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  • 1
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    In-line Pullout Strength of 2 Acetabular Fixation Methods for Ligamentum Teres Reconstruction of the Hip: A Cadaveric Study
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 12 ( 2021-12-01), p. 232596712110525-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 12 ( 2021-12-01), p. 232596712110525-
    Abstract: Ligamentum teres (LT) reconstruction is an appropriate alternative in select cases of LT full-thickness tears, resulting in hip micro- or macroinstability. Graft fixation at the acetabular fossa is critical to achieving the best functional results. Purpose: The purpose of this study is to compare the pullout strength of 2 graft fixation methods used for LT reconstruction of the hip. Study Design: Controlled laboratory study. Methods: In 7 cadaveric specimens, the acetabular socket was prepared after the native LT was transected and the femoral head was removed. Seven separate tibialis anterior grafts were then prepared by suturing a running-locking No. 2 suture on each tail of the graft. Three specimens had fixation of the graft to the acetabulum using an adjustable cortical suspension suture button; the remaining 4 were fixed to the acetabulum using a knotless suture anchor. Specimens were then mounted onto a custom jig within a mechanical test frame to allow for the in-line pull of the graft fixation construct. After a preload of 5 N, each specimen was loaded to failure at 0.5 mm/s. Stiffness and load to failure were measured for each specimen construct. Results: Suture button fixation had a higher mean load to failure when compared with the knotless anchor fixation method (mean ± SD, 438.1 ± 114.3 vs 195.9 ± 50.0 N; P = .01). There was no significant difference in mean stiffness between the methods of fixation (24.5 ± 1.4 vs 26.5 ± 5.8 N/mm; P = .6). Conclusion: In this cadaveric study, the suture button fixation demonstrated greater load to failure than the knotless anchor fixation. Clinical Relevance: Results of this study can guide surgical decision making when selecting an acetabular fixation method for LT reconstruction.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/23259671211052533
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
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  • 2
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    Patient-Reported Outcome Scores and Rate of Return to Sport After Hip Arthroscopic Surgery: A Sex-Based Comparison in Professional and Collegiate Athletes
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 12 ( 2021-10), p. 3242-3249
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 12 ( 2021-10), p. 3242-3249
    Abstract: No studies have compared outcomes and return to sport (RTS) after hip arthroscopic surgery between matched groups of male and female athletes with a minimum 2-year follow-up. Purpose: (1) To report minimum 2-year postoperative patient-reported outcome (PRO) scores and the RTS rate for elite female athletes undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI) and (2) to compare clinical results with a matched control group of elite male athletes. Study Design: Cohort study; Level of evidence, 3. Methods: Data on all consecutive female athletes who underwent primary hip arthroscopic surgery performed at our institution between March 2009 and July 2018 were collected. Patients were eligible if they underwent hip arthroscopic surgery for labral tears or FAI and participated in collegiate or professional athletics within 1 year of surgery. Minimum 2-year postoperative PRO scores were collected for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain as well as RTS status. The percentages of patients achieving the minimal clinically important difference (MCID) and patient acceptable symptomatic state were recorded. These patients were matched to elite male athletes for comparison. Results: A total of 73 female hips were included, with a mean follow-up of 65.1 ± 27.9 months. They demonstrated a significant improvement from preoperatively to latest follow-up on the mHHS, NAHS, HOS-SSS, and VAS ( P 〈 .05). When outcomes were compared with a control group of male athletes, female athletes demonstrated lower preoperative scores, similar postoperative scores, and a significantly greater magnitude of improvement (delta value) on the mHHS, NAHS, and VAS. Female athletes also achieved the MCID at higher rates than did male athletes for the HOS-SSS (85.1% vs 70.0%, respectively; P = .035) and NAHS (79.1% vs 62.9%, respectively; P = .037). RTS rates among patients who attempted were similar between the 2 groups (female: 75.4%; male: 83.1%; P = .409). Conclusion: Elite female athletes undergoing primary hip arthroscopic surgery for FAI demonstrated a significant improvement in PRO scores and a high RTS rate. Female athletes exhibited a greater improvement in PRO scores (mHHS, NAHS, VAS) and achieved the MCID (HOS-SSS, NAHS) at higher rates compared with a control group of male athletes.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465211039834
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 3
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    Clinical Outcomes and Reoperation Rates After Hip Arthroscopy in Female Athletes With Low Versus Normal Body Mass Index: A Propensity-Matched Comparison With Minimum 2-Year Follow-up
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 1 ( 2022-01), p. 58-67
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 1 ( 2022-01), p. 58-67
    Abstract: The effect of low body mass index (BMI) on outcomes in female athletes is unknown. Purpose: (1) To report minimum 2-year patient-reported outcomes and return to sports for high-level female athletes with low BMI undergoing hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare results with those of a propensity-matched control group of high-level female athletes with a normal BMI. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all professional, collegiate, and high school female athletes who had a low BMI and underwent primary hip arthroscopy between September 2009 and March 2017 at our institute. Return-to-sports status and minimum 2-year patient-reported outcomes were collected for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale (VAS) for pain. The percentage of patients achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) was also recorded. These patients were propensity matched to high-level female athletes with a normal BMI for comparison. Results: A total of 21 high-level female athletes (25 hips) with a mean ± SD follow-up of 58.9 ± 31.5 months were included. They demonstrated significant improvement from preoperatively to latest follow-up for the mHHS, Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and VAS ( P 〈 .001). When outcomes were compared with those of the control group, female athletes with low BMI demonstrated lower rates of achieving the MCID for the mHHS (54.5% vs 77.4%; P = .041), PASS for the International Hip Outcome Tool–12 (45.5% vs 72.6%; P = .022), and MOIST for the VAS (31.8% vs 56.5%; P = .047). There were no other significant differences in the rate of achieving the MCID, PASS, or MOIST between the groups ( P 〉 .05). Female athletes with low BMI also had higher rates of revision when compared with the control group (27.2% vs 10.6%; P = .049), but there were comparable return-to-sports rates (75.0% vs 74.5%; P 〉 .05). Conclusion: High-level female athletes with low BMI undergoing primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes and acceptable rates of return to play. When compared with a control group with normal BMI, they exhibited higher rates of revision and lower rates of achieving the MCID for the mHHS, PASS for the International Hip Outcome Tool–12, and MOIST for the VAS.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465211055175
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 4
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    Pertrochanteric Calcifications in Patients With Greater Trochanteric Pain Syndrome: Description, Prevalence, and Correlation With Intraoperatively Diagnosed Hip Abductor Tendon Injuries
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 7 ( 2021-06), p. 1759-1768
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 7 ( 2021-06), p. 1759-1768
    Abstract: Pertrochanteric calcifications can be found in patients with greater trochanteric pain syndrome (GTPS). A systematic description of the types and prevalence of these calcifications has not been undertaken. Furthermore, there is conflicting evidence regarding their association with abductor tendon injuries. Purpose: (1) To describe the various types and prevalence of pertrochanteric calcifications in patients presenting for the surgical management of recalcitrant GTPS. (2) To evaluate the association of the various calcifications with intraoperatively diagnosed hip abductor tendon injuries, including tendinosis, partial-thickness tears, and full-thickness tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients undergoing surgical management for GTPS, in isolation or as an ancillary procedure during hip arthroscopy for femoroacetabular impingement, between April 2008 and February 2020 were included. Of these, 85 procedures were isolated treatment of GTPS and the remaining 628 were ancillary to hip arthroscopy. Radiographs were scrutinized for the presence of pertrochanteric calcifications. The hip abductor tendon status was intraoperatively classified as intact, partial-thickness tear, or full-thickness tear. The prevalence and correlation of the various radiographic findings in relation to the intraoperatively classified tendon condition were analyzed via the odds ratio (OR). Results: Surgery was performed on 713 hips with recalcitrant GTPS. No tear was found in 340 hips (47.7%), 289 hips (40.5%) had a partial-thickness tear, and 84 hips (11.8%) had a full-thickness tear. Radiographically, 102 hips (14.3%) demonstrated proximally directed enthesophytes, and 34 (4.8%) had distally directed enthesophytes. In addition, 75 hips (10.5%) had amorphous calcifications, 47 (6.6%) had isolated ossicles, and 110 (15.4%) had surface irregularities. The presence of any calcification was associated with partial-thickness tears (OR, 1.67 [95% CI, 1.21-2.21]; P = .002) and full-thickness tears (OR, 6.40 [95% CI, 3.91-10.47] ; P 〈 .001). Distally directed enthesophytes (OR, 10.18 [95% CI, 3.08-33.63]; P 〈 .001) and proximally directed enthesophytes (OR, 8.69 [95% CI, 4.66-16.21]; P 〈 .001) were the findings with the highest OR for the presence of any type of tear. Distally directed enthesophytes were the findings with the highest OR for a full-thickness tear (OR, 15.79 [95% CI, 7.55-33.06]; P 〈 .001). Isolated ossicles were the findings with the highest OR for a partial-thickness tear (OR, 1.73 [95% CI, 0.96-3.13]; P = .070). Conclusion: Pertrochanteric calcifications were common radiographic findings in patients with GTPS and can help guide management in these patients. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear, and increasing size of the findings was associated with more severe tendon injuries.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465211008104
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2063945-4
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  • 5
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    Workers’ Compensation Patients Improved After Hip Arthroscopy for Labral Tears: A 5-Year Outcome Propensity Score–Matched Study
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 5 ( 2022-04), p. 1281-1290
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 5 ( 2022-04), p. 1281-1290
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221078620
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2063945-4
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  • 6
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    Outcomes of Staged Bilateral Hip Arthroscopic Surgery in the Context of Femoroacetabular Impingement Syndrome: A Nested Matched-Pair Control Study Focusing on the Effect of Time Between Procedures
    SAGE Publications ; 2022
    In:  The American Journal of Sports Medicine Vol. 50, No. 11 ( 2022-09), p. 2998-3008
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 50, No. 11 ( 2022-09), p. 2998-3008
    Abstract: Bilateral hip symptoms from femoroacetabular impingement syndrome (FAIS) are a common finding in patients regardless of athletic involvement. Oftentimes, patients and surgeons choose to stage bilateral hip arthroscopic surgery. Purpose/Hypothesis: The purpose of this study was (1) to compare minimum 2-year outcomes between patients who underwent staged bilateral hip arthroscopic surgery for FAIS to a propensity score–matched control group that underwent unilateral hip arthroscopic surgery and (2) to investigate the effect of time between bilateral procedures on patient-reported outcomes (PROs). We hypothesized that, after bilateral hip arthroscopic surgery, the improvement in outcomes would be similar to that after unilateral hip arthroscopic surgery and the time duration between bilateral procedures would not affect the final outcome. Study Design: Cohort study; Level of evidence, 3. Methods: Data were retrospectively reviewed on a consecutive series of patients who underwent primary hip arthroscopic surgery at our institution between June 2008 and November 2017. Patients who underwent bilateral hip arthroscopic surgery with minimum 2-year PROs for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score–Sports Specific Subscale (HOS-SSS), patient satisfaction, and a visual analog scale (VAS) for pain were included. The study group was matched 1:1 based on age, sex, and body mass index to a control group that only required unilateral hip arthroscopic surgery. Additionally, a subanalysis was performed on the study group to determine the effect of time between arthroscopic procedures. Rates of achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the mHHS and HOS-SSS were determined. The P value was set at 〈 .05. Results: A total of 205 patients (410 hips) were included. The mean age and body mass index of the study group were 32.3 ± 13.2 years and 25.0 ± 5.1, respectively. All 410 hips that met the inclusion criteria were matched. There were no significant differences in patient, radiographic, or procedural data. A significant and comparable improvement was reported for all PRO measures and the VAS ( P 〈 .0001) in both groups. Similarly, rates of achieving the MCID and PASS were comparable. After dividing the study group based on whether the contralateral procedure was performed 〈 3 months or 〉 3 months after the first procedure, it was determined that patients had a significant improvement and favorable outcomes regardless of time between bilateral procedures. Conclusion: Patients who underwent unilateral and bilateral hip arthroscopic surgery for FAIS had a significant and comparable improvement in PROs at a minimum 2-year follow-up. A time interval of 〈 3 months or 〉 3 months between bilateral procedures did not affect PROs.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465221108955
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 7
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    Direct Anterior Birmingham Hip Resurfacing: Surgical Technique
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Techniques in Orthopaedics Vol. 36, No. 4 ( 2021-01-19), p. 536-540
    Details
    In: Techniques in Orthopaedics, Ovid Technologies (Wolters Kluwer Health), Vol. 36, No. 4 ( 2021-01-19), p. 536-540
    Abstract: Birmingham hip resurfacing (BHR) arthroplasty is an established alternative to total hip arthroplasty for end-stage osteoarthritis, specifically in the younger male patient population who wish to return to high-performance physical activity. Traditionally, this procedure has been performed via the posterolateral approach mainly due to the design of intraoperative equipment utilized for femoral component placement. In other words, no current intraoperative equipment has been designed to perform the BHR via any approach other than the posterolateral approach. Recent literature has shown numerous advantages to direct anterior approach arthroplasty, among total hip arthroplasty patients, such as shorter recovery times, less pain, and improved overall functional outcomes. This technique paper aims to highlight a step-by-step approach of achieving the benefits of direct anterior approach arthroplasty in the patients indicated for BHR. A novel guide-pin technique has been developed to account for lack of intraoperative equipment, with pearls and pitfalls explained in detail. We hope this technique will help to guide surgeons in performing the direct anterior BHR with safety and success thereby maximizing patient outcomes.
    Type of Medium: Online Resource
    ISSN: 0885-9698
    URL: Article
    DOI: 10.1097/BTO.0000000000000517
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2055188-5
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  • 8
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    Arthroscopic Triple Reconstruction in the Hip Joint: Restoration of Soft-Tissue Stabilizers in Revision Surgery for Gross Instability
    Elsevier BV ; 2021
    In:  Arthroscopy Techniques Vol. 10, No. 5 ( 2021-05), p. e1239-e1248
    Details
    In: Arthroscopy Techniques, Elsevier BV, Vol. 10, No. 5 ( 2021-05), p. e1239-e1248
    Type of Medium: Online Resource
    ISSN: 2212-6287
    URL: Article
    DOI: 10.1016/j.eats.2021.01.018
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2653101-X
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  • 9
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    Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique
    Elsevier BV ; 2021
    In:  Arthroscopy Techniques Vol. 10, No. 2 ( 2021-02), p. e587-e597
    Details
    In: Arthroscopy Techniques, Elsevier BV, Vol. 10, No. 2 ( 2021-02), p. e587-e597
    Type of Medium: Online Resource
    ISSN: 2212-6287
    URL: Article
    DOI: 10.1016/j.eats.2020.10.045
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 10
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    Hip Pain Increases With Age and Experience Level in Adult Karate Athletes: A Statewide Survey Study
    Elsevier BV ; 2022
    In:  Arthroscopy, Sports Medicine, and Rehabilitation Vol. 4, No. 2 ( 2022-04), p. e325-e333
    Details
    In: Arthroscopy, Sports Medicine, and Rehabilitation, Elsevier BV, Vol. 4, No. 2 ( 2022-04), p. e325-e333
    Type of Medium: Online Resource
    ISSN: 2666-061X
    URL: Article
    DOI: 10.1016/j.asmr.2021.10.003
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 3003188-6
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