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  • Larson, Christopher M.  (3)
  • Sierra, Rafael J.  (3)
  • 1
    Online Resource
    Online Resource
    The Impact of Age on Clinical Outcomes of Acetabular Microfracture During FAI Surgery
    SAGE Publications ; 2023
    In:  The American Journal of Sports Medicine Vol. 51, No. 10 ( 2023-08), p. 2559-2566
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 51, No. 10 ( 2023-08), p. 2559-2566
    Abstract: Full-thickness acetabular cartilage lesions are common findings during primary surgical treatment of femoroacetabular impingement (FAI). Purpose: To evaluate clinical outcomes after acetabular microfracture performed during FAI surgery in a prospective, multicenter cohort. Study Design: Cohort Study; Level of evidence, 3. Methods: Patients with FAI who had failed nonoperative management were prospectively enrolled in a multicenter cohort. Preoperative and postoperative (mean follow-up, 4.3 years) patient-reported outcome measures were obtained with a follow-up rate of 81.6% (621/761 hips), including 54 patients who underwent acetabular microfracture. Patient characteristics, radiographic parameters, intraoperative disease severity, and operative procedures were analyzed. Propensity matching using linear regression was used to match 54 hips with microfracture to 162 control hips (1:3) to control for confounding variables. Subanalyses of hips ≤35 and 〉 35 years of age with propensity matching were also performed. Results: Patients who underwent acetabular microfracture were more likely to be male (81.8% vs 40.9%; P 〈 .001), be older in age (35.0 vs 29.9 years; P = .001), have a higher body mass index (27.2 vs 25.0; P = .001), and have a greater alpha angle (69.6° vs 62.3°; P 〈 .001) compared with the nonmicrofracture cohort (n = 533). After propensity matching to control for covariates, patients treated with microfracture displayed no differences in the modified Harris Hip Score or Hip Disability and Osteoarthritis Outcome Score ( P = .22-.95) but were more likely to undergo total hip arthroplasty (THA) (13% [7/54] compared with 4% [6/162] in the control group; P = .002), and age 〉 35 years was associated with conversion to THA after microfracture. Microfracture performed at or before 35 years of age portended good outcomes with no significant risk of conversion to THA at the most recent follow-up. Conclusion: Microfracture of acetabular cartilage defects appears to be safe and associated with reliably improved short- to mid-term results in younger patients; modified expectations should be realized when full-thickness chondral lesions are identified in patients 〉 35 years of age.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/03635465231184398
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 2
    Online Resource
    Online Resource
    The Reliability of Arthroscopic Classification of Acetabular Rim Labrochondral Disease
    SAGE Publications ; 2012
    In:  The American Journal of Sports Medicine Vol. 40, No. 10 ( 2012-10), p. 2224-2229
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 40, No. 10 ( 2012-10), p. 2224-2229
    Abstract: The results of surgical treatment for femoroacetabular impingement have been increasingly reported, and more advanced intra-articular disease has been identified as an important predictive factor of outcome. Yet, the reliability of arthroscopic hip disease classification has not been well defined. Purpose/Hypothesis: To determine the intraobserver and interobserver reliability of the Beck classification of labral and articular cartilage disease (anterior-superior acetabular rim) encountered in hip arthroscopy. Secondly, we identified the sources of poor reliability that may be improved with future disease classification schemes. Our hypothesis was that the Beck classification of labral and chondral lesions would demonstrate substantial reliability, while the differentiation of early forms of disease would be a common source of disagreement. Study Design: Cohort study; Level of evidence, 3. Methods: Four experienced hip arthroscopists reviewed standardized arthroscopic videos of 40 cases. Arthroscopic findings at the anterior-superior acetabular rim were classified using the Beck classification of labral and articular cartilage disease. Repeat classification of videos was performed at least 2 weeks later. The reliability of arthroscopic classification was defined using the average weighted Cohen κ values and agreement rates. Results: Arthroscopic classification of labral disease using the Beck classification demonstrated moderate to substantial interobserver reliability (average κ = .62; range, .48-.78) and an overall agreement rate of 81.7%. Intraobserver reliability showed a similar level of reliability (average κ = .65; agreement rate, 80.6%). The differentiation between labral degeneration and labral detachment was a common source of disagreement. Similarly, the Beck classification of articular cartilage disease had moderate to substantial interobserver reliability (average κ = .65; range, .49-.78) and overall agreement rate of 57.5%. Intraobserver reliability showed a slightly better level of reliability (average κ = .80; agreement rate, 77.5%). The differentiation between articular cartilage malacia and debonding was a common source of disagreement. Conclusion: The arthroscopic classification of acetabular rim disease with the Beck classification has substantial interobserver reliability. This level of reliability is similar to previously reported arthroscopic disease classifications in the knee and shoulder and seems appropriate for future outcome reporting. Future classifications that eliminate common sources of disagreement may further improve the reliability.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546512457157
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2063945-4
    SSG: 31
    Location Call Number Limitation Availability
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  • 3
    Online Resource
    Online Resource
    Surgical Treatment of Femoroacetabular Impingement: Hip Arthroscopy Versus Surgical Hip Dislocation : A Propensity-Matched Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Bone and Joint Surgery Vol. 102, No. Suppl 2 ( 2020-11-4), p. 51-58
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 102, No. Suppl 2 ( 2020-11-4), p. 51-58
    Abstract: Surgical treatment of femoroacetabular impingement (FAI) continues to evolve and is most commonly approached with either hip arthroscopy (HA) or surgical dislocation (SD) of the hip. The purpose of this study was to compare the outcomes of similar patients undergoing surgical treatment of FAI with either HA or SD. Methods: A prospective multicenter cohort study of patients undergoing primary surgical treatment of FAI was performed. Follow-up at a minimum of 1 year (mean, 4.3 years) was available for 621 hips (81.7%), including 399 procedures with HA and 222 procedures with SD. Propensity scores were calculated and reflect the likelihood of surgical treatment with HA versus SD for a given set of covariates. Propensity scores allowed 1:1 matching to identify similar patients at baseline. After propensity matching, 128 matched pairs of patients who underwent HA and 128 matched pairs of those who underwent SD were included in the study. The primary outcome was the postoperative modified Harris hip score (mHHS); secondary outcomes included the Hip disability and Osteoarthritis Outcome Score (HOOS), the University of California Los Angeles (UCLA) activity score, and the Short Form-12 (SF-12) physical and mental subscores, as well as the rate of persistent symptoms, revision surgery, and total hip arthroplasty (THA). Results: After propensity matching, the 2 groups exhibited similar distributions of all of the covariates that were included in the model. Both groups demonstrated significant improvements in all patient-reported outcomes (PROs). The final mHHS was not significantly different between the 2 matched groups (81.3 for the HA group versus 80.2 for the SD group, p = 0.67). Likewise, the HOOS pain subscale was similar at the time of final follow-up (77.6 versus 80.5, respectively, p = 0.32). No difference between the HA group and the SD group was identified in the rate of THA (0% and 3.1%, respectively, p = 0.41) and revision surgery (7.8% and 10.9%, respectively, p = 0.35); overall rates of persistent symptoms were 21.9% for the HA group and 24.4% for the SD group (p = 0.55). Conclusions: In a propensity-matched analysis of patients who were treated with either approach, patients undergoing HA or SD demonstrated similar outcomes at a mean of 4 years postoperatively. Level of Evidence: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.20.00265
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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