The Role of Comprehensive Capsular Management in Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome.

Advances in the understanding of femoroacetabular impingement syndrome and advancements in hip arthroscopic techniques, including chondrolabral preservation and labral repair, have led to improvements in success rates, functional outcomes, and return to sports over the past several years. This improvement in outcomes also is attributed to the increased awareness of performing capsular closure after addressing intra-articular hip pathology, to preserve the biomechanical properties of the hip. A number of biomechanical studies have demonstrated that the iliofemoral ligament is a critical component of hip biomechanics, providing stability and limiting joint translation, distraction, and rotation within the normal range of hip motion.

Editorial Commentary: Rehabilitation After Hip Arthroscopy-Bear in Mind the Bearing of Weight.

Hip arthroscopy is the surgical treatment of choice for the treatment of femoroacetabular impingement syndrome and hip labral tears. Current guidelines on postoperative rehabilitation protocols are based on expert opinion, and evidence-based protocols are scarce. Previously, a non-weight-bearing protocol for several weeks after surgery was thought to prevent axial-load damage to the newly repaired labrum.

Two-Year Patient-Reported Outcomes for Patients Undergoing Revision Hip Arthroscopy with Capsular Incompetency.

Purpose: To determine clinical outcomes of patients undergoing revision hip arthroscopy for failure to improve with magnetic resonance imaging (MRI) and intraoperative evidence of a capsular incompetency as compared with (1) patients undergoing revision hip arthroscopy without evidence of a capsular incompetency and (2) patients undergoing primary surgery for femoroacetabular impingement syndrome (FAIS) at a minimum follow up of 2 years.

Methods: Data from consecutive patients undergoing revision hip arthroscopy with MRI/arthrogram-confirmed capsular incompetency between January 2012 and June 2016 were analyzed. All revision patients with capsular incompetency was matched 1:1 by age and body mass index to FAIS revision patients without capsular incompetency and primary FAIS patients.

Unplanned Admissions Following Hip Arthroscopy: Incidence and Risk Factors.

Purpose: To determine the rate of and risk factors for 30-day unplanned admissions following hip arthroscopy in a U.S.

Methods: Patients undergoing hip arthroscopy were identified in the American College of Surgeons National Surgical Quality Improvement Program database using validated Current Procedural Terminology and International Classification of Diseases, Ninth Revision and Tenth Revision codes.

Is There an Association Between Preoperative Expectations and Patient-Reported Outcome After Hip Arthroscopy for Femoroacetabular Impingement Syndrome?

Purpose: To determine the relationship between preoperative patient expectation and postoperative satisfaction and overall patient-reported outcome (PRO) of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome.

Methods: Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome completed the validated Hip Preservation Surgery Expectations Survey (21 questions; 0-100 range), as well as multiple PROs before surgery. High expectation was defined as an expectation score greater than 1 standard deviation above the mean.

Functional and Clinical Outcomes of Patients Undergoing Revision Hip Arthroscopy With Borderline Hip Dysplasia at 2-Year Follow-up.

Purpose: To compare outcomes of borderline hip dysplasia (BHD) patients undergoing revision hip arthroscopy with 1) patients with BHD undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and 2) patients without BHD undergoing revision hip arthroscopy for FAIS.

Methods: A retrospective cohort study was performed to identify patients who underwent arthroscopy from January 2012 to January 2016 by a single fellowship-trained surgeon, including a 2-year follow-up. Patient demographics, comorbid medical conditions, and preoperative outcome scores were compared between patients with BHD (lateral center-edge angle 18° to 25°) who had revision hip arthroscopy to patients with BHD undergoing primary arthroscopy and patients without BHD (lateral center-edge angle >25°) undergoing revision arthroscopy.

Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome.

Background: A growing number of studies have examined return to sport in competitive athletes after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); however, few have evaluated the rate of achieving meaningful clinical outcomes in this group.

Purpose: To determine if competitive athletes (professional, semiprofessional, or collegiate) have better 2-year patient-reported outcomes and achieve the minimal clinically important difference (MCID) and substantial clinical benefit at higher rates when compared with nonathletes undergoing hip arthroscopy for the treatment of FAIS.

Study Design: Cohort study; Level of evidence, 3.

Defining Meaningful Functional Improvement on the Visual Analog Scale for Satisfaction at 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Purpose: To (1) define Substantial Clinical Benefit (SCB), Patient Acceptable Symptomatic State (PASS), and Minimal Clinically Important Difference (MCID) for the visual analog scale (VAS) Satisfaction in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and (2) identify preoperative predictors of achieving each outcome end-point.

Methods: Data from consecutive patients who underwent primary hip arthroscopy between November 2014 and January 2017 were prospectively collected and retrospectively analyzed. Inclusion criteria consisted of patients with clinical and radiographic diagnosis of FAIS, who failed nonoperative treatment, underwent primary hip arthroscopy to address the FAIS, and had at minimum 2-year follow-up.

Contemporary Hip Capsular Management and Closure Using a Suture Passing Device.

Before comprehensive correction of femoroacetabular impingement syndrome, capsular management must be thoughtfully considered to ensure both adequate visualization for bony resection and prevention of iatrogenic microinstability. A number of biomechanical and clinical studies have shown the importance of performing comprehensive capsular closure to restore native hip biomechanical kinematics. The purpose of this Technical Note is to describe the technique of using a suture passing device for capsular plication by a fellowship-trained hip arthroscopist at a large-volume academic center.

A T-capsulotomy provides increased hip joint visualization compared with an extended interportal capsulotomy.

The purpose of this study was to compare the cross-sectional area (CSA) of joint visualization between extended interportal and T-capsulotomies. Twenty fresh-frozen cadaveric hips were dissected to their capsuloligamentous complexes and fixed in a custom apparatus in neutral hip position. Ten hips underwent sequential interportal capsulotomies at lengths of 2, 4, 6, and 8 cm.

Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After Isolated Endoscopic Gluteus Medius Repair.

Background: Endoscopic surgical repair has become a common procedure for treating patients with gluteus medius tears. However, meaningful clinical outcomes after the procedure have not been defined.

Purpose: To (1) define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients undergoing endoscopic gluteus medius repair and (2) determine correlations between preoperative patient characteristics and achievement of MCID/PASS.

How Can We Define Clinically Important Improvement in Pain Scores After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? Minimum 2-Year Follow-up Study.

Background: Patient postoperative pain is being increasingly reported in the field of hip preservation surgery. The visual analog scale (VAS) for pain is one of the most commonly utilized measures for perioperative pain assessment. Currently, there is limited understanding of clinically significant improvement in VAS pain.

Radiographic Prevalence of Sacroiliac Joint Abnormalities and Clinical Outcomes in Patients With Femoroacetabular Impingement Syndrome.

Purpose: To quantify the prevalence of sacroiliac joint (SIJ) abnormalities in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) by use of various imaging modalities and to compare outcomes based on SIJ abnormalities.

Methods: Plain radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans of patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. The exclusion criteria included patients undergoing bilateral or revision surgery, those with a history of dysplasia, and those with less than 2 years' follow-up.

Endoscopic Repair of Proximal Hamstring Tear With Double-Row Suture Bridge Construct.

Hamstring strains account for 25% to 30% of all muscle strains and are an exceedingly common injury in the athletic population. Although proximal hamstring avulsion injuries occur less commonly than strains at the myotendinous junction, they are more severe and debilitating. Proximal hamstring avulsions do not respond well to conservative treatment and are more likely to require surgical intervention.

Patients With Borderline Hip Dysplasia Achieve Clinically Significant Outcome After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With Minimum 2-Year Follow-up.

Background: There is a growing trend for hip arthroscopists to treat patients with borderline hip dysplasia (BHD) for femoroacetabular impingement syndrome (FAIS) without addressing the acetabular coverage. However, the literature of outcomes and failure rates for these patients is conflicting.

Purpose: (1) To identify whether patients with BHD achieved 2-year similar patient-reported outcome, minimal clinically important difference (MCID), and patient acceptable symptomatic state (PASS) when compared with patients without BHD and (2) to identify predictors for achieving the MCID and PASS among patients with BHD who are undergoing hip arthroscopy for FAIS.

Prevalence and Clinical Implications of Chondral Injuries After Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome.

Background: Studies on the effect of partial- and full-thickness chondral damage of the hip on outcomes and the ability to achieve meaningful clinical outcomes are limited.

Purpose: To determine the effect of full- and partial-thickness chondral injuries on 2-year outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) compared with patients without chondral damage, and to identify significant predictors of achieving the patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID).

Study Design: Case-control study; Level of evidence, 3.

Preoperative Predictors of Achieving Clinically Significant Athletic Functional Status After Hip Arthroscopy for Femoroacetabular Impingement at Minimum 2-Year Follow-Up.

Purpose: To identify predictors of achieving clinically significant sport function in athletic patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

Methods: Data were analyzed for all patients who treated for FAIS between 2012 to 2016 and reported being athletes, including recreational and competitive athletes. All patients had a minimum of 2-year follow-up with patient-reported athletic function in the form of the Hip Outcome Score-Sport Specific (HOS-SS), visual analog score-pain, and patient satisfaction.

Surface Mapping of the Musculotendinous Attachments at the Pubic Symphysis in Cadaveric Specimens: Implications for the Treatment of Core Muscle Injury.

Purpose: To characterize the 3-dimensional muscular, musculotendinous, and neurovascular anatomy about the pubic symphysis relevant to core muscle injury (CMI).

Methods: Ten cadaveric hips were dissected to characterize the musculotendinous insertion of the rectus abdominis and inguinal ligament, origins of the adductor longus and adductor brevis, and the pubic cartilage plate. A 3-dimensional coordinate measuring system and data acquisition software were used to calculate structure cross-sectional area, and the landmark anatomical relationships to 1 another and relevant neurovascular structures.

Arthroscopic Outcomes as a Function of Acetabular Coverage From a Large Hip Arthroscopy Study Group.

Purpose: To report comparative hip arthroscopic outcomes of patients with low (borderline dysplasia), normal, and high (global pincer femoroacetabular impingement [FAI]) lateral acetabular coverage.

Methods: A retrospective analysis of prospectively collected data from a multicenter registry was performed. Primary hip arthroscopy patients were assigned to 1 of 3 groups based on preoperative lateral center-edge angle: borderline dysplasia (≤25°), normal (25.

Preoperative Performance of the PROMIS in Patients Undergoing Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome.

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is being increasingly evaluated for use in orthopaedic surgery. The performance of the PROMIS in patients undergoing hip preservation surgery is unknown.

Purpose: To investigate the psychometric performance of the PROMIS compared with legacy patient-reported outcome measures (PROMs) in patients indicated for hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS).

How Should We Define Clinically Significant Outcome Improvement on the iHOT-12?

Background: There is increased emphasis on efficiently administering patient-reported outcome measures (PROMs). The International Hip Outcome Tool-12 (iHOT-12) is a short-form version of the iHOT-33, and relatively little is known about clinically significant outcomes using the iHOT-12.

Questions/purposes: The purpose of this study was to define minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the iHOT-12 and to identify predictors for achieving these psychometric end points in patients undergoing arthroscopic treatment of femoroacetabular impingement (FAI).

Early Hip Arthroscopy for Femoroacetabular Impingement Syndrome Provides Superior Outcomes When Compared With Delaying Surgical Treatment Beyond 6 Months.

Background: There is literature on the association between chronic preoperative pain and worse outcomes among patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). However, there are few data on whether there is an optimum window that provides the best midterm surgical outcomes.

Purpose: To assess the outcomes of hip arthroscopy for FAIS according to timing of surgical intervention.

Contemporary Management of the Hip Capsule During Arthroscopic Hip Preservation Surgery.

Purpose Of Review: The importance of the hip capsule and its effect on hip biomechanics, functional outcomes, and hip arthroscopy success rates has been demonstrated in recent studies. These results have led to a shift in management of the hip capsule, where an increasing number of surgeons routinely perform complete capsular closure. The purpose of this review is to highlight recent studies evaluating the hip capsule and describe contemporary capsular management and repair.

Indications and Outcomes of Arthroscopic Labral Reconstruction of the Hip: A Systematic Review.

Purpose: The primary purpose of this investigation was to systematically evaluate the literature for the current indications and outcomes of arthroscopic labral reconstruction of the hip. Our secondary purpose was to evaluate the role of arthroscopic labral reconstruction in the management of reparable labral tears.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using a PRISMA checklist.