Simon, Karissa N.

Abstract Acetabular labral tears are commonly diagnosed in patients with hip or groin pain, most of which occur anterosuperiorly. In some cases, operative intervention in the form of arthroscopic labral repair may be necessary to restore labral function. Posterolateral tears can be technically challenging when using traditional modified anterior portal and anterolateral (AL) portal access owing to a suboptimal drill trajectory. In this article, we describe the establishment of a posterolateral (PL) portal 1 to 2 cm posterior to the tip of the greater trochanter, mirroring the distal‐to‐proximal trajectory of the AL portal and entering the capsulotomy at the 10‐o'clock position. This method highlights that the PL portal is used for drilling and anchor placement, whereas the remaining work is performed through the AL portal. This avoids the use of any shavers or burrs in the PL portal near important neurovascular structures, including the sciatic nerve. Addressing posterolateral labral tears in the 9‐ to 11‐o'clock position using a PL portal can enhance labral fixation, thereby mitigating the risk of suboptimal repairs that can negatively impact postoperative outcomes. Technique Video video See video under supplementary data.

Purpose To report the clinical outcomes and reoperation rates of arthroscopic and endoscopic iliopsoas release at short‐term follow‐up after ipsilateral total hip arthroplasty (THA) at 2 separate medical institutions and to evaluate whether demographic and radiographic parameters are associated with postoperative patient‐reported outcomes (PROs). Methods Patients with iliopsoas tendinitis in the setting of prior THA who underwent arthroscopic iliopsoas fractional lengthening from 1988 to 2023 at 2 academic institutions were reviewed. Patients were included if they had 12 months of follow‐up and underwent evaluation of preoperative anterior acetabular component overhang, surgery satisfaction, postoperative subjective hip flexion strength and anterior groin pain improvement, modified Harris Hip Score, Single Assessment Numeric Evaluation score, Tegner activity scale score, visual analog scale (VAS) score, and revision hip arthroplasty. Results Sixty hips in 58 patients (19 male and 39 female patients) were followed up for a mean of 39.3 months (range, 12.0‐105.9 months) postoperatively. Of the patients, 77% reported feeling “much better” or “slightly better,” 75% reported improved anterior groin pain, and 60% reported improved subjective hip flexion strength. The surgery satisfaction rating was 7.2 ± 3.3 (scale of 0 to 10). The mean postoperative modified Harris Hip Score, VAS score for pain at rest, VAS score for pain with use, and Single Assessment Numeric Evaluation score were 73.9 ± 19.4, 1.3 ± 2.4, 3.8 ± 2.9, and 71.9 ± 21.9, respectively. Preoperative anterior acetabular component overhang was 3.3 ± 6.5 mm and did not significantly correlate with postoperative PROs ( P ≥ .45). The Tegner score improved from 2.5 ± 1.7 preoperatively to 2.9 ± 1.4 postoperatively ( P = .0253). Three patients underwent revision arthroplasty at a mean of 25.3 months (range, 11.6‐40.4 months) postoperatively, with an acetabular component revision rate of 3.3%. Conclusions Satisfactory outcomes and low revision arthroplasty rates were observed in patients undergoing arthroscopic iliopsoas lengthening after THA. There was no statistically significant relation between anterior acetabular component overhang and final PROs. Level of Evidence Level IV, therapeutic case series.

Abstract Capsular management in hip arthroscopy has recently become a popular topic in the literature. Various approaches have been developed around the critical balance between safe and satisfactory exposure while maintaining hip joint stability and the restoration of capsular integrity at the conclusion of the case. Advocates for capsular closure recognize the role of the capsule in providing hip joint stability and aim to reestablish normal hip biomechanics through capsule preservation. Several recent studies have also shown capsular management strategies to influence both clinical outcomes and risk of revision surgery. We present an effective method for capsular management in hip arthroscopy that consistently allows excellent exposure and working space while allowing for facile, anatomic closure. Technique Video video See video under supplementary data.