in diabetic patients undergoing hip arthroscopy. The purpose of our study was to evaluate intra-articular hip pathology and surgical variables in patients with diabetes compared to matched, non-diabetic controls. We hypothesised that diabetic patients would demonstrate a higher prevalence and severity of hip chondral pathology.

Arthroscopic Treatment of Hip Chondral Defect With Microfracture and Platelet-Rich Plasma-Infused Micronized Cartilage Allograft Augmentation.

Over the past decade, arthroscopic microfracture has become increasingly popular to treat full-thickness (Outerbridge grade IV) chondral defects of the hip. This procedure borrows marrow stimulation treatment principles and techniques from knee arthroscopy, with similar mixed clinical outcomes that may be more favorable in the short term (<2 years) and poorer in the long term. Despite these varied outcomes, microfracture remains the most frequently used technique to treat small focal chondral defects because of the relative ease and cost-effectiveness of the procedure.

Return-to-Play and Performance Outcomes of Professional Athletes in North America After Hip Arthroscopy From 1999 to 2016.

Background: The effect of hip arthroscopy on athletic performance compared with preinjury levels for professional athletes in different sports remains unknown. In addition, while return rates have been reported for professional baseball, football, and hockey players, return rates have not been reported for professional basketball players.

Hypothesis: Professional athletes in 4 major North American sports would be able to return to their sport and preoperative level of performance at a high rate after arthroscopic hip surgery.

Arthroscopic Microfracture of Hip Chondral Lesions.

Microfracture of hip chondral lesions has been performed for more than a decade with modified treatment principles and techniques from knee arthroscopy. This note and accompanying video review the pertinent techniques, pearls, and pitfalls of the microfracture procedure in the treatment of hip chondral lesions. After debridement of damaged chondral tissue, the size of the lesion is approximated to determine the number of microfracture holes to create.

High Degree of Variability in Reporting of Clinical and Patient-Reported Outcomes After Hip Arthroscopy.

Background: Hip arthroscopy for the treatment of intra-articular pathology is a rapidly expanding field. Outcome measures should be reported to document the efficacy of arthroscopic procedures; however, the most effective outcome measures are not established.

Purpose: To evaluate the variability in outcomes reported after hip arthroscopy and to compare the responsiveness of patient-reported outcome (PRO) instruments.

Basic Hip Arthroscopy: Diagnostic Hip Arthroscopy.

Hip arthroscopy is increasing in popularity for the diagnosis and management of hip preservation. The basics of hip arthroscopy positioning, fluoroscopic assessment, and portal establishment are reviewed in the first 2 parts of this series. This article is the third installment in which we describe a systematic approach to performing a diagnostic hip arthroscopy.

Multicenter Outcomes After Hip Arthroscopy: Epidemiology (MASH Study Group). What Are We Seeing in the Office, and Who Are We Choosing to Treat?

As the field of hip arthroscopy continues to grow rapidly, our understanding of the population of patients undergoing hip arthroscopy has led to improved diagnosis and management of hip joint pathologies. The Multicenter Arthroscopic Study of the Hip (MASH) Study Group conducts multicenter clinical studies in arthroscopic hip preservation surgery. Patients undergoing arthroscopic hip preservation surgery are enrolled in a large prospective longitudinal cohort at 10 separate sites nationwide by 10 fellowship-trained hip arthroscopists.

The Hip Restoration Algorithm.

Background: Despite the rapid advancement of imaging and arthroscopic techniques about the hip joint, missed diagnoses are still common. As a deep joint and compared to the shoulder and knee joints, localization of hip symptoms is difficult. Hip pathology is not easily isolated and is often related to intra and extra-articular abnormalities.

Basic Hip Arthroscopy: Anatomic Establishment of Arthroscopic Portals Without Fluoroscopic Guidance.

Hip arthroscopy has gained popularity in recent years for diagnostic and therapeutic hip preservation management. This article details the establishment of arthroscopic portals of the hip, specifically the anterolateral and modified anterior portals without fluoroscopic guidance. The anterolateral portal is established anatomically, and the modified anterior portal is then established under arthroscopic guidance.

Arthroscopic Bullet Removal From the Central and Peripheral Compartments of the Hip Joint.

Recent advances in hip arthroscopy offer an approach for treating an uncommon but highly disabling injury from intra-articular missile injury to the hip. Hip arthroscopy affords the patient the benefit of minimally invasive surgery while allowing for the diagnosis and treatment of concomitant pathology, which may be either acute, from the trauma of the missile, or chronic. We present a technique for the removal of projectiles from the central and peripheral compartments of the hip joint.

Cyclists Have Greater Chondromalacia Index Than Age-Matched Controls at the Time of Hip Arthroscopy.

Purpose: To evaluate the clinical symptoms and intraoperative pathology associated with hip pain in the cyclist compared with a matched hip arthroscopy surgical group.

Methods: In an institutional review board-approved study, we retrospectively reviewed a prospective database of 1,200 consecutive hip arthroscopy patients from 2008 to 2015. Adult patients were identified who reported cycling as a major component of their activity.

Arthroscopic Management of Hip Chondral Defects: A Systematic Review of the Literature.

Purpose: To critically evaluate the evidence for arthroscopic management of chondral defects in the hip through a systematic literature review.

Methods: A systematic literature review was performed to identify all articles addressing the arthroscopic management of chondral defects about the hip. Case reports, open techniques, and those associated with osteonecrosis were excluded.

Tissue engineering and the future of hip cartilage, labrum and ligamentum teres.

As the field of hip arthroscopy continues to evolve, the biological understanding of orthopaedic tissues, namely articular cartilage, labral fibro-cartilage and the ligamentum teres continues to expand. Similarly, the need for biological solutions for the pre-arthritic and early arthritic hip continues to be a challenge for the sports medicine surgeon and hip arthroscopist. This article outlines existing biological and tissue-engineering technologies, some being used in clinical practice and other technologies being developed, and how these biological and tissue-engineering principals may one day influence the practice of hip arthroscopy.