Search

To determine whether patients who reported a discrete traumatic event precipitating the onset of femoroacetabular impingement syndrome (FAIS) reported similar patient-reported outcomes for the modified Harris Hip Score (mHHS) and the Non-Arthritic Hip Score (NAHS) following hip arthroscopy as patients with atraumatic hip pain associated with FAIS alone.A retrospective comparative therapeutic investigation of a prospectively collected database of cases performed by a single surgeon from 2010 to 2015 identified a group of patients who developed FAIS after a discrete traumatic event. This group was compared 1:2 with a body mass index and age-matched group of primary hip arthroscopies with atraumatic hip pain attributed to FAIS. Preoperative mHHS and NAHS were obtained and compared with those at 2-year follow-up. Clinical failure at 2 years was defined as any further ipsilateral hip surgery including revision arthroscopy and conversion to arthroplasty.In the traumatic etiology group, the mean mHHS and NAHS improved from 49.6 to 82.7 (P.001) and from 46.9 to 84.0 (P.001), respectively. The mean mHHS and NAHS in the atraumatic group improved from 51.5 to 85.82 (P.001) and from 49.3 to 85.2 (P.001), respectively. Survivorship at 2 years was 81.1% for traumatic etiology and 88.3% for atraumatic etiology; adjusted proportional hazards regression analysis demonstrated a difference in survivorship that was not statistically significant between the traumatic and atraumatic cohorts (hazard ratio 1.8, 95% confidence interval 0.8-4.0).The findings of this study demonstrate that patients presenting with FAIS and history of a traumatic hip injury can expect to experience similar good outcomes at 2 years following primary hip arthroscopy as compared with patients with atraumatic FAIS.Level III (Therapeutic) retrospective comparative study.

This report examines 4-year patient reported outcomes and procedural survivorship in patients who underwent microfracture during hip arthroscopy compared to a matched group of non-microfracture patients as well as the risk factors for procedural failure following microfracture of articular lesions in the hip.Data for 38 consecutive patients undergoing arthroscopic microfracture was retrospectively analyzed. Propensity score matching identified a matched group of hip arthroscopy patients who had Outerbridge grade 3 or grade 4 chondral lesions but did not undergo microfracture. Preoperative modified Harris Hip Scores (mHHS) and NonArthritic Hip Scores (NAHS) were compared to those at 2- and 4-year follow-up. Postoperative rates of ipsilateral revision arthroscopic surgery or hip arthroplasty were assessed.Thirty-three (86.8%) of the 38 microfracture patients were available for 4-year follow-up. Forty-six patients were matched with the microfracture group. Scores including mHHS and NAHS increased postoperatively for both groups (p0.05), though there were no significant differences between groups (p0.05). Overall reoperations rates were 24.2% and 21.7% (p = 0.873) for the microfracture and non-microfracture groups, respectively. Hip arthroplasty rates were higher among microfracture patients (18.2% vs. 2.2%, p = 0.038), wherein Tonnis grade ≥ 2, cartilage lesions ≥ 400 mm2 , and femoral-sided lesions were associated with failure.Patients who underwent microfracture treatment of chondral lesions fared no better than a matched group of patients who did not receive microfracture treatment. Risk of reoperation is high for both groups and microfracture patients are more likely to require conversion to total hip arthroplasty or hip resurfacing.

Context: Major League Baseball (MLB) players are at risk of hook of hamate fractures. There is a paucity of data assessing the effect of a hook of hamate fracture on MLB players’ future athletic performance. Objective: To determine if MLB players who sustain hook of hamate fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their control-matched peers. Design: Retrospective case-control design. Setting: Retrospective database study. Participants: 18 MLB players who sustained hook of hamate fractures. Methods: Data for 18 MLB players with hook of hamate fractures incurred over 26 seasons (1989–2014) were obtained from injury reports, press releases, and player profiles (www.mlb.com and www.baseballreference.com). Player age, position, number of years in the league, mechanism of injury, and treatment were recorded. Individual season statistics for the 2 seasons immediately prior to injury and the 2 seasons after injury for the main performance variable—Wins Above Replacement—were obtained. Eighteen controls matched by player position, age, and performance statistics were identified. A performance comparison of the cohorts was performed. Main Outcome Measures: Postinjury performance compared with preinjury performance and matched-controls. Results: Mean age at the time of injury was 25.1 years with a mean of 4.4 seasons of MLB experience prior to injury. All injuries were sustained to their nondominant batting hand. All players underwent operative intervention. There was no significant change in Wins Above Replacement or isolated power when preinjury and postinjury performance were compared. When compared with matched-controls, no significant decline in performance in Wins Above Replacement the first season and second season after injury was found. Conclusion: MLB players sustaining hook of hamate fractures can reasonably expect to return to their preinjury performance levels following operative treatment.

Background We sought to determine whether professional baseball positional players who underwent medial ulnar collateral ligament (MUCL) reconstruction demonstrate decreases in performance on return to competition compared with preoperative performance metrics and their control-matched peers. Methods Data for 35 Major League Baseball positional players who underwent MUCL reconstruction during 31 seasons were obtained. Twenty-six players met inclusion criteria. Individual statistics for the 2 seasons immediately before injury and the 2 seasons after injury included wins above replacement (WAR), on-base plus slugging (OPS), and isolated power (ISO). Twenty-six controls matched by player position, age, plate appearances, and performance statistics were identified. Results Of the 35 athletes who underwent surgery, 7 did not return to their preinjury level of competition (return to play rate of 80%). In comparing preinjury with postinjury statistics, players exhibited a significant decrease in plate appearances, at-bats, and WAR 2 seasons after injury but did not demonstrate declines in WAR 1 season after injury. Compared with matched controls, athletes who underwent MUCL reconstruction did not demonstrate significant decline in statistical performance, including OPS, WAR, and ISO, after return to play from surgery. Of all positional players, catchers undergoing surgery demonstrated lowest rates of return to play (56%) along with statistically significant decreases in home run rate, runs batted in, and ISO. Conclusion Major League Baseball positional players undergoing MUCL reconstruction can reasonably expect to return to their preinjury level of competition and performance after surgery compared with their peers. Positional players return to play at a rate comparable to that of pitchers; catchers may experience more difficultly in returning to preinjury levels of play.

Background: Iliopsoas tendinitis is a known source of extra-articular hip pain and it has been shown to be a common cause of continued hip pain following total hip arthroplasty. While iliopsoas tendinitis after hip arthroscopy is a well-known phenomenon amongst hip arthroscopists, its presentation, course, and treatment has yet to be elucidated. Methods: An IRB-approved chart review was performed of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between March 2015 and July 2017. No cases of dysplasia were included. All patients had combined cam/pincer impingement as well as labral pathology. Tendinitis patients were identified. Patient demographics, surgical data, time to onset/diagnosis of iliopsoas tendinitis, treatment (oral anti-inflammatories, corticosteroid injection, physical therapy), and resolution of symptoms were recorded. These cases were age- and sex-matched to a control group that did not develop postoperative iliopsoas tendinitis for comparison. Patient outcomes were measured with the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) recorded from the preoperative and 1-year postoperative visits. Results: Of 258 hip arthroscopy cases, 18 cases (7.0%) of postoperative iliopsoas tendinitis were diagnosed under high resolution ultrasound. On average, iliopsoas tendinitis was diagnosed 2.8 ± 1.8 months after surgery. There were no significant differences in age, sex, and BMI between patients that developed IP tendinitis compared to those that did not. No specific procedures were found to be significantly associated with incidence of postoperative IP tendinitis, including capsular closure. 18 patients were treated with corticosteroid injection, which provided mild to moderate improvement for 5 (27.8%) patients and completely resolved symptoms for 13 patients (72.2%). Of all 18 patients with postoperative iliopsoas tendinitis confirmed by response to a diagnostic injection, 10 (55.6%) had symptoms improve within 3 months of diagnosis, 2 (11.1%) between 3 and 6 months, 4 (22.2%) between 6 and 12 months, and 2 (11.1%) after 1 year. No patients went on to have surgery for this problem. Patients with iliopsoas tendinitis had lower MHHS ( p = 0.04) and NAHS ( p = 0.09) scores at their 1-year postoperative visits. Conclusions: Iliopsoas tendinitis is a common source of pain following arthroscopic hip surgery and can be effectively diagnosed and treated with ultrasound-guided injection. Therefore, surgeons performing arthroscopic procedures of the hip must remain aware of and include it in their differential when encountering patients with hip flexion pain after surgery. Research should be continued to further evaluate the long-term outcomes and return to sport rates of these patients.

Anterior instability of the glenohumeral joint is a common and functionally limiting shoulder condition, particularly in young and active patients. In this population, non-operative management has been increasingly demonstrated to be associated with recurrent instability and increased long-term morbidity. Surgical treatment options include both arthroscopic and open techniques. In appropriately indicated patients, surgical treatment of first-time anterior shoulder instability is a cost-effective and successful treatment option.

Osteochondral lesions of the talus are common injuries that affect a wide variety of active patients. The majority of these lesions are associated with ankle sprains and fractures though several nontraumatic etiologies have also been recognized. Patients normally present with a history of prior ankle injury and/or instability. In addition to standard ankle radiographs, magnetic resonance imaging and computed tomography are used to characterize the extent of the lesion and involvement of the subchondral bone. Symptomatic nondisplaced lesions can often be treated conservatively within the pediatric population though this treatment is less successful in adults. Bone marrow stimulation techniques such as microfracture have yielded favorable results for the treatment of small (

Traumatic hip dislocations are high-energy injuries that often result in considerable morbidity. Although appropriate management improves outcomes, associated hip pathology may complicate the recovery and lead to future disability and pain. Historically, open reduction has been the standard of care for treating hip dislocations that require surgical intervention. The use of hip arthroscopy to treat the sequelae and symptoms resulting from traumatic hip dislocations recently has increased, however. When used appropriately, hip arthroscopy is a safe, effective, and minimally invasive treatment option for intra-articular pathology secondary to traumatic hip dislocation.

Purpose To determine when patients reach critical thresholds of clinical improvement after hip arthroscopy for femoroacetabular impingement (FAI) using previously defined cutoffs for the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) and to identify risk factors for prolonged recovery. Methods Consecutive patients with a diagnosis of FAI who underwent unilateral hip arthroscopy between January 2010 and January 2015 with at least 2 years of clinical follow-up were studied. The modified Harris Hip Score was collected prospectively at 6 consecutive time points. The number of patients reaching the MCID and PASS at each time point was determined. Results During the study period, 340 consecutive hip arthroscopies were performed in 316 patients with a mean final follow-up period of 50 months (range, 29-84 months). The mean modified Harris Hip Score and percentage of patients reaching the MCID and PASS increased at each time point. At 2 years, 271 patients (93%) surpassed the MCID and 212 patients (73%) achieved the PASS. Female sex, age of 40 years or older, and body mass index of 30 or greater were associated with lower rates of achieving the MCID and PASS at set time points. Patients undergoing labral repair had superior PASS rates at 3 months and beyond than patients undergoing labral debridement alone. Patients who did not achieve the PASS by 3 months were more likely to require reoperation. Conclusions Hip arthroscopy for FAI results in increased patient-reported outcome measures at interval follow-up. Most patients reach critical thresholds of minimal and satisfactory clinical improvement. Patients who are female, older, or obese or who undergo labral debridement alone are less likely to reach these milestones at major time intervals. Patients who do not reach the PASS by 3 months are more likely to require reoperation. Level of Evidence Level IV, therapeutic case series.

Background: Basketball players are at risk for foot injuries, including Jones fractures. It is unknown how this injury affects the future play and performance of athletes. Hypothesis: National Basketball Association (NBA) players who sustain Jones fractures of the base of the fifth metatarsal have high rates of return to play and do not experience a decrease in performance on return to competition when compared with preinjury and with control-matched peers. Study Design: Retrospective cohort study. Level of Evidence: Level 5. Methods: Data on 26 elite basketball players with Jones fractures over 19 NBA seasons (1994-1995 to 2012-2013) were obtained from injury reports, press releases, player profiles, and online public databases. Variables included age, body mass index (BMI), player position, experience, and surgical treatment. Individual season statistics pre- and postinjury were collected. Twenty-six controls were identified by matched player position, age, and performance statistics. Results: The mean age at the time of injury was 24.8 years, mean BMI was 24.7 kg/m2, and the mean experience prior to injury was 4.1 NBA seasons. Return to previous level of competition was achieved by 85% of athletes. There was no change in player efficiency rating (PER) when pre- and postinjury performance was compared. When compared with controls, no decline in PER measured performance was identified. Conclusion: The majority of NBA players sustaining a Jones fracture return to their preinjury level of competition. These elite athletes demonstrate no decrease in performance on their return to play. Clinical Relevance: Jones fractures are well-studied injuries in terms of etiology, diagnosis, and management. However, the effect of these injuries on future performance of athletes is unknown. Using the findings of our study, orthopaedic surgeons may be better prepared to counsel and educate elite athletes who sustain a Jones fracture.

Objectives: Hip arthroscopy for femoroacetabular impingement (FAI) and related hip pathology is increasing in volume. Variable presentations of hip pain often lead to confusion with lumbar spine pathology however. We sought to define the relationship between the lumbar spine and the hip joint. Our hypothesis is that patients with concurrent lumbar spine pathology will experience inferior outcomes after hip arthroscopy when compared to patients without lumbar spine pathology. Methods: Prospectively-collected data from a single-surgeon database from 2010 to 2014 was used to identify patients who had undergone hip arthroscopy and had documented concurrent lumbar spine pathology. Patients with spine pathology were matched by age, gender, and BMI in a 3:1 fashion to patients without spine pathology. Baseline pre-operative modified Harris Hip Scores (mHHS) were compared to scores at two-year follow-up. “Poor outcome” of initial hip arthroscopy was defined as any combination of: requiring a revision procedure, conversion to THA, or mHHS below 70. Results: 167 patients met inclusion criteria: 72.5% were “normal” while 27.5% had spine pathology. Baseline demographics were appropriately matched between cohorts (Table I). Preoperative and two-year mHHS scores were significantly different between cohorts (Figure 1). Both cohorts demonstrated significant within-group improvement at two-year follow-up, however normal patients had greater improvements than those with spine pathology (34.0 vs 31.76, pConclusion: Our results demonstrate that patients undergoing hip arthroscopy with concomitant lumbar spine pathology demonstrate significantly lower total improvement, significantly higher revision/THA conversion rates and significantly higher rates of suboptimal outcomes after hip arthroscopy than patients without spine pathology. [Table: see text][Figure: see text]

The incidence of Type II SLAP tears is increasing, and this injury represents a common clinical presentation to the sports medicine specialist. Patients often present with a chief complaint of vague, aching shoulder pain that adversely affects daily activities and/or athletic performance. Diagnosis consists of careful history taking, dedicated physical examination, and magnetic resonance imaging studies.

A 67-year-old man presented to orthopaedic care with a painful knee. Workup was consistent with septic arthritis of a native knee, and the patient underwent operative treatment. Cultures from the operating room were speciated to Staphylococcus lugdunensis. To the investigators' knowledge, this is the first reported S. lugdunensis infection in a peripheral joint in the absence of an orthopaedic prosthesis. Although traditionally associated with infectious endocarditis, S. lugdunensis has been identified as a causative agent in many organ systems, including orthopaedic infections. This case report emphasizes the importance of familiarity with this emerging pathogen in the treatment of a septic joint.

A 39-year-old man presented to orthopaedic care with a painful, fully locked knee. Workup revealed free intraarticular nodules, which were subsequently arthroscopically removed and identified to be synovial hemangioma. To the investigators' knowledge, this is the second reported case of synovial hemangioma presenting as a painful, definitively locked knee. Synovial hemangioma should be considered in the differential diagnosis of knee pain, particularly after more common diagnoses have been ruled out. Efficient and appropriate diagnosis and treatment may result in favorable patient outcomes and avoid long-term disability and dysfunction.

A 35-year-old female presented to orthopaedic clinic with a chief complaint of chronic left hip pain, beginning 17 years prior when she had sustained a gunshot wound to her left buttock. Imaging demonstrated significant left hip arthritis with a retained projectile in the femoral head. Lead levels were also found to be significantly elevated. The patient underwent successful left total hip arthroplasty, with subsequent postoperative pain relief and consistent decrease in serum lead level. This report presents a rare case that emphasizes lead intoxication as a potentially dangerous complication of gunshot wounds and retained projectiles in the orthopaedic patient. Recognition of lead intoxication as a potential complication of retained gunshot projectiles allows for efficient diagnosis and treatment, which may prevent associated future morbidity.

Background: The aim was to determine whether players in the National Basketball Association (NBA) who sustain metacarpal fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their control-matched peers. Methods: Data for 32 NBA players with metacarpal fractures incurred over 11 seasons (2002-2003 to 2012-2013) were obtained from injury reports, press releases, and player profiles ( www.nba.com and www.basketballreference.com ). Player age, body mass index (BMI), position, shooting hand, number of years in the league, and treatment (surgical vs nonsurgical) were recorded. Individual season statistics for the 2 seasons immediately prior to injury and the 2 seasons after injury, including player efficiency rating (PER), were obtained. Thirty-two controls matched by player position, age, and performance statistics were identified. A performance comparison of the cohorts was performed. Results: Mean age at the time of injury was 27 years with an average player BMI of 24. Players had a mean 5.6 seasons of NBA experience prior to injury. There was no significant change in PER when preinjury and postinjury performances were compared. Neither injury to their shooting hand nor operative management of the fracture led to a decrease in performance during the 2 seasons after injury. When compared with matched controls, no significant decline in performance in PER the first season and second season after injury was found. Conclusion: NBA players sustaining metacarpal fractures can reasonably expect to return to their preinjury performance levels following appropriate treatment.

To examine clinical outcomes and survivorship in patients aged 60 years or older who underwent hip arthroscopy for management of hip pain.Prospectively collected data for patients 60 or older undergoing hip arthroscopy were obtained. All patients were indicated for hip arthroscopy based on standard preoperative examination as well as routine and advanced imaging. Demographic data, diagnosis, and details regarding operative procedures were collected. Baseline preoperative modified Harris Hip Scores (mHHS) and Non-arthritic Hip Scores (NAHS) were compared to mHHS and NAHS at the 2-year follow-up. Survivorship was assessed to determine failure rates, with failure defined as any subsequent ipsilateral revision arthroscopic surgery and/or hip arthroplasty.Forty-two patients met inclusion criteria. Mean age (standard deviation) and body mass index were 65.8 years (4.5 years) and 26.1 (4.7), respectively. Baseline mean mHHS and NAHS for all patients improved from 47.8 (±12.5) and 47.3 (±13.6) to 75.6 (±17.6) and 78.3 (±18.6), respectively (P.001 for both). Five patients (11.9%) met failure criteria and underwent additional surgery at an average of 14.8 (8-30) months. Three underwent conversion to total hip arthroplasty (7.1%), whereas 2 had revision arthroscopy with cam/pincer resection and labral repair for recurrent symptoms (4.7%). One- and 2-year survival rates were 95.2% and 88.9%, respectively.Our results suggest that in patients 60 or older with Tonnis grade 0 or 1 osteoarthritic changes on initial radiographs-treatment with hip arthroscopy can lead to reliable improvement in early outcomes. As use of hip arthroscopy for treatment of mechanical hip pain increases, additional studies with long-term follow-up are needed.Level IV, therapeutic case series.

Objectives: Hip arthroscopy has been an increasingly used tool in the treatment of labral tears, chondral defects and ligamentum teres lesions and has demonstrated efficacy in returning patients to function and relieving their pain. Despite this, failures continue to occur. Our understanding of risk factors for failure or poor outcome continues to evolve as larger cohorts of patients are available for study. We sought to identify risk factors for poor outcome in our patient population. Methods: Prospectively collected data for all patients undergoing hip arthroscopy by a single fellowship-trained surgeon was obtained. All patients were indicated for hip arthroscopy based on standard pre-operative examination as well as routine and advanced imaging. Baseline demographic data regarding patient age, gender, BMI was collected. Patients without two year follow-up were excluded. Baseline pre-operative modified Harris Hip Scores (mHHS) were compared to mHHS at two-year follow-up. “Poor outcome” of initial hip arthroscopy was defined as any combination of: requiring a revision procedure or conversion to THA or mHHS below 70. Multivariate logistic regression was performed to identify independent risk factors for “poor outcome.” Results: 258 patients met inclusion criteria. Mean age (SD) and body mass index (BMI) were 40.4 years (12.7 years) and 25.6 (4.7) respectively. 62.8% (162/258) of the sample was female. Mean preoperative baseline mHHS was 49.6 (12.5) and average mHHS at two year follow-up was 83.6 (15.6), resulting in a mean improvement of 34.1 (pConclusion: Our findings that female gender, obesity and poorer preoperative functional status increase the risk for failure of hip arthroscopy coincide and add to an increasing volume of literature examining risk factors for poor outcome after hip arthroscopy. These factors should be taken into consideration with operative indications as well as in counseling patients.

A 14-year-old right-hand dominant female lacrosse player presented with a complaint of right shoulder and upper posterior thorax pain of 8 days’ duration. She had been playing lacrosse at the attack wing and midfielder positions and experienced insidious pain after a game. She had no history of trauma to that shoulder during that game and had not experienced an injury in the past. Six days after the pain developed, she woke up one night with a sudden increase in the pain, which brought her to tears and caused slight difficulty with breathing. The pain was located anteriorly just lateral to the right sternoclavicular joint and posteriorly in the paraspinal muscles in the upper thoracic region. Physical examination suggested a first-rib stress fracture, which was subsequently confirmed by chest and shoulder radiographs.

Objectives: Objective and clinical results of microfracture for treatment of chondral defects of the knee is well documented, yet outcomes for microfracture of the hip have not been extensively studied. Recently, several studies demonstrated clinical improvements in patients treated with microfracture of the hip. The purpose of this study is to examine clinical outcomes and survivorship in patients who underwent microfracture during arthroscopic hip surgery. Methods: A retrospective analysis of a prospectively collected database was performed. Thirty-eight patients with a mean age of 41 (range, 17-64) who underwent microfracture during arthroscopic hip surgery by a single surgeon (senior author) were identified. Demographic data, diagnosis, and details regarding operative procedures were collected. All patients were indicated for hip arthroscopy based on standard pre-operative examination as well as routine and advanced imaging. Baseline pre-operative modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS) were compared to mHHS and NAHS at two-year follow-up. Additionally, survivorship data was assessed to determine failure, defined as any subsequent revision arthroscopic surgery and/or hip arthroplasty of the same hip. Results: Thirty-four of the 38 (89.5%) patients were available for two-year clinical follow-up. Baseline mean mHHHS and NAHS for all patients improved from 50.6 (+/- 12.7) and 46.9 (+/-12.8) to 84.7 (+/- 12.5) and 85.6 (+/- 11.2) respectively. Both improvements were statistically significant (p < 0.05). Eight patients (23.5%) met failure criteria and underwent additional surgery at an average of 23.9 months. Two patients (5.8%) underwent revision arthroscopic surgery, and six patients (17.7%) underwent hip arthroplasty. Conclusion: Significant improvements in clinical outcomes are seen at two-year follow-up after microfracture treatment of chondral lesions of the hip. Despite overall success, failure rates are relatively high. As with microfracture of the knee, results favor short-term clinical improvements, but results may decline at two years. Larger studies are needed to fully assess the efficacy of microfracture in arthroscopic hip surgery.