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Background: Staged bilateral hip arthroscopy is an option for athletes who have symptomatic bilateral femoroacetabular impingement; however, the optimal timing of the second procedure is unknown. Purpose: To evaluate minimum 2-year outcomes for patients undergoing accelerated bilateral arthroscopy against those undergoing (1) delayed bilateral and (2) unilateral arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was performed of prospectively collected data from patients undergoing bilateral primary hip arthroscopy for femoroacetabular impingement between 2009 and 2022. Inclusion criteria entailed competitive athletes with concurrent bilateral symptoms at initial presentation. Exclusion criteria (either hip) were Tönnis grade >1, dysplasia (lateral center-edge angle <25°), Perthes disease, protrusio acetabuli, and avascular necrosis. Two groups were established based on the duration between procedures: within 7 days (accelerated group) and within 4 to 12 weeks (delayed group). Patients from the accelerated group were matched in a 1:2 ratio with patients undergoing unilateral surgery based on age ±2 years, sex, and athletic status. Minimum 2-year postoperative patient-reported outcomes (PROs) (including modified Harris Hip Score, University of California Los Angeles activity scale, 36-Item Short Form Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index), rates of achieving the minimal clinically important difference, rates of continuing to play main sport, and satisfaction were compared between groups. Results: A total of 131 athletes (262 hips) with bilateral femoroacetabular impingement were included: 91 in the accelerated group and 40 in the delayed group. Duration between surgeries was 0.99 ± 0.02 and 6.35 ± 2.18 weeks, respectively. All accelerated athletes were each successfully matched to 2 athletes with unilateral procedures (N = 182). All 3 groups demonstrated significant improvement from baseline across all PROs (P <.001 for all). Acquired change in PROs was similar and not significantly different between groups (P >.05). Satisfaction with relief from pain was achieved by 85.9% of patients in the accelerated group compared with 83.1% in the delayed group (P =.053) and 87.3% in the unilateral group (P =.933). The minimal clinically important difference for the modified Harris Hip Score was achieved by 84.9% of patients in the accelerated group compared with 91.5% in the delayed group (P =.212) and 87.6% in the unilateral group (P =.456). At 2 years postoperatively, the continue-to-play rate was 73.6% for the accelerated group compared with 77.1% for the delayed group (P =.577) and 73.0% for the unilateral group (P =.903). There were no increased complications associated with the accelerated group. Conclusion: Accelerated bilateral hip arthroscopy 1 week apart was a safe and effective treatment option for athletes with bilateral symptoms. Improvement in PROs and continue-to-play rates were comparable with those after a delayed duration between procedures and with those case-control matched athletes undergoing unilateral arthroscopy. [ABSTRACT FROM AUTHOR]

Background: Inguinal disruption and femoroacetabular impingement (FAI) are well-recognized sources of groin pain in athletes; however, the relationship between inguinal disruption and FAI remains unclear. In cases of dual pathology, where both entities coexist, there is no definitive consensus regarding which pathology should be prioritized for treatment in the first instance. Purpose: (1) To examine the 2-year effectiveness and clinical outcome in athletes presenting with dual pathology in which the FAI component alone was treated with arthroscopic deformity correction. (2) To compare 2-year patient-reported outcome measures between athletes undergoing only hip arthroscopy (HA) and athletes undergoing groin repair and HA. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing HA for the treatment of FAI with concomitant clinical signs of inguinal disruption at initial consultation were between 2010 and 2016 were included in this study. Inclusion criteria were male sex, age <40 years, and involvement in competitive sporting activity. Athletes with previous HA on the symptomatic side, Tönnis grade >1, or lateral center-edge angle <25° were excluded. Revision HA or subsequent groin surgery was documented. Outcome evaluation consisted of validated patient-reported outcome measures (modified Harris Hip Score; University of California, Los Angeles Activity Scale; 36-Item Short Form Health Survey; Western Ontario and McMaster Universities Osteoarthritis Index) completed preoperatively and a minimum 2 years postoperatively. The minimal clinically important difference was assessed by using a distribution-based technique (SD, 0.5) and an anchor-based technique (percentage of possible improvement). Level of satisfaction and return to play were assessed. Results: A total of 113 cases of dual pathology were included in 91 patients with a mean ± SD age of 26.3 ± 5.1 years. The index surgical procedure was HA for 104 cases (92%) and groin repair for 9 (8%). For patients undergoing HA as the index procedure, 98.1% (102/104 cases) were successfully followed up to establish survivorship. In 89.2% (91/102 cases), no additional groin surgery was required. In 11 cases (10.8%), additional groin surgery was required for persisting inguinal-related groin pain. At 2 years after the operation, there was no difference for any patient-reported outcome measure (P >.099), improvement from baseline (P >.070), or proportion of cases achieving the minimal clinically important difference (P >.120) between the HA-only group and the group undergoing HA and groin repair at any stage. There was also no difference between groups in terms of return-to-play rate (P =.509) or levels of satisfaction (pain, P =.204; performance, P =.345). Conclusion: In patients with dual pathology, treatment of the FAI component alone using arthroscopic hip surgery results in a successful outcome without need for groin repair in 89.2% of cases. No statistical difference in clinical outcome 2 years after surgery was observed between athletes undergoing 1 procedure (HA alone) and those undergoing 2 procedures (HA and groin repair at any stage). [ABSTRACT FROM AUTHOR]

The important role of the acetabular labrum in maintaining stability and optimising fluid pressurisation of the hip joint is well recognised. Preservation and repair of the labrum is now considered an essential component of the arthroscopic management of labral tears and bony deformity correction in patients with symptomatic femoroacetabular impingement and hip dysplasia. Biomechanical studies have demonstrated improved stability and restoration of the sealing properties, vital for hydrostatic fluid pressurisation and reduction in cartilage contact forces, with labral repair. Clinical studies have shown labral repair, not only to have better results compared with debridement, but in conjunction with bony deformity correction, is durable, with successful medium to long-term outcome. Although a number of repair techniques have evolved to restore anatomy and function of the labrum, there are many deficiencies with traditional looped and pierced repair techniques including elevation and bunching, loss of fluid seal, rigidity of the labral body, low anchor positioning increasing risk of joint penetration, disruption of the important chondrolabral junction, and iatrogenic damage to labral tissue. Anatomic labral repair protects the intact chondrolabral junction and important fibrovascular attachments to the labrum; utilising a suspension repair technique the labral body is free from suture and iatrogenic injury, and remains stable but mobile to optimise the flap seal mechanism, vital for fluid pressurisation; the high anchor position reduces risk of joint penetration. Minimum 2-year clinical outcome demonstrates the excellent results from anatomic labral repair which protects and restores the anatomy, blood supply, and function of the labrum. This article describes the applied anatomy and the vital functions of the acetabular labrum, discusses the principles and controversies surrounding standard repair methods and details the operative technique, rationale and outcome for anatomic labral repair. [ABSTRACT FROM AUTHOR]

Introduction: To determine whether athletes undergoing surgical intervention for FAI completed more hours of structured training in adolescence than matched healthy athletes. Methods: Sixty-seven athletes (25.53 ± 4.8 years) undergoing surgical intervention for symptomatic FAI were asked to recall the number of hours engaged in structured training between the ages of 10-12 and 13-15 years old (FAI group). Results were compared to an age (24.56 ± 4.5 years), gender and activity level matched control group (n=71) with no history of chronic hip/groin pain or hip stiffness and who were currently engaged in similar levels of training and competition. Results: The FAI group reported significantly more structured training hours between the ages of 10-12 years than controls (6.55 ± 3.1 versus 5.69 ± 3.7 hrs/week, p=0.02) but no differences were observed for training volume between the ages of 13-15 years (8.45 ± 3.4 vs 8.03 ± 3.7 hrs/week, p=.397). Conclusion: Higher volumes of structured training in early adolescence are a potential risk factor for the development of symptomatic FAI later in the player pathway. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Objective: Femoroacetabular impingement (FAI) is a commonly recognized condition in athletes characterized by activity-related hip pain and stiffness, which if left untreated can progress to hip osteoarthritis. The aim of the study was to determine the effect of symptomatic FAI on performance in young athletes based on the hypothesis that athletes with FAI would show deficits in performance compared with healthy controls. Design: The functional performance of a cohort of preoperative, competitive sportsmen with symptomatic FAI (FAI group, n = 54), was compared with that of a group of age, sex and activity-level matched controls (n = 66). Outcome Measures: Participants performed functional tests including a 10-m sprint, a modified agility T-test, a maximal deep squat test and a single-leg drop jump (reactive strength index). Hip range of motion was assessed by measuring maximal hip flexion, abduction, and internal rotation (at 90 degree hip flexion). Results: The FAI group was significantly slower during the 10-m sprint (3%, P = 0.002) and agility T-test (8%, P < 0.001); flexion, abduction, and internal rotation values for the FAI group were reduced compared with controls (P < 0.001). No significant differences between groups were identified for squat depth or reactive strength index. The FAI group also reported higher levels of anterior groin pain during the 10-m sprint, modified agility T-test, and while squatting. Conclusions: Many sportsmen with confirmed FAI continue sports participation up to and after diagnosis, despite issues with activity-related pain and stiffness. This study highlights the functional limitations in speed, agility, and flexibility that are likely to be present in this group of FAI patients. [ABSTRACT FROM AUTHOR]