Proximal Hamstring Tears: Endoscopic Hamstring Repair.

Proximal hamstring tears are common among athletes, especially in sports involving eccentric lengthening during forced hip flexion and knee extension, such as hurdles or water skiing. Tears are described by timing (acute [<1 month] or chronic) and severity (partial or complete). Complete tears are easily identified with magnetic resonance imaging; however, partial tears may be subtle and potentially missed.

Editorial Commentary: Biomechanical Analyses of the Hip Capture Are Way Too Simple! The Capsule Is Just One Piece of the Puzzle.

The hip capsule is clearly a significant part of the hip and the considerations that we need to take into account when performing hip arthroscopy. Any study that adds some further clarity to this important structure is welcome and appreciated. The inherent problem with all of these articles is the lack of application to the reality of a living, breathing patient whose capsule changes following time zero of the capsular intervention and also whose negative intra-articular pressure is immediately violated and not recreated following any intervention that is undertaken.

Sonographic evaluation of anterior inferior iliac spine morphology demonstrates excellent accuracy when compared to false profile view.

Purpose: To compare ultrasound examination to false profile radiographs in identification and classification of AIIS morphology. The study hypothesis stated that sonographic imaging of the AIIS correlates well to AIIS morphology seen on false profile radiographs.

Methods: Fifty-three hips in 30 consecutive patients met the inclusion criteria.

Editorial Commentary: It's Not the Age; It's the Story: Acetabular Labral Repair.

The major factor separating a good from a poor outcome in any study is appropriate indications. We don't operate on x-rays, magnetic resonance images, or computed tomography scans alone; we operate on clinical symptoms. With proper patient selection, we can achieve good outcomes from hip arthroscopic surgery in many older patients.

Reliability of the Tönnis Classification and Its Correlation With Magnetic Resonance Imaging and Intraoperative Chondral Damage.

Purpose: To evaluate the reliability of the Tönnis classification in the setting of femoroacetabular impingement (FAI) hips without dysplasia.

Methods: Forty-nine patients with FAI underwent preoperative radiography and magnetic resonance imaging (MRI). Radiographs were evaluated in 2 separate settings by 5 observers and graded according to the Tönnis classification.

Endoscopic Proximal Hamstring Repair and Ischial Bursectomy Using Modified Portal Placement and Patient Positioning.

Endoscopic management has become an effective method to repair proximal hamstring injuries. However, due to the complexity of such a procedure, the dissemination of the technique of endoscopic hamstring repair has occurred slowly among orthopaedic surgeons. This Technical Note with a video modifies previously described techniques and provides safer and more simplified endoscopic management of proximal hamstring injuries.

Incorporating Hip Arthroscopy Into A Practice.

Hip arthroscopy is one of the most rapidly growing areas in orthopaedic surgery because of increased awareness of nonarthritic hip pathologies, advanced imaging modalities, and advanced techniques to reproducibly manage nonarthritic hip pathologies within a deep soft-tissue envelope and a constrained joint. In addition, more academic medical centers are providing residents with education on hip arthroscopy, and many hip preservation fellowships and courses are helping increase awareness of nonarthritic hip pathologies. Nonarthritic hip pathologies currently managed via hip arthroscopy include nonrepairable labral lesions, femoroacetabular impingement, hip instability, and hip fractures.

Editorial Commentary: Please Simplify Hip Arthroscopy.

Hip arthroscopy is a challenging technical procedure for which basic science principles have not been thoroughly discerned with respect to the procedures we perform. In this commentary, a plea is made to continue to expand the science behind what we do, but in as simple a fashion as possible such that more surgeons are willing to learn perfect hip arthroscopy.

Hamstring injuries.

There is a continuum of hamstring injuries that can range from musculotendinous strains to avulsion injuries. Although the proximal hamstring complex has a strong bony attachment on the ischial tuberosity, hamstring injuries are common in athletic population and can affect all levels of athletes. Nonoperative treatment is mostly recommended in the setting of low-grade partial tears and insertional tendinosis.

Anterior hip capsuloligamentous reconstruction for recurrent instability after hip arthroscopy.

A variety of complications, including iatrogenic anterior hip instability, have been reported after hip arthroscopy. We present a case of a patient sustaining a postoperative anterior hip dislocation after cam resection for treatment of femoroacetabular impingement. Our patient developed persistent instability and required anterior capsuloligamentous reconstruction with iliotibial autograft.

Endoscopic proximal hamstring repair and ischial bursectomy.

With the significant increase in use of the arthroscope around the hip have come several less invasive techniques to manage pathologies around this joint. This technical note with a video details one such technique that allows for the endoscopic management of proximal hamstring tears and chronic ischial bursitis, which until now have been managed exclusively with much larger open approaches. This procedure allows for complete exposure of the posterior aspect of the hip in a safe, minimally invasive fashion.

Intra-abdominal fluid extravasation during hip arthroscopy: a survey of the MAHORN group.

Purpose: The purpose of this study was to survey experts in the field of hip arthroscopy from the Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) group to determine the frequency of symptomatic intra-abdominal fluid extravasation (IAFE) after arthroscopic hip procedures, identify potential risk factors, and develop preventative measures and treatment strategies in the event of symptomatic IAFE.

Methods: A survey was sent to all members of the MAHORN group. Surveys collected data on general hip arthroscopy settings, including pump pressure and frequency of different hip arthroscopies performed, as well as details on cases of symptomatic IAFE.

The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33).

Purpose: The purpose of this study was to develop a self-administered evaluative tool to measure health-related quality of life in young, active patients with hip disorders.

Methods: This outcome measure was developed for active patients (aged 18 to 60 years, Tegner activity level ≥ 4) presenting with a variety of symptomatic hip conditions. This multicenter study recruited patients from international hip arthroscopy and arthroplasty surgeon practices.

Differences in physician and patient ratings of items used to assess hip disorders.

Background: The purpose of this study was to determine what issues are important to active individuals with hip lesions and to assess whether these issues are different from those that surgeons think are important.

Hypothesis: A discrepancy will be noted between what patients and surgeons believe to be important.

Study Design: Cross-sectional study; Level of evidence, 3.

Advanced techniques in hip arthroscopy.

The indications for hip arthroscopy are expanding as the understanding of hip disease increases. Improved instrumentation and technical skills also have facilitated the ability to treat some hip disorders arthroscopically. Femoroacetabular impingement (FAI) is increasingly recognized as a disorder that can lead to progressive intra-articular chondral and labral injury.

The 23-point arthroscopic examination of the hip: basic setup, portal placement, and surgical technique.

The 23-point arthroscopic examination of the hip has been used for more than 400 arthroscopic hip procedures. It ensures that all components of the hip are carefully inspected and allows for proper documentation. It is vital that a precise knowledge of hip anatomy and common portal placement is coupled with proper patient selection, sound preoperative planning, and a consistent arthroscopic technique in order to maximize clinical outcomes.

Clinical update: MR imaging of the hip.

With the increasing awareness of hip pathologies and their treatment with arthroscopic surgery, an explosion in the knowledge base has occurred. With this expansion has come the need to assess many injuries with magnetic resonance imaging and other modalities. This update will serve to delineate the common injuries that are seen and their imaging assessment.

A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report.

Purpose: Our purpose was to develop an alternative method to divide the acetabulum and femoral head into different zones based on anatomic landmarks clearly visible during arthroscopy to facilitate reporting the geographic location of intra-articular injuries.

Methods: Two vertical lines are positioned across the acetabulum aligned with the anterior and posterior limits of the acetabular notch. A horizontal line is positioned aligned with the superior limit of the notch perpendicular to the previous lines.

Arthroscopic treatment of femoroacetabular impingement.

The etiology of degenerative joint disease of the hip remains unsolved. A precursor for some patients, especially younger ones, may be hip impingement. Repetitive microtrauma at maximal flexion can cause chronic pain from the abutment at the femoral head-neck junction caused by an abnormal offset.

Arthroscopic single-row versus double-row suture anchor rotator cuff repair.

Background: Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair.

Purpose: To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques.