Holliday, Charles L.

Purpose To evaluate the differences in clinical outcomes and complication rates between open and arthroscopic iliopsoas (IP) tenotomy between 1998 and 2023 at our institution. Methods Patients who underwent arthroscopic iliopsoas fractional lengthening (IPFL) or open tenotomy for IP tendinitis following total hip arthroplasty (THA) between 1988 and 2023 were identified. Patients were excluded if they underwent revision IP tendon release, had additional concomitant procedures, or had less than a 24‐month postoperative follow‐up. Patient records were reviewed, and patient‐reported outcomes were collected via electronic survey. Results Fifty‐two patients (36 arthroscopic, 16 open) were followed for an average of 68.7 (24.0‐203.7) months. Overall surgery satisfaction was 7.9 (scale 0‐10) following arthroscopic IPFL and 6.0 following open tenotomy ( P = .178). Eighty‐six percent of patients reported improvement in their anterior groin pain following arthroscopic IPFL, compared to 45% following open tenotomy ( P = .065). In the arthroscopic cohort, 64% reported improved hip flexion strength, compared to 36% in the open cohort ( P = .158). Visual analog scale for pain at rest was lower following arthroscopic IPFL (1.1 ± 2.2 vs 3.3 ± 3.2, P = .0092), while pain with use did not differ between cohorts (3.1 ± 1.3 vs 2.6 ± 1.1, P = .786). There were no differences in postoperative Tegner (3.1 ± 1.3 vs 2.6 ± 1.1, P = .302), modified Harris Hip Score (77.0 ± 19.0 vs 69.2 ± 26.9, P = .073), or Single Assessment Numeric Evaluation (70.9 ± 28.7 vs 66.7 ± 31.8, P = .571) scores between arthroscopic and open cohorts. Revision THA rates did not differ following arthroscopic or open procedures (8.3% vs 25%, P = .104). Conclusions Patients have improved pain at rest following arthroscopic IPFL when compared to open tenotomy for IP tendinitis following THA. Overall complication and reoperation rates were low for both techniques. Level of Evidence Level III, retrospective cohort study.

Abstract Background: Iliopsoas (IP) tendinitis is a recognized complication following total hip arthroplasty (THA) and isolated iliopsoas fractional lengthening (IPFL) has been able to provide symptom relief. IPFL has traditionally been done openly; however, the arthroscopic IPFL has recently been described as an alternative, offering the potential for lower surgical site morbidity and a more favorable post-operative recovery. Purpose: To compare clinical and patient reported outcomes following open and arthroscopic IPFL. We hypothesize that patients undergoing arthroscopic IPFL will have improved pain, function, and satisfaction with lower post-operative complication rates when compared to patients undergoing open IPFL. Methods: Patients with symptomatic IP tendinitis following THA who underwent IPFL from 1988-2023 were reviewed. Inclusion criteria included 2 years follow-up and no concomitant procedures. Patient records were evaluated for surgery type, radiographic anterior acetabular component overhang, reoperations, and need for revision THA. Surveys were used to report overall surgery satisfaction, postoperative subjective hip flexion strength and anterior groin pain improvement, mHHS, SANE score, Tegner activity scale, and VAS for pain. Results: Fifty-two patients (16 males and 36 females, age: 63.9 ± 11.7 years, BMI: 28.8 ± 5.4 kg/m2) were followed for a mean of 68.7 (24.0 – 203.7) months postoperatively. Overall surgery satisfaction was 7.9 (arthroscopic) and 6.0 (open) (p = 0.178). 86% of patients treated arthroscopically reported feeling “slightly” or “much better” and 86% also reported improvement in their anterior groin pain, compared to 55% and 45% respectively treated openly. In the arthroscopic cohort, 64% reported that their hip flexion strength was “slightly ” or “much better”, compared to 36% treated openly. Average VAS pain score was 1.7 ± 2.7 at rest (arthroscopic: 1.1 ± 2.2, open: 3.3 ± 3.2, p = 0.0092) and 3.0 ± 1.3 (arthroscopic: 3.1 ± 1.3, open: 2.6 ± 1.1) with use. Mean postoperative Tegner score was 3.0 ± 1.3 (arthroscopic: 3.1 ± 1.3, open: 2.6 ± 1.1) compared to 2.3 ± 1.2 preoperatively (arthroscopic: 2.3 ± 1.3, open: 2.1 ± 1.1) (p = 0.0018). Mean post-operative mHHS and SANE score was 74.9 ± 21.6 (arthroscopic: 77.0 ± 19.0, open: 69.2 ± 26.9) and 69.7± 29.7 (arthroscopic: 70.9 ± 28.7, open: 66.7 ± 31.8) respectively. Conclusion: The results indicate that arthroscopic IPFL trends towards significantly improved pain, function, and satisfaction scores when compared to patients undergoing open IPFL, and should be considered when appropriate over an open IPFL given the less invasive nature of an arthroscopic procedure.

Abstract Unstable osteochondritis dissecans lesions of the medial femoral condyle have classically been treated with open reduction and fixation under direct visualization through an open arthrotomy. Given the value of avoiding open arthrotomies, we present an arthroscopic approach for lesion elevation, debridement, and fixation. The lesion is first elevated using an arthroscopic elevator, leaving a laterally based osseous hinge. Once elevated, fibrous debris is debrided from the base of the lesion. Subsequently, the fragment is reduced, and percutaneous transpatellar instrumentation is used for fixation. The use of this technique allows for excellent mobilization, debridement, and fixation of the osteochondritis dissecans lesion while minimizing violation of periarticular soft tissues. Technique Video video See video under supplementary data.

Abstract In the standard approach to hip arthroscopy, access to the joint is achieved using fluoroscopic guidance to enter the central compartment of the hip using the Seldinger technique, penetrating the capsule with a needle and subsequently cannulating and obtaining direct visualization of the joint. In such a way, arthroscopists then proceed with accessory portal creation and capsulotomy, as desired, under direct intra‐articular visualization. In cases with severe pincer morphology or coxa profunda, it may not be possible to safely access the central compartment under fluoroscopic guidance due to significant lateral overcoverage of the femoral head. We present an outside‐in arthroscopic approach for accessing the hip joint in such patients, allowing for safe visualization, osseous pincer resection, and improved central compartment access while minimizing the risk to cartilage and labral tissue. Technique Video video See video under supplementary data.

Background: Arthrofibrosis (AF) after anterior cruciate ligament reconstruction (ACLR) remains a challenge. There is a paucity of data on arthroscopic interventions for AF after ACLR. Purpose: To (1) describe the patient, injury, and surgical characteristics and patient-reported outcomes (PROs) of those requiring an arthroscopic intervention for loss of motion after ACLR and (2) compare outcomes between patients undergoing an early intervention (within 3 months) versus those undergoing a late intervention (after 3 months). Study Design: Case series; Level of evidence, 4. Methods: Patients with a history of ACLR and a subsequent operative procedure for postoperative AF at a single institution between 2000 and 2018 were retrospectively identified. Arthroscopic interventions included lysis of adhesions, capsular release with or without manipulation under anesthesia, and excision of cyclops lesions. Patients were excluded if they had a knee dislocation or multiple-ligament injury, a periarticular fracture, or less than 2-year follow-up from the arthroscopic intervention. PROs including the Tegner activity score, visual analog scale pain score, and International Knee Documentation Committee score as well as knee range of motion (ROM) were recorded. Results: A total of 40 patients were included with a mean age of 27.2 years (range, 11.0-63.8 years) at surgery and a mean follow-up of 10.0 years (range, 2.9-20.7 years). The mean preoperative flexion and extension were 102° (range, 40°-150°) and 8° (range, 0°-25°), respectively. The mean postoperative flexion and extension were 131° (range, 110° to 150°) and 0° (range, –10° to 5°), respectively. After the arthroscopic intervention, the mean ROM improved from 94° (range, 40°-140°) preoperatively to 131° (range, 107°-152°) at final follow-up ( P < .001), and the visual analog scale pain score improved from 3.0 preoperatively to 1.2 postoperatively ( P = .001). Overall, 13 patients (32.5%) underwent an intervention within 3 months and 27 (67.5%) after 3 months. The early intervention group had a higher postoperative International Knee Documentation Committee score compared with the late intervention group (86.8 vs 71.7, respectively; P = .035). Conclusion: An arthroscopic intervention for AF after ACLR successfully improved knee ROM and pain. Patients who underwent either early or late surgery obtained satisfactory motion and function, although improved PROs were observed when the intervention occurred within 3 months of the primary procedure.