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This study reports the long-term effectiveness of meniscal allograft transplantation performed by a single senior operating surgeon. In this study 22 meniscus transplantations in 22 patients were evaluated at a minimum of 7-year follow-up (mean 8.5 +/- 1.3 years) using standardized scoring scales. Subgroup analysis was performed to stratify outcomes based on medial (59.1%) versus lateral (40.9%) meniscus transplantation, and transplantations performed in isolation (36.4%) versus those performed concomitantly (63.6%). Patients reported significant improvement in all scoring scales (p < 0.05). Average satisfaction was 8.8 out of 10. All the patients were completely or mostly satisfied with the results of their surgery. Overall subjective knee condition improved from 3.5 to 6.9 (p < 0.05). Patients undergoing medial compartment repair and combined transplantations reported greater improvement from baseline to followup than did their counterparts. An overall success rate of 88% was found for all patients at the final follow-up. Based on this data, meniscal allograft transplantation is a viable treatment option for meniscal-deficient patients in reducing pain, increasing range of motion, and improving patient function and satisfaction at a minimum of 7 years postsurgery.

Purpose: The purpose of this study was to report the clinical outcomes of autologous chondrocyte implantation (ACI) procedures performed by a single orthopedic surgeon at a minimum of 7 years follow-up. Methods: A retrospective review of prospectively collected data was performed on 29 patients who underwent ACI of the knee between the years of 1998 and 2003. Prospective data were collected to assess changes in standardized outcome measures preoperatively and 2, 4, and 7 years postoperatively. All patients enrolled in the study were also recruited to undergo physical examination when possible. Results: The final cohort consisted of 29 patients with a mean final follow-up time of 8.40 years (range = 7.14-10.88 years). Comparing preoperative scores to 7-year postoperative values, the mean International Knee Documentation Committee (IKDC) score improved from 39.80 to 59.24 ( P < 0.001), mean Tegner-Lysholm score increased from 48.07 to 74.17 ( P < 0.001), SF-12 physical score improved from 40.38 to 48.66 ( P < 0.001), and SF-12 mental score improved from 44.14 to 48.98 ( P < 0.05). Significant improvement occurred in Knee Injury and Osteoarthritis Outcome Score (KOOS) pain (56.03 to 80.36), symptoms (54.19 to 74.75), activities of daily living (72.01 to 85.90), sports (23.34 to 55.34), and quality of life (24.56 to 56.03) ( P < 0.001). In addition, 7-year postoperative scores were at or near levels seen at 2 years (mean = 2.16; range = 0.94-4.03 years) and 4 years (mean = 4.43; range = 2.16-5.88 years) postoperatively, reflecting durable improvement. Subjectively, on a scale of 1 to 10 (10 being completely satisfied), the mean postoperative satisfaction rate was 8.14. Additionally, 88.9% of the patients would elect to have this surgery again if the same problem was to occur in the contralateral joint. Conclusions: The results of ACI in patients who present with symptomatic, full-thickness chondral defects remain durable at a minimum of 7-year follow-up with persistent, high levels of patient satisfaction. Level of Evidence: Case series; Level of evidence, IV.

The techniques utilized for the management of articular cartilage and labrum injuries during hip preservation surgery have changed dramatically recently. Conservative treatment may involve image-guided injection of cortisone or viscosupplementation in conjunction with oral NSAIDs and physical therapy. Damage to the labrum runs a broad spectrum, and the treatments are individualized, but span from debridement to repair and reconstruction. The overarching goal of labral treatment is to restore the native functions of the labrum to allow for more normal biomechanical function. Similarly, cartilage injuries can be managed a number of different ways, including with debridement, microfracture or drilling, cartilage transplants, and higher level restorative techniques. These cartilage restoration techniques have evolved rapidly as well, and may include the use of scaffolds, allograft cartilage cells, and other stem-cell-related procedures.

The development of the suture anchor has played a pivotal role in the transition from open to arthroscopic techniques of the shoulder. Various suture anchors have been manufactured that help facilitate the ability to create a soft tissue to bone repair. Because of reported complications of loosening, migration, and chondral injury with metallic anchors, bioabsorbable anchors have become increasingly used among orthopaedic surgeons. In this review, the authors sought to evaluate complications associated with bioabsorbable anchors in or about the shoulder and understand these in the context of the total number of bioabsorbable anchors placed. In 2008, 10 bioabsorbable anchor–related complications were reported to the US Food and Drug Administration. The reported literature complications of bioabsorbable anchors implanted about the shoulder include glenoid osteolysis, synovitis, and chondrolysis. These potential complications should be kept in mind when forming a differential diagnosis in a patient in whom a bioabsorbable anchor has been previously used. These literature reports, which amount to but a fraction of the total bioabsorbable anchors implanted in the shoulder on a yearly basis, underscore the relative safety and successful clinical results with use of bioabsorbable suture anchors. Product development continues with newer composites such as PEEK (polyetheretherketone) and calcium ceramics (tricalcium phosphate) in an effort to hypothetically create a mechanically stable construct with and improve biocompatibility of the implant. Bioabsorbable anchors remain a safe, reproducible, and consistent implant to secure soft tissue to bone in and about the shoulder. Meticulous insertion technique must be followed in using bioabsorbable anchors and may obviate many of the reported complications found in the literature. The purpose of this review is to provide an overview of the existing literature as it relates to the rare complications seen with use of bioabsorbable suture anchors in the shoulder.

Purpose There is currently limited information available in the orthopaedic surgery literature regarding the appropriate management of symptomatic partial-thickness rotator cuff tears. Methods A systematic search was performed in PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials of all published literature pertaining to the arthroscopic management of partial-thickness rotator cuff tears. Inclusion criteria were all studies that reported clinical outcomes after arthroscopic treatment of both articular-sided and bursal-sided lesions using a validated outcome scoring system and a minimum of 12 months of follow-up. Data abstracted from the selected studies included tear type and location (articular v bursal sided), treatment approach, postoperative rehabilitation protocol, outcome scores, patient satisfaction, and postoperative imaging results. Results Sixteen studies met the inclusion criteria and were included for the final analysis. Seven of the studies treated partial-thickness rotator cuff tears with debridement with or without an associated subacromial decompression, 3 performed a takedown and repair, 5 used a transtendon repair technique, and 1 used a transosseous repair method. Among the 16 studies reviewed, excellent postoperative outcomes were reported in 28.7% to 93% of patients treated. In all 12 studies with available preoperative baseline data, treatment resulted in significant improvement in shoulder symptoms and function. For high-grade lesions, the data support arthroscopic takedown and repair, transtendon repairs, and transosseous repairs, with all 3 techniques providing a high percentage of excellent results. Debridement of partial-thickness tears of less than 50% of the tendon's thickness with or without a concomitant acromioplasty also results in good to excellent surgical outcomes; however, a 6.5% to 34.6% incidence of progression to full-thickness tears is present. Conclusions This systematic review of 16 clinical studies showed that significant variation is present in the results obtained after the arthroscopic management of partial-thickness rotator cuff tears. What can be supported by the available data is that tears that involve less than 50% of the tendon can be treated with good results by debridement of the tendon with or without a formal acromioplasty, although subsequent tear progression may occur. When the tear is greater than 50%, surgical intervention focusing on repair has been successful. There is no evidence to suggest a differential in outcome for tear completion and repair versus transtendon repair of these lesions because both methods have been shown to result in favorable outcomes. Level of Evidence Level IV, systematic review of Level IV studies.

Context: The reconstruction of isolated complete posterior cruciate ligament (PCL) injuries remains a controversial topic. Proponents for reconstruction cite the premature development of arthritis in the medial and patellofemoral compartments as a compelling reason to offer reconstruction. Currently, no consensus exists about which technique should be used to reconstruct the PCL. Type of Study: Surgical technique. Evidence Acquisition: A MEDLINE and PUBMED search was performed using the following combination of keywords for the years 1985-2009: PCL, posterior cruciate ligament, and rehabilitation. The reviewed articles were those that addressed rehabilitation of the PCL after reconstruction and were written in the English language. Results: This PCL reconstruction technique may be more inherently stable and allow a more progressive rehabilitation program. Conclusion: There are unique features of all-arthroscopic, double-bundle, allograft reconstruction of the PCL that allow a more aggressive approach in PCL reconstruction rehabilitation. The stability afforded by the anatomic press-fit tibial plug and the augmented tibial and augmented femoral fixation are a plus. The anatomic position of the tibial insertion avoids the “killer turn” of the transtibial approach, limiting concerns for graft abrasion with range of motion and resultant elongation. The outside-in method for the femoral tunnels also minimizes the abrasion that can occur at the “critical corner.”

Context: Knee injuries, particularly of the medial collateral ligament (MCL), are the most common injury sustained in American football. In 1979, Anderson et al described a knee brace that could protect uninjured knees from MCL injuries resulting from lateral impact. Since then, a number of light and free-moving bracing devices have been developed. However, the efficacy of prophylactic knee bracing remains in question. Objective: A systematic review of the efficacy of prophylactic knee bracing in preventing MCL injuries in football players. Data Sources: Based on MedSearch and PubMed, articles from 1985 to November 2009 were identified with the following keywords and their combinations: prophylactic, prevent injury, knee brace, prevention, medial collateral ligament, MCL, football, and bracing. Study Selection: One randomized controlled trial (level 1 study) and 5 prospective cohort studies (level 2 studies) were selected. Results: The results of the studies were inconsistent; only 1 study showed that prophylactic knee bracing significantly reduced MCL injuries ( P < .05). In contrast, 2 studies found that knee bracing was associated with an increase in knee injuries. Conclusions: Prophylactic bracing in American football has not consistently reduced MCL injuries. There remains a lack of evidence to support the routine use of prophylactic knee bracing in uninjured knees. There is limited high-level evidence, bias in the available literature, and confounding variables that limit the current literature.

Objectives: Labral reconstruction using iliotibial band (ITB) autograft and semitendinosus (Semi-T) allograft have recently been described in cases of labral deficiency. The current study seeks to understand the biomechanical effects of an intact labrum, segmental labral resection, and labral reconstruction on joint contact area, contact pressure, and peak force. Methods: Ten fresh-frozen human cadaver hips were analyzed utilizing thin-film piezoresistive load sensors to measure contact area, contact pressure, and peak force 1) with the native intact labrum, 2) after segmental labral resection and 3) after graft labral reconstruction with either ITB autograft or Semi-T allograft. Each specimen was examined at 20° extension and 60° flexion. Statistical analysis was conducted through one-way ANOVA with post-hoc Games-Howell tests. Results: For the ITB group, labral resection significantly decreased contact area (20°: 73.2%±5.38, P=0.0010; 60°: 78.5%±6.93, P=0.0063) and increased contact pressures (20°: 106.7%±4.15, P=0.0387; 60°: 103.9%±1.15, P=0.0428). ITB reconstruction improved contact area (20°: 87.2%±12.3, P=0.0130; 60°: 90.5%±8.81, P=0.0079) and contact pressures (20°: 98.5%±5.71, P=0.0476; 60°: 96.6%±1.13, P=0.0056) from the resected state. Contact pressure at 60° flexion was significantly lower compared to the native labrum ( P = 0.0420). For the Semi-T group, labral resection significantly decreased contact area (20°: 68.1±12.57, P=0.0002; 60°: 67.5%±6.70, P=0.0002) and increased contact pressures (20°: 105.3%±3.73, P=0.0304; 60°: 106.8%±4.04, P=0.0231). Semi-T reconstruction improved contact area (20°: 87.9%±7.95, P=0.0087; 60°: 92.9%±13.2, P=0.0014) and contact pressures (20°: 97.1%±3.18, P=0.0017; 60°: 97.4%±4.39, P=0.0027) from the resected state. Comparative analysis demonstrated no statistically significant differences between either graft reconstruction in relation to contact area, contact pressure, or peak forces. (Figure 1). Conclusion: Segmental anterosuperior labral resection results in significantly decreased contact area and increased contact pressures, while labral reconstruction partially restores time-zero acetabular contact areas and pressures as compared to the resected state. Although labral reconstruction improved the measured biomechanical properties as compared to the resected state, some of these properties remained significantly different compared to the native intact labrum.

Background: There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip arthroscopy for femoroacetabular impingement (FAI). Purpose: To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: “Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?” Results: There were 130 patients (mean ± SD age, 35.6 ± 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values—at which patients considered their status to be satisfactory—at 1 year after surgery were 74 (mHHS), 87 (HOS–activities of daily living subscale), and 75 (HOS–sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 [mHHS], 3.83 [HOS–activities of daily living], 3.38 [HOS-sports]). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS. Conclusion: This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for responder analyses in future randomized trials related to hip arthroscopy and the treatment of FAI.

Purpose To investigate the relation between cam, acetabular version, and pelvic incidence. Methods This was a retrospective analysis of 65 patients with symptomatic hip pain and radiographic signs of femoroacetabular impingement (FAI). Twenty-seven patients were used as a control. All patients received a CT scan of the pelvis that included the sacral endplate. Alpha angle, acetabular version, and pelvic incidence (PI) were measured on 2D CT. Patients were then assigned to 1 of 4 groups: control, cam (alpha angle > 55°, version > 15°), retroverted (alpha angle 55°, version Results The PI in mixed-type FAI was 46.7° ± 3.7°, which showed a statistically significant decrease from the PI of the control group, 56.1° ± 4.4° ( P = .01). The PI for cam-only deformity was 50.8° ± 4.6°, and the PI for retroverted-only deformity was 51.0° ± 4.6°. Neither was statistically different from the control. Conclusions This study suggests that mixed-type FAI may develop as a response to decreased PI. This result is consistent with previous reports showing decreased PI associated with cam and retroversion deformities. Although the cause of FAI remains controversial, the potential impact of sagittal balance of the pelvis, and specifically, decreased PI, should not be ignored. Level of Evidence Level IV, therapeutic case series.

Background: The majority of rim recession for femoroacetabular impingement (FAI) is performed anteriorly and has traditionally been assessed by the lateral center-edge (CE) angle, which correlates most closely with lateral coverage. The radiographic false-profile view permits measurement of anterior coverage via the anterior CE angle and more closely correlates with anterior coverage. Purpose: To answer the following questions: (1) How does incremental anterior rim recession change lateral and anterior CE angles? and (2) Can these changes be predicted by a formula? Study Design: Descriptive laboratory study. Methods: Twelve cadaveric hips were dissected free of soft tissue to expose the anterior acetabular rim. Incremental resections of 2.5 mm (range, 0-10 mm) were performed from the 12- to 3-o’clock position using a Dremel rotary tool. Anteroposterior hip and false-profile radiographs were obtained at each interval using a fluoroscopic C-arm. The lateral and anterior CE angles were measured by 3 orthopaedic surgeons. Results: The average preresection lateral CE angle was 35.1°, and the mean decrease in lateral CE angle from 0 to 10 mm was 9.9°; the average preresection anterior CE angle was 38.4° and the mean decrease in anterior CE angle from 0 to 10 mm was 18.2°. The anterior CE angle decreased by a factor of 1.9 when compared with the lateral CE angle ( P = 2 × 10−7). The lateral CE angle decreased by approximately 1° (1.0°) per millimeter of rim recessed. The anterior CE angle decreased by approximately 2° (1.8°) per millimeter of rim recessed. Conclusion: The lateral CE angle should not be extrapolated to reflect anterior acetabular coverage. The anterior CE angle is a superior marker and predictably decreases with rim recession at double the rate of the lateral CE angle. Clinical Relevance: The false-profile view is recommended in the perioperative workup for all patients undergoing arthroscopic treatment of pincer impingement.

Endoscopic techniques for the treatment of greater trochanteric pain syndrome have become increasingly popular with evolving indications and advances in instrumentation; the majority of abnormalities associated with greater trochanteric pain syndrome can now be effectively treated with these minimally invasive techniques. The indications for hip arthroscopy have expanded greatly over the past decade and remain an area of tremendous growth in orthopaedic surgery. With improvements in surgical technique and instrument design, there are increasing opportunities to treat peritrochanteric hip conditions endoscopically and intra-articular hip disorders arthroscopically. Greater trochanteric pain syndrome is a relatively common clinical entity that is seen in 10% to 25% of the general population1. It encompasses disorders of the lateral, peritrochanteric space of the hip and includes trochanteric bursitis, gluteus medius and minimus tendon tears, and external coxa saltans …

Background: Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. Purpose: To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Study Design: Case series; Level of evidence, 4. Methods: A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes’ first season in the NFL were gathered using publicly available databases. Results: Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Conclusion: Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder surgery or those with isolated soft tissue shoulder repair. Glenohumeral arthritis and advanced imaging findings of labral tearing and Hill-Sachs lesions in elite American football players with a history of glenoid augmentation did not significantly affect NFL participation 1 year after the combine.

Objectives: The development of injury prevention strategies is important in maximizing athlete health and safety. Increased training loads have been associated with increased odds of injury in collision sports during all phases of training. To date, the relationship between training load and injury has not been investigated in NFL players. The primary objective of this study was to determine the correlation between player workload and soft tissue injury utilizing wearable GPS technology. Methods: Player workloads were assessed during training sessions during the preseason and regular season using GPS and triaxial accelerometer from 2014-2016. Soft tissue injuries were recorded during each season and were divided into ligamentous and myotendinous injuries. Player workload during the week of injury and mean weekly workload in the 4 weeks prior to injury were determined for each soft tissue injury. These variables were also determined in uninjured position-matched controls during the same week. Descriptive statistics were used to summarize player workload for injuries and controls. Subgroup analysis was also conducted to determine whether observed effects were confounded by training period and type of injury. Results: Data was obtained over 2 NFL seasons from 2014-2016. A total of 136 lower extremity injuries were recorded. 62/136 (45%) of injuries were sustained during the preseason. Ankle sprains were the most common type of ligamentous injury (60%) while hamstring strains were the most common type of myotendinous injury (49%). 100 injuries that had a set of GPS data were included in the analysis. Injuries were associated with greater increases in player workload during the week of injury compared to uninjured individuals (193.6, 95% CI 104.6-282.5 versus 101.2, 95% CI 27.7-174.8, p = .0038). Injured players were associated with a 110% increase in training load during the week of injury compared to uninjured players, who were associated with a 73% increase ( p = .032). This effect was most pronounced with myotendinous injuries during the preseason as these injuries were associated with significantly greater increases in workload during the week of injury compared to uninjured controls (617.0, 95% CI 318.4-915.6 versus 384.1, 95% CI 137.5-630.8, p = .0095). Injured players were associated with 260% increase in training load during the week of injury compared to uninjured controls who were associated with 165% increase in workload ( p = .012). Conclusion: Soft tissue injuries in professional football are associated with large increases in training load during the week of injury. This effect seems to be especially pronounced during the preseason when workloads are generally higher and is primarily applicable to myotendinous injuries. These results suggest that a gradual increase in training intensity is a potential method to reduce risk of soft tissue injury. Preseason versus regular season specific training programs monitored with wearable technology may assist team athletic training and medical staff with developing programs to optimize player performance.

Background: Hip capsular management after hip arthroscopic surgery for femoroacetabular impingement (FAI) is controversial. Purpose/Hypothesis: To compare the clinical outcomes of patients undergoing hip arthroscopic surgery for FAI with T-capsulotomy with partial capsular repair (PR; closed vertical incision, open interportal incision) versus complete capsular repair (CR; full closure of both incisions). The hypothesis was that there would be improved clinical outcomes in patients undergoing CR compared with those undergoing PR. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients undergoing hip arthroscopic surgery for FAI by a single fellowship-trained surgeon from January 2011 to January 2012 were prospectively collected and analyzed. Inclusion criteria included all patients between ages 16 and 65 years with physical examination and radiographic findings consistent with symptomatic FAI, with a minimum 2-year follow-up. For analysis, patients were matched according to sex and age ±2 years. Primary clinical outcomes were measured via the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales, the modified Harris Hip Score (mHHS), patient satisfaction (measured on a visual analog scale), and clinical improvement at baseline, 6 months, 1 year, and 2 years. Statistical analysis was performed utilizing Student paired and unpaired t tests, with P < .05 considered significant. Results: A total of 64 patients were included in the study, with 32 patients (12 male, 20 female) in each group. The average follow-up was 29.9 ± 2.6 months. There were no significant demographic differences between the groups. The CR group demonstrated significantly superior outcomes in the HOS-SS at 6 months (PR: 63.8 ± 31.1 vs CR: 72.2 ± 16.1; P = .039), 1 year (PR: 72.7 ± 14.7 vs CR: 82.5 ± 10.7; P = .006), and 2.5 years (PR: 83.6 ± 9.6 vs CR: 87.3 ± 8.3; P < .0001) after surgery. Patient satisfaction at final follow-up was significantly better in the CR group (PR: 8.4 ± 1.0 vs CR: 8.6 ± 1.1; P = .025). Both groups demonstrated significant improvements in the HOS-ADL (PR: 64.6 ± 17.0 to 90.7 ± 8.4 [ P < .0001]; CR: 66.1 ± 15.7 to 92.1 ± 7.9 [ P < .0001]) and HOS-SS (PR: 39.4 ± 23.9 to 83.6 ± 9.6 [ P < .0001]; CR: 39.1 ± 24.2 to 87.3 ± 8.3 [ P < .0001]) at final follow-up. There were no significant differences between the groups in the HOS-ADL at any time point. There were no significant differences in the mHHS between the groups at final follow-up (PR: 82.5 ± 5.0 vs CR: 83.0 ± 4.4; P = .364). The overall revision rate was 6.25%; all patients (n = 4) who required revision arthroscopic surgery were in the PR group (13% of 32 patients), while no patients in the CR group required revision surgery. Conclusion: While significant improvements were seen at 6 months, 1 year, and 2.5 years of follow-up regardless of the closure technique, patients who underwent CR of the hip capsule demonstrated superior sport-specific outcomes compared with those undergoing PR. There was a 13% revision rate in the PR group, but no patients in the CR group required revision surgery. While longer term outcome studies are needed to determine if these results are maintained over time, these data suggest improved outcomes after CR compared with PR at 2.5 years after hip arthroscopic surgery for FAI.

Background: The sacropelvic parameter of pelvic incidence (PI) is a position-independent anatomic parameter that regulates lumbar lordosis and pelvic orientation. While it has been extensively studied in relation to spine pathology, only a single study has correlated PI with femoroacetabular impingement (FAI). Hypothesis: Decreased PI would be associated with an increased prevalence of cam and pincer lesions. Study Design: Controlled laboratory study. Methods: Measurements of the acetabulum, proximal femur, and sacropelvis were made bilaterally on 40 cadaveric specimens, for a total of 80 hips. Twenty specimens had the presence of bilateral cam deformities (alpha angle >55°), and 20 age- and sex-matched specimens had bilateral normal hips. Pincer lesions were defined as an anteversion Results: The mean PI was 43.1° ± 8.6° for hips with a cam lesion and 47.7° ± 9.3° for normal hips, demonstrating a significant association between decreased PI and the presence of a cam lesion ( P = .02). The mean version of acetabula with pincer lesions (n = 28) was 11.4° ± 2.5°, and the mean version of normal acetabula (n = 52) was 20.1° ± 3.8°. The mean PI of hips with pincer lesions was 42.5° ± 8.5°, significantly less than that of normal hips, 47.0° ± 9.2° ( P = .04). Conclusion: This study supports a recent study that suggested patients with pincer impingement have a smaller PI than the healthy population, and it is the first to demonstrate a significant association between decreased PI and cam-type femoral deformity. Based on results of this study, further clinical study of the effects of pelvic geometry on FAI is warranted. Clinical Relevance: While the study results do not prove a causal relationship, it is theorized that the restriction of range of motion and biomechanical adaptations of the pelvis around the hip joints resulting from a smaller PI may affect hip development and FAI. The influence of mechanical factors beyond the hip joint in the development of FAI should be considered by clinicians.

To identify the accuracy of measuring the alpha angle on the false-profile, anteroposterior (AP), and 90° Dunn lateral views of the hip as compared with computed tomography (CT) scan findings.Forty patients were needed to have power greater than 80%. Forty-five consecutive patients undergoing hip arthroscopy were retrospectively reviewed with preoperative radial oblique CT reformatted scans and plain radiographs. Alpha angles were measured on plain radiographs (AP, 90° Dunn lateral, and false profile) and CT reformatted views. Abnormal alpha angles were considered greater than 50.5°. Two orthopaedic surgeons independently measured the images, and the results were compared between imaging modalities.The false-profile view was 60% sensitive and 89.0% specific for diagnosing cam deformities of the hip. All radiographs combined were 86% sensitive and 75% specific for diagnosing cam deformities. The false-profile view most strongly correlated with the 2-o'clock (R = 0.746, P = .001) and 3-o'clock (R = 0.698, P.0001) positions. An intraclass correlation coefficient of 0.81 was found for measurement of the alpha angle on the false-profile view.This study has proved that the false-profile view effectively characterizes cam deformity, especially anterior deformity at the 3-o'clock position. Measuring the alpha angle on the false-profile view appears to be reproducible. The false-profile view along with standing AP pelvis and 90° Dunn lateral views of the hip comprises a good screening radiographic series for patients presenting with symptoms of femoroacetabular impingement.Level III, diagnostic study.

We conducted a study to further understand the effect of capsulotomy on hip joint stability using an in vitro cadaver model. Thirteen fresh-frozen cadaveric hip specimens were subjected to an external rotation torque of 0.588 Nm. The experimental kinematics, post-process translation, and rotation data for each specimen were tested under 4 conditions: neutral flexion with capsule intact; neutral flexion with transverse capsulotomy; maximum flexion with capsule intact; and maximum flexion with transverse capsulotomy. A segmented 3-dimensional model of the femur was used to evaluate femoral head translation after application of external rotation torque. In maximum flexion, hips with intact capsules rotated less than hips with capsulotomy in the y (abduction) and z (external rotation) planes (y-plane, P = .01; z-plane, P = .02). After capsulotomy, there was a qualitative observation of increased distal, lateral, and anterior translation of the femoral head in neutral position, and a qualitative observation of increased medial, posterior, and distal translation of the femoral head in flexion. Qualitatively, after capsulotomy, hips tested in neutral position demonstrated more translation than rotation, whereas hips tested in flexion demonstrated more rotation than translation. Capsulotomy appears to permit increased rotation in maximum flexion. Hips tested in neutral trended toward more translation than rotation, whereas hips in flexion trended toward more rotation than translation. Judicious capsular management is indicated during arthroscopic hip procedures.

The purpose of this study was to develop a novel method to quantify hip capsular volume in patients undergoing hip arthroscopic surgery, utilizing magnetic resonance arthrogram (MRA) and to determine whether there are demographic or radiological factors that are associated with capsular volume. A retrospective review was performed from 2006 to 2014 of consecutive patients who presented with hip pain and received a hip MRA and plain radiographs. All patients were suspected of soft tissue injury due to underlying femoroacetabular impingement (FAI). A novel technique using Osirix MD for the quantification of capsular and femoral head volumes was described. Ninety-seven patients met the study criteria and were included for analysis. The average total capsular volume (including the femoral head) measured 79.89 ± 20.35 cm3, average femoral head volume 46.68 ± 12.32 cm3, and average true capsular volume measured 33.20 ± 12.58 cm3. Average total capsular:femoral head volume ratio was 1.74 ± 0.27. Significant differences were seen between genders for total capsular volume (P

Failure of metal-backed cementless patellar components frequently has been observed clinically. To determine the effect of component design on clinical outcome, the authors reviewed the results of total knee arthroplasty with metal-backed patellar components of two different designs. The results of 168 total knee arthroplasties (Miller-Galante) with dome-shaped metal-backed patellar components and 93 total knee arthroplasties Miller-Galante II with modified dome-shaped metal-backed patellar components were reviewed. Kaplan-Meier survivorship was determined for both groups. Revision for patellar wear or failure was done or recommended in 36 Miller-Galante total knee arthroplasties. The cumulative survival rates at 3, 5, 7, and 9 years postoperatively were 99%, 92%, 81%, and 73%, respectively for this group. In contrast, only three of 93 Miller-Galante II patellar components required revision. Catastrophic patellar component failure, typically seen with the Miller-Galante metal-backed patellar components, was not observed with the Miller-Galante II components. Cumulative survival of the Miller-Galante II patella at 3, 5, 7, and 9 years postoperatively was 100%, 100%, 98.7%, and 93.2% respectively. The results of the current study show a dramatic reduction in metal-backed component failure by design changes incorporated into the modified dome-shaped Miller-Galante II patellar component and highlights the importance of design on the survival of cementless metal-backed patellar components.

The purpose of this article is to determine normative values for the length of the acetabular rim and detect differences between gender, age, ethnicity, height and leg length. Six measurements were taken on the acetabular rim of 143 cadaveric skeleton specimens (286 acetabula) using a coordinate-measuring device: circumferential (excluding acetabular notch), anterior inferior iliac spine (AIIS)-anterior, AIIS-posterior, 12–3 o’clock, 12–9 o’clock and 11–5 o’clock. Museum specimen height data and leg length data from a previous study were recorded for 109 of 143 specimens. Intraclass correlation coefficients were calculated. Student t-tests compared mean values. Multiple regression analysis was used to determine the relationship between acetabular rim length and gender, age, ethnicity, height and leg length. The average acetabular rim length in males for circumferential, AIIS-anterior, AIIS-posterior, 12–3, 12–9 and 11–5 o’clock were 15.8, 4.2, 11.7, 4.9, 4.7 and 9.5 cm, respectively; and for females: 13.7, 3.7, 10.0, 4.3, 4.1 and 8.3 cm, respectively. Intraclass correlation coefficients were 0.953, 0.930, 0.958, 0.857, 0.913 and 0.951, respectively, for each measurement. All six measurements were significantly larger for males (P

From the first shoulder arthroscopy performed on a cadaver in 1931, shoulder arthroscopy has grown tremendously in its ability to diagnose and treat pathologic conditions about the shoulder. Despite improvements in arthroscopic techniques and instrumentation, it is only recently that arthroscopists have begun to explore precise anatomical structures within the subdeltoid space. By way of a thorough bursectomy of the subdeltoid region, meticulous hemostasis, and the reciprocal use of posterior and lateral viewing portals, one can identify a myriad of pertinent ligamentous, musculotendinous, osseous, and neurovascular structures. For the purposes of this review, the subdeltoid space has been compartmentalized into lateral, medial, anterior, and posterior regions. Being able to identify pertinent structures in the subdeltoid space will provide shoulder arthroscopists with the requisite foundation in core anatomy that will be required for challenging procedures such as arthroscopic subscapularis mobilization and repair, biceps tenodesis, subcoracoid decompression, suprascapular nerve decompression, quadrangular space decompression and repair of massive rotator cuff tears.

Background: Suture anchor fixation has become the preferred method for arthroscopic repairs of rotator cuff tears. Recently, newer arthroscopic repair techniques including transosseous-equivalent repairs with anchors or arthroscopic transosseous suture passage have been developed. Purpose: To compare the initial biomechanical performance including ultimate load to failure and localized cyclic elongation between transosseous-equivalent repair with anchors (TOE), traditional transosseous repair with a curved bone tunnel (TO), and an arthroscopic transosseous repair technique utilizing a simple (AT) or X-box suture configuration (ATX). Study Design: Controlled laboratory study. Methods: Twenty-eight human cadaveric shoulders were dissected to create an isolated supraspinatus tear and randomized into 1 of 4 repair groups (TOE, TO, AT, ATX). Tensile testing was conducted to simulate the anatomic position of the supraspinatus with the arm in 60° of abduction and involved an initial preload, cyclic loading, and pull to failure. Localized elongation during testing was measured using optical tracking. Data were statistically assessed using analysis of variance with a Tukey post hoc test for multiple comparisons. Results: The TOE repair demonstrated a significantly higher mean ± SD failure load (558.4 ± 122.9 N) compared with the TO (325.3 ± 79.9 N), AT (291.7 ± 57.9 N), and ATX (388.5 ± 92.6 N) repairs ( P < .05). There was also a significantly larger amount of first-cycle excursion in the AT group (8.19 ± 1.85 mm) compared with the TOE group (5.10 ± 0.89 mm). There was no significant difference between repair groups in stiffness during maximum load to failure or in normalized cyclic elongation. Failure modes were as follows: TOE, tendon (n = 4) and bone (n = 3); TO, suture (n = 6) and bone (n = 1); AT, tendon (n = 2) and bone (n = 3) and suture (n = 1); ATX, tendon (n = 7). Conclusion: This study demonstrates that anchorless repair techniques using transosseous sutures result in significantly lower failure loads than a repair model utilizing anchors in a TOE construct. Clinical Relevance: Suture anchor repair appears to offer superior biomechanical properties to transosseous repairs regardless of tunnel or suture configuration.

Purpose The purpose of this study was to validate additional radiographic parameters that detect changes within the acetabular cavity during acetabular rim trimming for pincer-type femoroacetabular impingement in an in vivo setting. Methods Patients who met the inclusion criteria and underwent arthroscopic acetabular rim trimming had their preoperative and postoperative anteroposterior radiographs measured. Intraoperatively, these patients had their labrums detached, acetabular walls trimmed by roughly 3 to 5 mm, and then labrums reattached. Radiographic measurements were subsequently obtained by use of the anterior rim angle (ARA), anterior wall angle (AWA), and anterior margin ratio (AMR). Results Statistically significant changes were seen in the postoperative ARA, AWA, and AMR. Mean pre- and post-trimming changes were 83.8° and 87.9°, respectively, for the ARA; 38.8° and 35.8°, respectively, for the AWA; and 0.57 and 0.53, respectively, for the AMR. There were no postoperative complications. No patients had any instability events. Conclusions This study shows that significant changes in anterior acetabular anatomy can be evaluated radiographically in the in vivo setting for treatment of pincer-type femoroacetabular impingement. We saw a significant, consistent decrease in both the AWA and AMR and increase in the ARA. This research serves to guide surgeons with preoperative and intraoperative templating while providing the groundwork to investigate these radiographic parameters in an asymptomatic patient population. Clinical relevance These novel radiographic measurements can be used by hip arthroscopists to better characterize their surgical role in altering acetabular morphology. In addition, these measurements will be able to better describe acetabular anatomy.

Background: The current study evaluated the outcomes of biologic resurfacing of the glenoid using a lateral meniscus allograft or human acellular dermal tissue matrix at intermediate-term follow-up. Methods: Forty-five patients (mean age, 42.2 years) underwent biologic resurfacing of the glenoid, and 41 were available for follow-up at a mean of 2.8 years. Lateral meniscal allograft resurfacing was used in 31 patients and human acellular dermal tissue matrix interposition in 10. Postoperative range of motion and clinical outcomes were assessed at the final follow-up. Results: The overall clinical failure rate was 51.2%. The lateral meniscal allograft cohort had a failure rate of 45.2%, with a mean time to failure of 3.4 years. Human acellular dermal tissue matrix interposition had a failure rate of 70.0%, with a mean time to failure of 2.2 years. Overall, significant improvements were seen compared with baseline with respect to the visual analog pain score (3.0 vs 6.3), American Shoulder and Elbow Surgeons score (62.0 vs 36.8), and Simple Shoulder Test score (7.0 vs 4.0). Significant improvements were seen for forward elevation (106 � to 138 � )a nd external rotation (31 � to 51 � ). Conclusion: Despite significant improvements compared with baseline values, biologic resurfacing of the glenoid resulted in a high rate of clinical failure at intermediate follow-up. Our results suggest that biologic resurfacing of the glenoid may have a minimal and as yet undefined role in the management of glenohumeral arthritis in the young active patient over more traditional methods of hemiarthroplasty or total shoulder arthroplasty.

The treatment of patellofemoral (PF) articular cartilage pathology is difficult because the pathology is multifactorial and symptoms related to the cartilage portion of the problem are expressed through noncartilaginous tissue. Since cartilage is aneural, the symptoms from the cartilage defects are mediated through the mechanical effects on bone and by cartilage debris that causes noxious stimulation of soft tissues. A systematic history, thorough physical examination, and appropriate imaging studies are essential to assign a portion of the patient’s symptoms to the cartilage pathology. A successful outcome for patellofemoral articular cartilage restoration requires treatment of each individual component of the multifactorial pathology, and with careful patient selection and comprehensive patient and knee specific surgical management, it is possible for cartilage restoration in the patellofemoral compartment to have a success rate similar to the tibiofemoral compartment.

There is currently limited information available in the orthopaedic surgery literature regarding the appropriate management of symptomatic partial-thickness rotator cuff tears.A systematic search was performed in PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Central Register of Controlled Trials of all published literature pertaining to the arthroscopic management of partial-thickness rotator cuff tears. Inclusion criteria were all studies that reported clinical outcomes after arthroscopic treatment of both articular-sided and bursal-sided lesions using a validated outcome scoring system and a minimum of 12 months of follow-up. Data abstracted from the selected studies included tear type and location (articular v bursal sided), treatment approach, postoperative rehabilitation protocol, outcome scores, patient satisfaction, and postoperative imaging results.Sixteen studies met the inclusion criteria and were included for the final analysis. Seven of the studies treated partial-thickness rotator cuff tears with debridement with or without an associated subacromial decompression, 3 performed a takedown and repair, 5 used a transtendon repair technique, and 1 used a transosseous repair method. Among the 16 studies reviewed, excellent postoperative outcomes were reported in 28.7% to 93% of patients treated. In all 12 studies with available preoperative baseline data, treatment resulted in significant improvement in shoulder symptoms and function. For high-grade lesions, the data support arthroscopic takedown and repair, transtendon repairs, and transosseous repairs, with all 3 techniques providing a high percentage of excellent results. Debridement of partial-thickness tears of less than 50% of the tendon's thickness with or without a concomitant acromioplasty also results in good to excellent surgical outcomes; however, a 6.5% to 34.6% incidence of progression to full-thickness tears is present.This systematic review of 16 clinical studies showed that significant variation is present in the results obtained after the arthroscopic management of partial-thickness rotator cuff tears. What can be supported by the available data is that tears that involve less than 50% of the tendon can be treated with good results by debridement of the tendon with or without a formal acromioplasty, although subsequent tear progression may occur. When the tear is greater than 50%, surgical intervention focusing on repair has been successful. There is no evidence to suggest a differential in outcome for tear completion and repair versus transtendon repair of these lesions because both methods have been shown to result in favorable outcomes.Level IV, systematic review of Level IV studies.

Knee meniscectomy is the most common procedure performed by orthopaedic surgeons. While it is generally believed that loss of meniscal tissue leads to osteoarthritis and poor knee function, many variables may significantly influence this outcome. Through literature search engines including PubMed and Ovid, 4 randomized controlled trials, 2 prospective cohorts, and 23 retrospective cohorts that fit the criteria for level I, II, and III level of evidence were included in this systematic review. For the level III evidence studies, follow-up of 5 years or more was required. Preoperative and intraoperative predictors of poor clinical or radiographic outcomes included total meniscectomy or removal of the peripheral meniscal rim, lateral meniscectomy, degenerative meniscal tears, presence of chondral damage, presence of hand osteoarthritis suggestive of genetic predisposition, and increased body mass index. Variables that were not predictive of outcome or were inconclusive or had mixed results included meniscal tear pattern, age, mechanical alignment, sex of patient, activity level, and meniscal tears associated with anterior cruciate ligament (ACL) reconstruction. While an intact meniscus or meniscal repair was generally favorable in the ACL-reconstructed knees, meniscal repair of degenerative meniscal tissue was not favorable. There is a lack of uniformity in the literature on this subject with a preponderance of lower level evidence. Although randomized controlled trials are considered to be the gold standard in medical research, a multicenter prospective cohort design may be more appropriate in assessing the long-term outcome of meniscal surgery and the role that multiple preoperative and intraoperative variables may play in clinical outcomes. In addition, future studies should include factors not assessed or adequately evaluated by several of the included studies, such as meniscal tear pattern, age, mechanical alignment, sex of the patient, activity level, meniscal tears associated with other injuries such as the ACL, smoking, and the effect of previous surgery.

The Orthopaedic In-Training Examination (OITE), produced by the American Academy of Orthopaedic Surgeons, was first administered in 1963. It was the first surgical subspecialty examination of its kind to be administered to resident trainees. The inaugural OITE consisted of 150 questions derived from the American Board of Orthopaedic Surgery (ABOS) examination1. The number of questions on the OITE and the number of examinees taking the test have increased substantially during subsequent test administrations. The most recent examination (2008) consisted of 275 questions that were administered to 4137 examinees. The current test is divided into twelve domains: sports medicine, foot and ankle, hand, hip and reconstruction, medically related issues, orthopaedic diseases, basic science and tumors, pediatric orthopaedics, rehabilitation, shoulder and elbow, spine, and musculoskeletal trauma. After the OITE examination, the score reports are returned to individual examinees, along with a list of preferred responses for each question and associated literature or textbook references. As a result, the OITE serves as an important educational tool identifying areas of weakness and future study for individual examinees. Recently, Frassica et al.2 and Marker et al.3 published analyses of the OITE pathology and hand sections. The information derived from these studies enables trainees to study more comprehensively, facilitating the development of a core orthopaedic knowledge base. Additionally, faculty may use this information to direct journal club topics and didactic lectures and to improve their educational curriculum. To our knowledge, no analysis of the sports medicine questions on the OITE has been published. The purpose of this study was to systematically examine the OITE sports medicine questions, along with the associated answers and recommended reading lists, during a five-year period. This analysis produced a list of commonly tested topics and provides an educational resource that residents and attending surgeons may use to …

Background Although entrapment of the suprascapular nerve (SSN) is an infrequent presentation of shoulder pain, proper diagnosis and treatment are critical to prevent chronic supraspinatus and infraspinatus atrophy. Materials and methods We present a technique that allows SSN decompression at the spinoglenoid notch or suprascapular notch through the subacromial space. Results and conclusions This method allows for facile decompression of the SSN after repair of concomitant shoulder pathology and allows direct visualization of the medial neck of the glenoid to avoid complications of iatrogenic SSN nerve injury from aggressive medial capsule dissection. The purpose of this article is to provide surgeons with a safe, reliable method to decompress the SSN at the suprascapular or spinoglenoid notch

Pediatric intrasubstance posterior cruciate ligament (PCL) injuries are rare but present a significant treatment challenge. Untreated instability may lead to further knee injury, including meniscal or chondral damage. Surgical intervention risks damage to the physis, growth arrest, and angular deformity. We present the case of a skeletally immature 11-year-old boy with a high-grade intrasubstance PCL injury reconstructed using an all-arthroscopic tibial inlay technique modified to minimize risk of physeal injury. The femoral tunnels were placed entirely within the epiphysis, and the tibial physis was minimally crossed with a small drill hole and suture material. At 17 months' follow up, the patient had returned to full activity, including sports. He had a grade 1 posterior drawer and no posterior sag. Radiographs showed no degenerative changes. Both the proximal tibial and distal femoral physes were widely patent with no angular deformity. The patient had a 1-cm leg length discrepancy, with the operative limb being longer. This technical note with a case report describes a novel physeal-sparing reconstruction of the PCL in a pediatric patient with open physes.

We read with great interest the article by Martinez et al. entitled, “Chondrolysis After Hip Arthroscopy.” 1 The authors report the development of chondrolysis in the left hip of a 58-year-old woman 2 months postoperative after hip arthroscopy with labral repair, acetabular microfracture, and CAM femoroplasty. The patient ultimately underwent left hip resurfacing arthroplasty secondary to persistent pain. The authors succinctly reviewed the literature for potential etiologies that may lead to this rare complication. Specifically, use of electrocautery, infusion of intra-articular anesthetic, iatrogenic injury to the femoral head cartilage, infection, traction force and duration, elevated pump pressure, and vascular injury were outlined. We would like to submit another etiology to the differential diagnosis of chondrolysis after hip arthroscopy in this patient. The patient was 58 years old with a history of resurfacing arthroplasty in the contralateral hip presumably for advanced arthritis. On the basis of the increased age of the patient, history of right hip arthritis, and presence of full-thickness acetabular chondral loss of the left hip at the time of arthroscopy, rapid progression of underlying degenerative joint disease is certainly plausible. 2 The progression of articular cartilage disease in this patient population can be seen to progress rapidly even in the absence of surgical intervention. It is often the case that in a select group of patients there is underlying pathology of the articular cartilage that is a harbinger of rapid progression to endstage arthrosis. 3 This would seem to be a potential etiology in this patient on the basis of the surgical findings and patient demographics. On the basis of this knowledge and our experience in over 800 hip arthroscopy procedures, we have employed caution to recommend hip arthroscopy in this patient population. When hip arthroscopy is indicated, we discuss rapid and/or gradual progression of degenerative joint disease and potential need for arthroplasty in the future as an informed risk of the procedure. The authors of this paper are commended for reporting and discussing this rare but important complication of hip arthroscopy.

UNLABELLED bTwo-staged exchange with delayed reimplantation of a new prosthesis is considered by many to be the preferred method of treatment for deep periprosthetic infection after total hip arthroplasty. Until recently, most authors of previously published reports of this two-staged exchange procedure have used cemented implants fixed with antibiotic-containing bone cement. In view of the superior results of revision total hip arthroplasties with cementless implants, we reviewed the results of 33 two-staged revision total hip arthroplasties done for deep infection using cementless femoral components. There were no recurrent infections in the 28 patients in this study who had a 2-year minimum followup. Two patients developed a new infection with a different organism after reimplantation of their hip. Three patients with considerable acetabular bone deficiency had acetabular component revision for aseptic loosening; however, there were no cases of femoral component loosening. The overall infection rate of 7% using this approach was comparable to previous reports of two-staged revision total hip arthroplasties done with cemented components fixed with antibiotic-containing bone cement. In addition, cementless femoral component fixation seemed to be more reliable and durable in comparison to previous reports of revision total hip arthroplasty with cemented stems. The results of this study support the continued use of cementless implant fixation for two-staged reconstruction of the infected total hip arthroplasty. LEVEL OF EVIDENCE Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Introduction This study reports the outcomes of patients undergoing total shoulder arthroplasty following failed management of degenerative joint disease with biological resurfacing of the glenoid. The purpose of this study is to report the results of patients who underwent biological resurfacing and were later converted to total shoulder arthroplasty (TSA). Methods Seven patients (mean age 37.4 ± 10.3 years) treated with biologic resurfacing of the glenoid using lateral meniscal allograft (5 patients) or human acellular dermal tissue matrix (2 patients) failed the procedure and were converted to TSA after an average of 2.0 ± 1.4 years. All patients were available for follow up at an average of 3.3 ± 1.8 years. Results Only limited improvement was observed post-conversion. Forward flexion and external rotation improved from 103.3° ± 34.4° and 28.3° ± 12.9° to 109.4° ± 52.9° and 41.0° ± 14.8°, respectively. The mean ASES, SST, and VAS scores for this group were 29.5 ± 12.1, 1.0 ± 1.4, and 6.25 ± 1.7 preoperatively and 38.3 ± 18.6, 3.7 ± 3.5, and 5.3 ± 1.9 postoperatively, respectively. The threshold of failure was set at an ASES score of Conclusion Biological interposition arthroplasty is designed to postpone the need for prosthetic glenoid components and thus delay the risks associated with polyethylene glenoid implants such as component wear, fragmentation, and glenoid loosening or disassociation. The poor clinical outcomes seen in patients who are converted to a TSA after failure of biological resurfacing suggests that TSA may be the preferred primary procedure in young patients with severe glenohumeral arthritis.

Objectives: The objective of this study was to determine the minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS) in a population of patients with femoroacetabular impingement treated with arthroscopic surgery of the hip. Methods: We conducted a prospective cohort study at a single centre in a consecutive series of patients with femoroacetabular impingement who were treated with arthroscopic labral repair/re-fixation and femoral osteoplasty. The mHHS and HOS were administered at baseline and at 3, 6, and 12 months post-operatively. Using external anchor questions at the aforementioned post-operative time points, the approach outlined by Juniper et al. was used to determine the MCID, whereas the specific anchor question designed by Tubach was used to determine the PASS. A receiver-operator curve was constructed and used to determine the cuff off point which optimally defined the MCID based on sensitivity and specificity values for each observed change score. The PASS was defined as the 75th percentile of the final mHHS score or HOS subscale scores for patients who considered their state satisfactory. We also stratified the analysis according whether baseline scores influenced the likelihood of achieving the MCID and PASS and odds ratios (OR) were also calculated. Results: There were 130 patients with a mean age of 35.6 (sd 11.7) years and 42.3% were male. The MCID for the mHHS at 3, 6, and 12 months was 13.0, 9.0, and 20.0, respectively. For the HOS (ADL), the MCID was 14.7, 15.0, and 23.0 at 3, 6, and 12 months. For the HOS (Sports), MCID values at 3, 6, and 12 months were 25, 28, and 47. In regards to the PASS, the observed values at 1 year following surgery were as follows: mHHS 84, HOS (ADL) 98, HOS (Sport) 94. The high values observed for the PASS across the different subscales suggests a high proportion of ceiling effects with the mHHS and HOS in this population. The MCID was significantly greater at 1 year for patients with an initial ‘low’ baseline score compared to patients with a ‘high’ baseline score. The PASS was not affected by baseline scores across different instruments. Patients with lower baseline scores were less likely to achieve the MCID one year following surgical intervention [mHHS - OR 0.28; HOS (ADL) - OR 0.23; HOS (Sports) - OR 0.06] yet more likely to achieve the PASS [mHHS - OR 3.36; HOS (ADL) - OR 3.83; HOS (Sports) - OR 3.38). There was a significant negative correlation between increasing age and the ability to obtain a mHHS or HOS above the PASS threshold (pConclusion: This is the first study in the literature to determine the MCID and PASS for two commonly used hip-joint specific patient-reported outcome measures in patients undergoing arthroscopic hip surgery for FAI. Our findings will allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for power calculations in future randomized trials related to hip arthroscopy and the treatment of FAI.