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The acetabular labrum is essential for stability during physiologic motion of the hip. Labral repairs frequently are attempted in cases of primary tears, although labral reconstruction is an important alternative in the revision setting or in the primary setting when the tissue is unsalvageable. Labral reconstruction has been shown to restore the hip’s suction-seal and fluid pressurization to that of the premorbid state, and cohort studies have demonstrated significantly improved patient-reported outcomes at midterm follow-up. Notably, the cost is of consideration during any reconstruction, and techniques have been described using both allograft and autograft sources. Autograft sources include the iliotibial band, ligamentum teres, gracilis tendon, and hip capsule. A previously described technique using the capsule was noted to hinder routine capsular closure. We present an alternative method for labral reconstruction using hip capsular tissue that is easily performed and allows for routine capsular closure., Technique Video Video 1 The patient is positioned supine in a lower-extremity traction table to undergo a right hip arthroscopy. An assessment of the central compartment and labral tissue is performed where it is determined that a labral reconstruction is indicated. Given the laxity of the capsular tissue, a capsular autograft is harvested longitudinally from the interportal capsulotomy for labral reconstruction. A traction stitch is placed in the capsulotomy to perform a complete femoral osteochondroplasty. A dynamic examination using fluoroscopy confirms complete resection of cam-type impingement. Labral reconstruction using capsular autograft is then performed along the areas of labral deficiency.

The purpose of this in vitro study was to quantify the bone resected from the proximal femur during hip arthroscopy using metrics generated from magnetic resonance imaging (MRI) and computed tomography (CT) reconstructed three-dimensional (3D) bone models. Seven cadaveric hemi-pelvises underwent both a 1.5 T MRI and CT scan before and following an arthroscopic proximal femoral osteochondroplasty. The images from MRI and CT were segmented to generate 3D proximal femoral surface models. A validated 3D--3D registration method was used to compare surface--to--surface distances between the 3D models before and following surgery. The new metrics of maximum height, mean height, surface area and volume, were computed to quantify bone resected during osteochondroplasty. Stability of the metrics across imaging modalities was established through paired sample t--tests and bivariate correlation. Bivariate correlation analyses indicated strong correlations between all metrics (r = 0.728--0.878) computed from MRI and CT derived models. There were no differences in the MRI- and CT-based metrics used to quantify bone resected during femoral osteochondroplasty. Preoperative- and postoperative MRI and CT derived 3D bone models can be used to quantify bone resected during femoral osteochondroplasty, without significant differences between the imaging modalities.

The hip capsule and acetabular labrum are critical structures that function to protect and stabilize the hip joint. As the use of hip arthroscopy increases, there is increasing interest in the integrity of the hip capsule and labrum in optimizing postoperative function and outcomes. In this report, we describe the surgical technique for capsular reconstruction with dermal allograft and labral augmentation with tibialis anterior allograft for the treatment of gross instability after hip arthroscopy. This technique may be applied in situations with large capsular defects and deficient labral tissue., Technique Video Video 1 Intraoperative assessment of the central compartment revealed labral insufficiency with residual femoroacetabular impingement syndrome pathology. Viewing from the MMAP, the first suture anchor is placed at the 10-o’clock position via the AL portal. The suture from the suture anchor is used to measure the length of labral insufficiency, which was 4.2 cm. The remaining 3 suture anchors are placed up to the 4-o’clock position through the DALA portal. Two double-loaded suture anchors are placed adjacent to the head of the rectus femoris tendon along the acetabulum for capsular reconstruction. The labral allograft is passed through the DALA portal using the Kite technique and knotted down anteromedially to posterolaterally. Upon plication of the vertical limb of the capsulotomy, a 2.0 × 2.5-cm defect remained. Sutures from the double-loaded anchors are passed through the distal lateral and distal medial T-capsulotomy leaflets in a mattress fashion and knotted. One suture from the proximal anchor and one suture from the distal anchor is retrieved through the DALA portal and passed through the proximal and distal corners of the capsular allograft, respectively. The graft is then shuttled through the DALA portal using the Kite technique and each corner is knotted down in a simple fashion. A dynamic examination is then performed to evaluate graft placement. (AL, anterolateral; DALA, distal anterior lateral accessory; MMAP, modified mid-anterior portal.)

Background: Femoroacetabular impingement syndrome (FAIS) is an increasingly common diagnosis among working-age adults. Hip arthroscopy provides reliable improvements in pain and may allow patients to return to physical activities. No study to date has evaluated return to work (RTW) among a general population of adults after arthroscopic surgery for FAIS. Purpose: To evaluate (1) patients’ rate of RTW, (2) time required to RTW, and (3) factors correlated with time required to RTW after arthroscopic surgery for symptomatic FAIS. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients aged 25 to 59 years who underwent arthroscopic surgery for FAIS between June 2018 and December 2018 were reviewed. Workers’ compensation cases and patients with Results: A total of 97 patients were selected through inclusion and exclusion criteria. RTW surveys were collected for 79 (81.4%), and 61 were employed preoperatively. Time worked per week was 42.8 ± 12.5 hours (mean ± SD). Patients’ work level was most commonly classified as sedentary (42.6%), followed by moderate (24.6%). All 61 (100%) patients returned to work at a mean 7.3 weeks (range, Conclusion: Patients undergoing arthroscopic treatment for FAIS demonstrated a high rate of RTW at a mean of

To compare patient functional scores and rates of achieving minimum clinically important differences (MCID) and patient acceptable symptomatic state (PASS) between patients with a hypotrophic labrum with those with a normal labrum width at a minimum 1-year follow-up from arthroscopic treatment of femoroacetabular impingement syndrome.Data from consecutive patients who underwent primary hip arthroscopy between November 2015 and July 2018 for the treatment of femoroacetabular impingement syndrome were analyzed. Baseline demographic data, preoperative patient-reported outcome measures (PROMs), and minimum 1-year PROMs, including Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score, international Hip Outcome Tool 12 questions, and visual analog scale for pain and satisfaction were recorded. The labrum size was determined using an arthroscopic probe at the 12- to 2-o'clock position with a hypotrophic labrum being defined as4 mm and normal labrum defined as having a width between 4 and 7 mm on the articular side. Patients with hypotrophic labrum were matched 1:1 by age and body mass index to patients with normal labrum width.A total of 346 patients were included in the study with an average age of 31.4 ± 11.9 and a majority being female (72.0%). There were 173 in each of the normal and hypotrophic groups. There were no significant differences seen in 1-year PROMs between the 2 groups (P.05 for all). The normal labrum group achieved MCID at a rate of 75% to 84% and PASS at a rate of 51% to 70%. The hypotrophic labrum group achieved MCID at a rate of 70% to 85% and PASS at a rate of 57% to 71%. There were no significant differences in rates between each group (P.05 for all).Patients with an intraoperative finding of labral hypotrophy achieve 1-year meaningful clinical outcome at the same rate as those with normal labral width following arthroscopic labral repair.III, Case-control study.

Osteoid osteomas are benign bone lesions that commonly occur in the lower extremities and spine, with the radiographic evidence of a central nidus surrounded by circumferential reactive bone. Although nonsteroidal anti-inflammatory drugs can provide symptomatic relief and are used as an important diagnostic tool, surgical intervention is the definitive treatment. Arthroscopic-assisted radiofrequency ablation has been shown to be an effective technique to directly visualize and treat the lesion while minimizing damage to the articular cartilage.

Background: Femoral torsion imaging measurements and classifications are heterogeneous throughout the literature, and the influence of femoral torsion on clinically meaningful outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well studied. Purpose: To (1) perform a computed tomography (CT)–based analysis to quantify femoral torsion in patients with FAIS and (2) explore the relationship between the orientation and magnitude of femoral torsion and the propensity for clinically meaningful outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients who underwent hip arthroscopy for FAIS between January 2012 and April 2018 were identified. Inclusion criteria were the presence of preoperative CT imaging with transcondylar slices of the knee and minimum 2-year outcome measures. Exclusion criteria were revision hip arthroscopy, Tönnis grade >1, congenital hip condition, hip dysplasia (lateral center-edge angle 25°). Treatment did not differ based on femoral torsion. Patient characteristics and clinical outcomes were analyzed, including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. Achievement of the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) by torsion stratification was analyzed using the chi-square test. Inter- and intrarater reliabilities for CT measurements were 0.980 ( P < .001) and 0.974 ( P < .001), respectively. Results: The study included 573 patients with a mean ± SD age and body mass index of 32.6 ± 11.8 years and 25.6 ± 10.6, respectively. The mean ± SD femoral torsion for the study population was 12.3°± 9.3°. After stratification, the number of patients within each group and the mean ± SD torsion for each group were as follows: SR (n = 36; –6.5°± 7.1°), MR (n = 80; 2.8°± 1.4°), N (n = 346; 12.3°± 4.1°), MA (n = 64; 22.2°± 1.4°), and SA (n = 47; 30.3°± 3.7°). No significant differences in age, body mass index, sex, tobacco use, workers’ compensation status, or participation in physical activity were observed at baseline. No significant differences were seen in pre- and postoperative VAS pain, mHHS, HOS-ADL, HOS-SS, iHOT-12, or postoperative VAS satisfaction among the cohorts. Furthermore, no statistically significant differences were found in the proportion of patients who achieved the MCID or the PASS for any outcome among the groups. Conclusion: The orientation and severity of femoral torsion at the time of hip arthroscopy for FAIS did not influence the propensity for clinically significant outcome improvement.

Background: Although minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) have been defined for hip-specific legacy patient-reported outcome measures, these metrics have not been defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments for patients undergoing hip arthroscopy. Purpose: To define the MCID, PASS, and SCB thresholds for the PROMIS Physical Function (PF) computerized adaptive test (CAT) and PROMIS Pain Interference (PI) instruments in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Patients undergoing primary hip arthroscopy between August 2018 and January 2019 for the treatment of FAIS were retrospectively analyzed. Patients were administered the PROMIS-PF, PROMIS-PI, Hip Outcome Score (HOS)–Activities of Daily Living, HOS–Sports Subscale, modified Harris Hip Score, and International Hip Outcome Tool–12 preoperatively and at 1 year postoperatively. MCID was calculated using the distribution method, whereas PASS and SCB were calculated using an anchor-based method. Patients achieving clinically significant outcomes (CSOs) were compared with those who did not achieve CSOs via chi-square and independent-samples t tests, and a multivariate logistic regression was conducted to determine predictors of CSO achievement. Results: 124 patients with a mean age of 32.7 ± 12.3 years were included in the analysis. The threshold scores required to achieve MCID, PASS, and SCB, respectively, were as follows: PROMIS-PI (–3.1, 53.7, 51.9) and PROMIS-PF (3.3, 47.0, 49.9). Patients achieved any MCID, PASS, and SCB for PROMIS scores at a rate of 89.0%, 71.8%, and 62.1%, respectively, compared with 87.1%, 76.6%, and 71.8% for legacy patient-reported outcome measurements. For PROMIS-PF, higher preoperative PROMIS-PF score was a positive predictor of CSO achievement, and patients achieving SCB were significantly younger (30.3 ± 12 vs 35.6 ± 12 years; P = .017) with significantly lower body mass index (BMI) (24.7 ± 6.4 vs 27.9 ± 7; P = .009). Preoperative chronic pain and history of orthopaedic surgery were negative predictors of PROMIS-PI CSO achievement, whereas higher (worse) preoperative PROMIS-PI scores were a positive predictor. Conclusion: Our study defined the MCID, PASS, and SCB for the PROMIS-PF CAT and PROMIS-PI CAT at 1 year postoperatively. Patients with higher preoperative PROMIS scores, younger age, and lower BMI were more likely to achieve CSO, whereas preoperative chronic pain and history of orthopaedic surgery were negative predictors of CSO achievement.

Objectives: To determine predictors of clinically significant outcome achievement at a minimum of 5-year follow-up in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement syndrome with routine capsular closure. Methods: Data were collected and analyzed from consecutive patients who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS from a single fellowship-trained surgeon between January 2012 and December 2018. Baseline data, preoperative patient reported outcome measures (PROMs) and 5- year PROMs including Hip Outcome Score-Activities of Daily Living, HOS-Sports Subscale, international Hip Outcome Tool 12 questions, modified Harris Hip Score and visual analog scale pain were recorded. The minimal clinically important difference (MCID) was calculated using the distribution method while patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) were determined from literature defined values. Bivariate correlations with any MCID achievement, any PASS achievement, and any SCB achievement as well as a principle components analysis for variable reduction were used to create three separate multivariate binary logistic regressions to identify significant predictors of achieving a clinically significant outcome. Results: 453 patients with an average age of 34.3 ± 12.5 and average BMI of 25.5 ± 4.9 and majority female (69.1%) were included in the final analysis. There was a significant improvement in all 5-year functional outcomes when compared to preoperative scores (pConclusions: At a minimum of 5-year follow-up, 82.8% of patients undergoing primary hip arthroscopy for the treatment of FAIS achieved any MCID, 69.8% achieved any PASS, 58.9% achieved any SCB. Female sex, higher preoperative PROs, and participation in running were positive predictors of achieving a clinically significant outcome while a higher Tönnis angle, Tönnis grade = 1, preoperative chronic pain, and back pain were negative predictors of achieving a clinically significant outcome.

Objectives: While minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) have been defined for hip-specific legacy patient reported outcome measures, they have not been defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) instruments for patients undergoing hip arthroscopy. The purpose of the study was to define the MCID, PASS, and SCB thresholds for the PROMIS Physical Function (PF) computerized adaptive test (CAT) and PROMIS Pain Interference (PI) instruments in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary hip arthroscopy between August 2018 and January 2019 for the treatment of FAIS were retrospectively analyzed. Patients received PROMIS-PF, PROMIS-PI, Hip Outcome Score Activities of Daily Living, Hip Outcome Score Sport Subscale, modified Harris Hip Score, and international Hip Outcome Tool-12 preoperatively and at 1 year postoperatively. MCID was calculated using the distribution method, while PASS and SCB were calculated using an anchor-based method. Patients achieving clinically significant outcomes (CSOs) were compared to those who failed to achieve via chi-square and independent sample t-tests, and a multivariate logistic regression was conducted to determine predictors of CSO achievement. Results: 124 patients with an average age of 32.7±12.3 were included in the analysis. The threshold scores required to achieve MCID, PASS, and SCB, respectively, were as follows: PROMIS-PI (-3.1, 53.7, 51.9) and PROMIS-PF (3.3, 47.0, 49.9). Patients achieved any MCID, PASS, and SCB for PROMIS scores at a rate of 89.0%, 71.8%, and 62.1%, respectively compared to 87.1%, 76.6%, and 71.8% for legacy PROMs. For PROMIS-PF, higher preoperative PROMIS-PF score was a positive predictor of CSO achievement, and patients achieving SCB were significantly younger (30.3±12 vs 35.6±12, p=0.017) with significantly lower BMIs (24.7±6.4 vs. 27.9±7, p=0.009). Preoperative chronic pain and past history of orthopaedic surgery were negative predictors of PROMIS-PI CSO achievement while higher (worse) preoperative PROMIS-PI scores were a positive predictor. Conclusions: Our study defined the MCID, PASS, and SCB for the PROMIS PF and PI CAT at 1-year postoperatively. CSO is achieved via PROMIS at a rate comparable, but slightly less than legacy hip PROMs. In addition, patients with higher preoperative PROMIS scores, younger age, and lower BMIs were more likely to achieve a CSO while preoperative chronic pain and past history of orthopaedic surgery were negative predictors of CSO achievement.

Purpose The purpose of this study was to compare outcomes after hip arthroscopy for FAIS in patients with borderline hip dysplasia and hip instability defined radiographically using the femoroepiphyseal acetabular roof (FEAR) index, and patients without radiographic evidence of hip instability. Methods Data from consecutive patients with borderline hip dysplasia (lateral center edge angle, LCEA, 18˚-25˚) who underwent primary hip arthroscopy between April 2012 and June 2017 for the treatment of femoroacetabular impingement syndrome (FAIS) were analyzed. Baseline demographic data, radiographic parameters, preoperative, and two-year postoperative patient reported outcome measures (PROM) were collected. FEAR index was measured by three different observers. Patients with an average FEAR index ≥2˚ were categorized as having radiographic evidence of instability as previously published. The analysis was powered to detect a minimal clinical important difference (MCID) for each outcome score. Statistical analysis was performed as appropriate to compare patients with FEAR index ≥2 and Results A total of 140 patients met the inclusion criteria. The average age and body mass index of included patients was 31.7±13.2 (p 0.05 for all). Conclusion Patients with borderline hip dysplasia and radiographic-evidence of hip instability, as measured by the FEAR index (≥2°), achieve similar improvement in 2-year outcomes compared to those with radiographically stable hips following arthroscopic treatment of FAIS.

To determine the agreeability of femoral torsion measurements on axial and oblique axial magnetic resonance imaging (MRI) sequences in patients with femoroacetabular impingement syndrome (FAIS).Patients who underwent primary hip arthroscopy for FAIS between January 2012 to January 2019 were identified. Inclusion criteria were all patients with an MRI scan containing the pelvis and knee imaging. MRI-based measurements of femoral torsion were performed on axial and oblique-axial slices by 2 raters, and inter-rater and intrarater reliability was assessed. Bland Altman plots were constructed to evaluate the agreeability between femoral torsion measurements performed using axial and oblique-axial slices. Bivariate correlation analyses were performed to assess the relationship between measurement methods on each respective scan. A linear regression was performed between measurements performed using axial and oblique-axial sequences.A total of 164 patients were included. The mean true-axial and oblique axial femoral torsion were 12.2° ± 9.9° and 11.1° ± 9.2°, respectively. The intrarater reliability for axial and oblique-axial measurements were 0.993 and 0.997, respectively. The inter-rater reliability for axial and oblique-axial measurements were 0.925 and 0.965, respectively. The number of differences within the limits of agreement for axial and oblique-axial femoral torsion measurements was 58.54%. On Pearson correlation analysis, strong positive correlations were found between oblique-axial measurements at multiple time points (r = 0.994, P .001), as well as axial measurements at multiple time points (r = 0.986, P.001). A strong positive correlation was found between axial and oblique-axial measurements (r = 0.894, P.001). A significant regression equation indicated that for each additional increase in axial femoral torsion, the oblique-axial femoral torsion increased 0.837 (95% confidence interval 0.772-0.901).Femoral torsion values measured on oblique-axial sequences are smaller than on true-axial sequences. Femoral torsion measurements on axial and oblique-axial MRI sequences exhibit poor agreement. Oblique-axial sequences demonstrated greater measurement consistency at multiple timepoints. When evaluating torsional measurements, it is important to delineate which axial sequence was used, especially in patients with suspected severe femoral antetorsion. Standardization of MRI femoral version protocols within one's practice can ensure more consistent decision-making, especially in patients with suspected femoral antetorsion.Retrospective cohort, level III.

Background: From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating diverse spinal disorders. There is still much work to be done in circumnavigating the technical challenges and elucidating relative advantages of endoscopic techniques in spine surgery. In this comprehensive literature review, we discuss the history, advantages, disadvantages, approaches, and technology of, and critically examine peer-reviewed studies specifically addressing, endoscopic thoracic spinal surgery. Methods: Literature review was conducted with the key words “endoscopic,” “minimally invasive,” and “thoracic spinal surgery,” using PubMed, Web of Science, and Google Scholar. Results: Review of 241 thorascopic procedures showed a success rate of 98% to 100%, low morbidity, and favorable complication profile. Review of 115 thoracic fixation procedures demonstrated high success rate, and 87% of screw positions were rated “good.” Review of 55 full endoscopic uniportal decompressions showed sufficient decompression in most patients. Match pair analysis of 34 patients comparing video-assisted thoracoscopy surgery (VATS) or posterior spinal fusion reported the VATS group had increased operative duration but reduced blood loss. Conclusions: Based on our literature review, there is a high rate of positive outcomes with endoscopic thoracic spine surgery, which reduces tissue dissection, intraoperative blood loss, and epidural fibrosis. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field. Level of Evidence: 3. Clinical Relevance: There is growing evidence demonstrating the success of endoscopic thoracic spinal surgery. Populations that could be helped include the elderly and immunocompromised, who would benefit from decreased hospital stay and enhanced recovery time.

Objectives: A preoperative or intraoperative finding of an acetabular labrum width of Methods: Data from consecutive patients who underwent primary hip arthroscopy between November 2015 and July 2018 for the treatment of FAIS were analyzed. Baseline demographic data, preoperative, and minimum 1 year post-operative clinical outcomes including Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool 12 questions (iHOT-12), and visual analog scale (VAS) for pain and satisfaction were recorded. The labrum size was documented by the senior surgeon for all patients using the tip of an arthroscopic probe measuring 4mm. Labrum hypoplasia was defined as a labrum width at the 12 o’clock position of Results: A total of 360 patients were included in the study with 180 in each of the normal and hypoplastic groups. There was no significant differences seen in 1-year post operative outcome scores or score improvement between the two groups. When examining only borderline dysplastic patients there were no significant differences in outcomes between normal and hypoplastic labrum patients. In the subset with a normal LCEA only post-operative VAS satisfaction (85.5 ± 19.3 vs 78.2 ± 27.4; p=0.050) was significantly higher in the normal labrum patients compared to hypoplastic labrum. Patients with hypoplastic labrum achieved MCID and PASS at the same rate as patients with normal labrum across all outcome measures. Conclusions: Patients with an intraoperative finding of labral hypoplasia achieve 1-year meaningful clinical outcome at the same rate as those with normal labral width following arthroscopic labral repair. These results bring into question the need for primary labral reconstruction in patients with labral hypoplasia with a normal or borderline dysplastic acetabulum.

Cervical laminectomy is a surgical technique that is used to decompress the spinal cord. The standard equipment for making bony cuts includes a high-speed drill (HSD) or osteotome; the ultrasonic BoneScalpel® (UBS) by Misonix (Farmingdale, NY) may be used for this purpose either alone or in combination with other instruments.We describe the operative technique and principles behind the use of the Misonix BoneScalpel (MBS) for subaxial cervical laminectomy.The features, functions and mechanism of the MBS are described. Use of a UBS for en bloc subaxial cervical laminectomy is outlined, including a description of the technique, the avoidance of complications, and perioperative considerations.Use of the MBS in cervical decompression is a safe and effective alternative to HSD when considering tissue selectivity, thermal control, and coagulative effects.While the initial upfront cost of the MBS is greater than that of similar equipment, the potential long-term savings in time and resources can yield a cost-effective return. The MBS should be progressively incorporated into the surgical protocol as dictated by the surgeon's comfort level.

Subchondral acetabular edema and cysts, as a consequence of degenerative changes of the hip, are associated with disability, pain, and worsened function in this joint. The arthroscopic treatment of intra-articular pathologies, such as femoroacetabular impingement syndrome and labral tears, when associated with those alterations, has been suggested to provide inferior outcomes to those in patients without subchondral changes. Yet, the direct treatment of subchondral pathology has been limited. Recently, a technique for insufflating bone substitute into the bone marrow lesions of the knee, Subchondroplasty (Zimmer Knee Creations, Exton, PA), has led to promising results. Subchondroplasty has raised attention as a possible minimally invasive procedure to treat cystic changes in the acetabulum in patients who are not yet candidates for hip replacement. We present the technique of acetabular Subchondroplasty, in which a bone substitute material is injected into subchondral acetabular cysts under fluoroscopic guidance. In this technique, hip arthroscopy is used in conjunction with fluoroscopic guidance to address intra-articular pathologies and assess for possible intra-articular extravasation of the injectable material.

Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied. Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; 25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts. Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m2, and 12.55° ± 9.58°, respectively. The mean torsion was –4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO ( P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group ( P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group ( P = .003). Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively.

Often referred to as a "sports hernia" or "core muscle injury," athletic pubalgia is a common yet poorly defined athletic injury. It is characterized by abdominal and groin pain likely from weakening or tearing of the abdominal wall without evidence of a true hernia. Symptoms can appear acutely or insidiously, primarily as groin and lower abdominal pain that can radiate toward the perineum and proximal adductors. Pain is exacerbated by athletic activity such as kicking, cutting, and sprinting. The pubis acts as a pivot point between the abdominal musculature and lower-extremity adductors, and therefore, pain with palpation over the symphysis or its surrounding structures is typical in athletic pubalgia. Symptoms can be reproduced during a resisted sit-up or with a forced cough or sneeze. Clinical examination should include an evaluation of articular hip pathology to identify underlying femoroacetabular impingement syndrome. Magnetic resonance imaging can aid in ruling out other pathologies and identify specific findings including tears or strains of the ipsilateral rectus abdominis or adductor tendons. Lidocaine injections can be used to localize the source of the pain. First-line treatment consists of a period of rest and anti-inflammatories, followed by a course of focused physical therapy. If conservative therapy fails to allow an athlete to return to activity, a variety of open or laparoscopic surgical techniques can be used. The surgical principles include reattachment of the rectus abdominis and repair or reinforcement of the abdominal musculature in layers to re-create the inguinal ligament anatomy. At times, variations of pelvic floor repair are performed or the addition of an adductor tenotomy or repair is used concomitantly. Numerous studies report a high rate of return to play after surgical management. Diagnosis and appropriate treatment of coexisting femoroacetabular impingement syndrome are crucial to a successful return to athletic activity.

Background: Proximal hamstring injuries are increasingly common. While open repair with suture anchors placed in the ischial tuberosity has long been the gold standard technique for surgical management, endoscopic techniques can allow for smaller incisions, reduced wound complications, and an expedited recovery. Indications: Patients with full-thickness 3-tendon proximal hamstring tears, 2-tendon tears with retraction >2 cm, or partial tears that remain symptomatic despite conservative management are considered for surgery. High-demand patients are often treated acutely, and low-demand patients may be offered surgery after a conservative management period. Technique Description: In the prone position, 2 arthroscopic portals are created in the gluteal fold. Fluoroscopy is used to verify safe portal placement, and the sciatic nerve is visualized along with the retracted tendon origin. The ischial tuberosity is identified, and the hamstring origin is debrided and decorticated. An accessory portal is created for suture anchor placement. Two double-loaded anchors are placed in the tuberosity, the sutures of which are used to repair the hamstring tendons using a horizontal mattress configuration. Patients undergo a stepwise postoperative physical therapy protocol. Results: An 85% return to sport rate can be expected following all hamstring repairs, with some studies reporting as high as 95% after endoscopic repair. Compared with nonoperative treatment, proximal hamstring repair overall results in higher patient satisfaction and return to sport. While large studies have yet to report on outcomes compared with the traditional open technique, the smaller incisions look to reduce wound complications and postoperative pain. Discussion/Conclusion: Recent advancements in endoscopic techniques have allowed for adequate visualization and robust repair of proximal hamstring avulsions. We present our endoscopic technique of the proximal hamstring, which, compared with the traditional open repair, can decrease perioperative complications and accelerate recovery.