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Purpose To compare postoperative pain and recovery after anterior cruciate ligament reconstruction (ACLR) in patients who received an adductor canal block (ACB) or periarticular local infiltrative anesthesia (LIA). Methods A retrospective review of a prospectively collected ACL registry was performed. Patients underwent ACLR at a single institution between January 2015 and September 2020 and received long-acting local anesthesia with a pre-operative ultrasound-guided ACB or peri-articular LIA after surgery. Visual Analog Scale (VAS) pain scores, milligram morphine equivalents (MME) consumed in the post-anesthesia care unit (PACU), and total hospital recovery time were compared. Univariate analysis was used to compare VAS pain and MME totals between overall groups and groups propensity score matched for age, sex, BMI, graft type, and meniscal treatment. Results are presented as mean(95%CI) unless otherwise indicated. Results There were 265 knees (253 patients) included (LIA, 157 knees; ACB, 108 knees). Overall, VAS pain scores before hospital discharge (LIA 2.6 (2.4-2.8) vs. ACB 2.4 (2.1-2.7), p=0.334) and total MMEs were similar (LIA 17.6 (16.4-18.8) vs. ACB 18.5 (17.2-19.8) (MME), p=0.134). Median time to discharge also did not significantly differ (LIA 137.5 (IQR:116-178) vs. ACB 147 (IQR:123-183) (min), p=0.118). Matched sub-analysis (LIA and ACB, n=94) did not reveal significant differences in VAS pain before discharge (LIA 2.4 (2.1-2.7) vs ACB: 2.7 (2.4-3.0), p=0.134) or total MMEs (LIA 18.6 (17.2-20.0) vs. ACB 17.9 (16.4-19.4), p=0.520). Conclusion The use of ACB or LIA resulted in similar early pain levels, opioid consumption, and hospital recovery times after ACLR surgery.

To evaluate the relationship between femoral version (FV) and α angle (AA) in a large osteological collection of human femurs.The University of Iowa-Stanford osteological collection was used to evaluate the research aims. To measure FV and AA, axial photographs of the proximal femurs were taken, referenced from the posterior condylar axis. FV and AA measurements were obtained using ImageJ software, and the relationship between FV and AA was assessed with repeated-measures analysis of variance and generalized linear models. A P value of.05 was considered statistically significant.A total of 1321 cadaveric femurs (666 left and 655 right) in 721 cadavers were examined. The average AA for all femurs was 47.8° ± 10.9°, and the average FV for all femurs was 8.53° ± 8.09°. Overall, 191 femurs (14.5%) exhibited cam morphology (AA ≥ 60°). Of the 721 cadavers, 600 had both femurs available for side-to-side comparison. The average FV of femurs with cam morphology was significantly higher than that of femurs without cam morphology (11.70° ± 8.82° vs. 7.99° ± 8.82°, P.001). Linear regression analysis demonstrated that increased AA was significantly correlated with increased FV (β ± standard error of the mean = 0.21 ± 0.02, P.0001).In a large osteological collection of human femurs, a significant positive relationship between AA and increasing FV was identified.FAI and hip impingement morphology are more complex than cam or pincer morphology. Cam morphology with high femoral anteversion may allow for normal or near-normal hip mechanics without impingement, and this may partially explain the high rates of asymptomatic cam-type femoroacetabular impingement (FAI) morphology in active and general populations. Given the multiple morphological factors implicated in the development of FAI syndrome, these findings warrant further investigation.

Background: Anterior inferior iliac spine (AIIS) impingement has been increasingly recognized as a source of extra-articular impingement and hip pain. However, no aggregate data analysis of patient outcomes after AIIS decompression has been performed. Purpose: To evaluate outcomes after arthroscopic AIIS decompression. Study Design: Meta-analysis; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for all English-language studies reporting outcomes of arthroscopic AIIS decompression performed in isolation or in conjunction with hip impingement correction surgery. After screening, 10 articles were included. The indications for AIIS decompression were recorded, and weighted mean improvements in patient-reported outcome (PRO) scores, complication rates, and revision rates were calculated. Results: A total of 547 patients (311 women; 57%) were identified, with a total of 620 operative hips. The mean age was 28.42 ± 5.6 years, and the mean follow-up was 25.22 ± 11.1 months. A total of 529 hips (85%) underwent AIIS decompression, 530 hips (85%) underwent femoral osteochondroplasty, and 458 hips (74%) underwent labral repair. Of the patients, 13% underwent bilateral AIIS decompression. The mean modified Harris Hip Score improved from 61.3 ± 6.9 to 88.7 ± 4.7 postoperatively (change, 27.4 ± 5.7 points; P < .001), the Hip Outcome Score–Activities of Daily Living improved from 67.2 ± 10.6 to 91.1 ± 3.2 postoperatively (change, 24.0 ± 8.0 points; P = .001), and the Hip Outcome Score–Sports Specific Subscale improved from 36.8 ± 19.2 to 82.8 ± 3.8 postoperatively (change, 46.0 ± 18.2 points; P = .002). The pooled risk of postoperative complications was 1.1% (95% CI, 0.1%-2.1%), and the pooled risk of needing revision surgery was 1.0% (95% CI, 0.1%-2.0%). No complication was directly attributed to the AIIS decompression portion of the procedure. Conclusion: PROs improved significantly after hip arthroscopy with AIIS decompression, with a low risk of postoperative complications and subsequent revision surgeries. Failure to identify extra-articular sources of hip pain in outcomes of femoroacetabular impingement syndrome, including from the AIIS, could lead to poorer outcomes and future revision surgery.

To compare postoperative pain and early recovery after hip arthroscopy with and without a perineal post for joint distraction.We retrospectively reviewed a consecutive series of patients who underwent hip arthroscopy before and after the adoption of a postless technique. Patients who underwent concurrent periacetabular or femoral osteotomy were excluded. Demographic information, procedure variables, and visual analog scale (VAS) pain scores were recorded. Analgesic medications given were converted to morphine milligram equivalents (MME) for comparison. Uni- and multivariate analyses were conducted to compare total MME, postoperative pain, and time to discharge between groups.One hundred patients were in each group. The overall age (mean ± standard deviation) was 26.5 ± 9.9 years (Post [P]: 57 females; No Post [NP]: 68 females). Total operative time (P 100.4 ± 17.9 minutes vs NP 89.1 ± 25.5 minutes, P = .0004), traction time (P 45.8 ± 10.3 minutes vs NP 40.9 ± 11.1 minutes, P = .0017), and operating room time (P 148.8 ± 19.3 minutes vs NP 137.3 ± 25.8 minutes, P = .0005) were found to be shorter in the NP group. Total MME, and final VAS pain scores in the PACU were similar between both groups (MME, P = .1620; VAS, P = .2139). Time to discharge was significantly shorter in the NP group (P 207.2 ± 58.8 vs NP 167.5 ± 47.9, P.0001). Patient age (≥25 years) (65.2 ± 18.1 vs 59.8 ± 15.7 [MME], P = .0269) and elevated body mass index (≥25) (65.1 ± 17.1 vs 59.3 ± 16.4 [MME], P = .0164) were factors associated with greater total MME consumption. Female sex was associated with higher postoperative VAS pain scores (FM 4.1 ± 1.6 vs M 3.4 ± 1.8 P = .0027).Adoption of the postless technique did not result in prolonged operating room or operative time. Overall, both groups had similar postoperative pain, however, the time from surgery to hospital discharge was shorter in the postless group.III, retrospective comparison study.

Purpose We evaluate the incidence of heterotopic ossification (HO) development with nonsteroidal anti-inflammatory drug (NSAID) prophylaxis in patients after open and arthroscopic hip preservation surgery. Methods A retrospective review identified patients who underwent hip preservation surgery at a single institution within the past 3 years. Patients who underwent hip arthroscopy with or without periacetabular osteotomy (PAO) or femoral osteotomy (FO) were included. Those who did not receive 3-month postoperative radiographs were excluded. The incidence and Brooker classification (BC) of HO in patients taking Naproxen or another NSAID (meloxicam, celecoxib, indomethacin, or aspirin alone) was assessed using AP radiographs available from 3-, 6-, and 12-month follow-up appointments. Univariate analysis was conducted to compare numerical means and categorical data (significance level P = .05). Results A total of 328 hips (284 patients) were included. All patients received hip arthroscopy, while 71 patients (21.6%) received concurrent periacetabular osteotomy (PAO; n = 65) or femoral osteotomy (FO; n = 6). Overall, 276 hips (84.4%) received Naproxen for HO prophylaxis. In total, 5 of 328 hips (1.5%) developed HO (4, BC I; 1, BC III). The rate of HO development was significantly higher in males versus females (4 of 121 (3.31%) vs 1 of 207 (.48%), P = .0441). All 5 patients received arthroscopic cam resection and labral repair, and 1 patient also received PAO. Three patients in the Naproxen group (.91%) developed HO, which was not statistically different from those taking a different NSAID (.61%, P = .1797). Conclusion The incidence of HO development was low with NSAID prophylaxis after hip preservation surgery.

BACKGROUND: The purpose of the present study is to determine the association between femoral version and traditional pathologic bony factors commonly used to measure and define patellofemoral alignment. METHODS: We performed a retrospective review of patients treated for patellofemoral instability (PFI) at a single institution. Patients included underwent magnetic resonance imaging (MRI) of the lower extremity using a rotational protocol prior to medial patellofemoral ligament reconstruction with or without tibial tubercle osteotomy. Those with a history of ipsilateral lower extremity surgery were excluded. Two independent reviewers measured femoral version, tibial tubercle-trochlear groove (TT-TG) distance, tibial tubercle-posterior cruciate ligament (TT-PCL) distance, and tibial torsion (TT). Pearson correlation coefficients were used to describe the relationships between all radiographic measures. RESULTS: A total of 51 knees (43 patients) were included. The average age and body mass index were 23.7 ± 9.33 years and 29.23 ± 8.04 kg/ m2, respectively. The mean femoral version was 15.61 ± 11.57°. The degree of femoral version did not significantly correlate with TT-TG (r=0.103, p=0.474), TT-PCL (-0.086, p=0.550), or TT (r=0.111, p=0.438). Increased TT-TG distance was strongly associated with increased TT-PCL (r=0.470, p=0.001). In females, increased femoral version significantly correlated with increased TT (r=0.381, p=0.029). CONCLUSION: Neither increased nor decreased amounts of femoral anteversion significantly correlated with TT-TG, TT-PCL, or TT. Therefore, assessment of femoral version should be measured independently of conventional measures when considering osteotomies to correct PFI. Level of Evidence: IV

The Femoro-Epiphyseal Acetabular Roof (FEAR) index is a newer measurement to identify the hip instability with borderline acetabular dysplasia. The purpose of this study is to (i) validate the FEAR index in determining the stability of the hip in patients who have previously been treated surgically for femoroacetabular impingement (FAI) and/or developmental dysplasia of the hip (DDH) and (ii) to examine the relationship between the FEAR index and femoral version, lateral center edge angle, Tönnis angle and alpha angle (AA). Patient demographics and radiographic measurements of 215 hips (178 patients), 116 hips treated with hip arthroscopy for FAI and 99 hips treated with periacetabular osteotomy (PAO) for DDH were compared between groups. The sensitivity and specificity of the FEAR index to detect the surgical procedure performed (PAO or hip arthroscopy) was calculated, and a threshold value was proposed. Pearson’s correlation coefficients were used to describe the relationships between the FEAR index, femoral version and other radiographic measurements. The FEAR index was higher in patients with DDH versus FAI (DDH: 2.81 ± 0.50° versus FAI: −1.00 ± 0.21°, P

Background:. The purpose of this study was to evaluate the influence of the volume and type of sport on the development of cam-type femoroacetabular impingement and acetabular dysplasia. Methods:. The Physical Activity Questionnaire for Adolescents (PAQ-A) was administered to Iowa Bone Development Study participants at the age of 17 years to identify those who had participated in at least 2 seasons of high school interscholastic sports. Based on relative peak strain and ground reaction forces, subjects were grouped as power sport athletes (basketball, cheerleading, football, gymnastics, soccer, and volleyball), non-power sport athletes (wrestling, baseball, cross-country or track and field, softball, or tennis), or non-athletes. Using anteroposterior views of the left hip formatted from dual x-ray absorptiometry (DXA) scans, the alpha angle, head-neck offset ratio (HNOR), and lateral center-edge angle (LCEA) were evaluated longitudinally at the ages of 17, 19, and 23 years. Logistic regression was used to evaluate the odds of hip cam morphology (alpha angle >55° and/or HNOR 0.05). There were no significant differences in the odds of cam morphology or acetabular dysplasia in non-power sport athletes compared with non-athletes (all p > 0.05). Higher physical activity levels were significantly associated with an increase in the alpha angle (beta and standard error, 0.77° ± 0.30°; p = 0.011) and a decrease in the HNOR (−0.003 ± 0.001; p = 0.003), but not the LCEA (−0.05 ± 0.15; p = 0.744). Conclusions:. A higher volume of physical activity and participation in sports with higher peak strain and ground reaction forces during the process of skeletal maturation may increase the risk of developing cam morphology during late adolescence. Level of Evidence:. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Purpose To evaluate femoral and acetabular morphology in patients who underwent anterior cruciate ligament reconstruction (ACLR). Methods A retrospective review of a prospectively collected ACL registry was performed to identify patients with pelvis radiographs before undergoing either primary or revision ACLR between January 2010 and August 2020. Alpha angle (AA), head-neck offset ratio (HNOR), lateral center edge angle (LCEA), and crossover sign (COS) were measured on the operative side. Values were compared to a negative control group that did not significantly differ in age, sex, or body mass index. Univariate analysis and Pearson's correlation coefficient were used to compare groups with significance defined as P < .05. Results In total, 114 patients were included (ACL, n = 38; control, n = 76). Eleven primary and 27 revision ACL reconstructions were identified. The mean AA in patients undergoing primary ACL reconstruction was higher than control (67.45° ± 11.30° vs 51.5° ± 10.8°, P < .001). A significantly elevated AA was also found in those undergoing revision ACL surgery (61.8° ± 7.51° vs 51.5° ± 10.8°, P < .001). In addition, the HNOR was significantly lower in the ACL group (0.12 ± 0.03 vs 0.14 ± 0.04, P = .0304). Acetabular morphology was similar between groups (LCEA, ACL 31.97° ± 5.04° vs control 30.01° ± 5.17°, P = .0549; COS, ACL 9 of 38 (23.7%) vs control 18 of 76 (23.7%), P = 1.00). Conclusion An association exists between radiographic cam morphology of the hip and patients who previously underwent ACLR. Level of Evidence III, retrospective comparison study.

Surgical treatment of femoroacetabular impingement (FAI) syndrome has been proven to be tremendously successful, outperforming the best conservative care and physical therapy in several prospective multicenter randomized controlled trials. The durability of this operation over time is less commonly reported on. We do know that FAI is associated with the development of hip osteoarthritis, and this is well established. We also know that surgical FAI treatment results in good short-term return to function/sport and improvements in patient-reported outcomes. We do not yet know if we are able to alter the natural history of FAI and prevent or delay conversion to total hip arthroplasty in this population.

Hip arthroscopy techniques have evolved to treat a wide range of extra-articular pathologies. Subspine impingement commonly occurs in femoroacetabular impingement, particularly in athletes with a high range of motion, patients with low degrees of femoral version, and those with large subspine deformities. A reliable technique that preserves the hip capsule would be helpful for hip arthroscopy surgeons. This note details our technique using pericapsular windows proximal to the interportal capsulotomy to access and decompress a subspine deformity in the setting of hip femoroacetabular impingement., Technique Video Video 1 The goal of this technique is to provide a capsule-preserving method to decompress AIIS deformities. The patient is positioned supine and standard diagnostic arthroscopy with interportal capsulotomy is performed. The base of the subspine at the level of the joint can be addressed from within the interportal capsulotomy. To visualize and decompress the proximal subspine, a pericapsular window is created using a banana-style Beaver blade slotted through the rectus and proximal capsule. A slotted canula and switching stick are placed, then the burr is taken apart and the sheath is placed over the switching stick followed by the inner burr component. For large deformities, 2 or 3 pericapsular windows can be created. Fluoroscopy is used to verify adequate resection of the subspine. (AISS, anterior inferior iliac spine.)

Case A 63-year-old woman presented with pain and limited range of motion 2 years after undergoing reverse shoulder arthroplasty (RSA). She underwent revision RSA for catastrophic implant failure caused by central screw breakage, subsequent polyethylene wear, and glenosphere loosening, and achieved excellent outcomes. Conclusion This is a unique case of a salvage procedure with satisfactory outcomes for a rare complication of RSA. It demonstrates the importance of clinical vigilance notwithstanding the absence of radiographic abnormalities in long-term monitoring of patient implant failure.