Ina, Jason

Abstract Purpose Patients presenting for iliopsoas tendinitis consultation after total hip arthroplasty (THA) often describe a prolonged time to diagnosis and subsequent surgical management. The purpose of this study was to quantify time from symptom onset to diagnosis and subsequent arthroscopic iliopsoas fractional lengthening, including number of providers seen. Methods Patients undergoing arthroscopic iliopsoas fractional lengthening after THA were prospectively identified between 2023-2025 at a single institution. Time from symptom onset to iliopsoas tendinitis diagnosis as well as arthroscopic lengthening were determined. Number of providers seen, diagnostic relief from preoperative iliopsoas bursal injections, and postoperative satisfaction after fractional lengthening were also evaluated to better quantify indications and outcomes of arthroscopic intervention in this population. Results A total of 44 hips in 41 patients (23 females and 18 males) were included (mean age: 64.7 ± 10.2, mean BMI: 29.9 ± 5.9 kg/m2). Of note, 7 patients (16%) had undergone revision THA prior to iliopsoas symptom onset. Patients had on average 2.2 ± 2.1 years of symptoms and saw 2.5 ± 1.7 [range: 1-8] providers prior to being diagnosed with iliopsoas tendinitis and referred for consideration of arthroscopic fractional lengthening. Preoperatively, 93% of patients underwent at least 1 iliopsoas bursal corticosteroid injection, with an average of 81.1% symptom relief during the diagnostic (anesthetic) phase. The mean time between THA and iliopsoas fractional lengthening was 4.8 ± 3.4 years, whereas the mean time between initial iliopsoas tendinitis symptoms to fractional lengthening was 3.1 ± 2.5 years. At a mean of 11.3 ± 6.8 months postoperatively, mean surgery satisfaction was 8.1 ± 2.6 on a scale of 1 to 10, with the vast majority of patients (89.5%) stating that they would undergo fractional lengthening again. Conclusion Patients often experience a protracted period of symptoms and see multiple clinicians prior to being diagnosed with iliopsoas tendinitis and undergoing arthroscopic management. In patients refractory to conservative management, arthroscopic fractional lengthening can provide high surgery satisfaction, with most patients stating they would undergo the procedure again. These findings highlight the importance of increased recognition and appropriate referral of patients with iliopsoas tendinitis following THA.

Abstract Purpose To investigate clinical outcomes, including patient reported outcome measures (PROMs), subjective anterior groin pain and hip flexion strength, and reoperation rates following arthroscopic iliopsoas fractional lengthening after total hip arthroplasty (THA). Methods Patients who were indicated for arthroscopic iliopsoas fractional lengthening after ipsilateral THA were prospectively identified between 2023-2025 at a single institution. Pre- and post-operative PROMs, including Visual Analog Scale (VAS), Tegner activity scale, Single Assessment Numeric Evaluation (SANE), and subjective anterior groin pain and hip flexion strength were analyzed. Reoperations at final follow-up were also evaluated. Results A total of 44 hips in 41 patients (23 females and 18 males) were included (mean age: 64.7 ± 10.2, mean BMI: 29.9 ± 5.9 kg/m2). Fifty-five percent of patients underwent surgery on their right hip. The mean postoperative follow-up timeframe was 10.0 ± 7.1 months. There was a significant improvement in postoperative PROMs compared to pre-operative levels for VAS at rest (1.3 ± 1.9 vs. 2.9 ± 2.2), VAS with use (3.1 ± 3.8 vs. 8.0 ± 1.6), Tegner activity scale (2.9 ± 1.3 vs. 2.1 ± 1.1), and SANE (74.0 ± 20.3 vs. 47.9 ± 23.4) (p<0.001 for all). Over 90% of patients reported feeling much better or slightly better regarding their anterior groin pain at 2-weeks post-operatively (93%), 6 weeks post-operatively (90%), 3 months post-operatively (93%), and at final follow-up (91%). Regarding hip flexion strength, 73% reported feeling much better or slightly better at 2-weeks post-operatively, 95% at 6-weeks post-operatively, 85% at 3 months post-operatively, and 61% at final follow-up. Only 2 patients (5%) reported feeling much weaker at final follow-up. Two of 44 hips (5%) underwent reoperation at final follow-up. One patient underwent a 2-stage revision THA at 5 months postoperatively due to infection, while 1 patient underwent an open iliopsoas release with acetabular screw removal and liner exchange. Overall, the mean surgery satisfaction was 8.1 ± 2.6 on a scale of 1-10. Conclusion Patients who underwent arthroscopic iliopsoas fractional lengthening following THA demonstrated satisfactory postoperative outcomes, with over 90% reporting durably improved anterior groin pain and nearly two-thirds reporting increased hip flexor strength throughout follow-up.

Abstract The acetabular labrum is a fibrocartilaginous structure that deepens the acetabular socket and helps maintain a suction seal. In patients with hip dysplasia, a distinct labral tear pattern called an inside‐out labral tear is often seen. This tear pattern is particularly challenging to correct via conventional techniques since the labrum can potentially remain everted and insufficiently restore the native hip labral suction seal after repair. An inverted hip labral repair technique is performed for this pathology at our institution and focuses on achieving optimal labral orientation to enhance the suction seal and joint stability, particularly in dysplastic hips. This Technical Note aims to describe the key surgical principles and clinical considerations of inverted hip labral repair. Technique Video video See video under supplementary data.

Abstract Meniscus allograft transplant (MAT) can provide meaningful improvement in patient outcomes in those who are otherwise meniscus deficient. A common finding in the setting of a failed MAT is meniscus extrusion. Meniscus centralization is a technique performed to reduce the meniscus to its intra‐articular location and has been shown to improve postoperative pain and function in patients with an extruded meniscus. Prior techniques have been described for meniscus centralization in the setting of a meniscus root tear or with the use of single tension devices that are tensioned after meniscocapsular fixation. We present a minimally invasive technique for meniscus centralization that can be performed in conjunction with MAT using a centralization stabilization suture and re‐tensionable root‐fixation subchondral anchors that can be secured prior to meniscocapsular fixation. Technique Video video See video under supplementary data.

Abstract As the prevalence of hip arthroscopy increases, management of capsular defects as well as capsulotomy closure has increasingly been recognized for their impact on recurrent symptoms in the young athletic hip. Several recent studies have shown that capsular closure at the time of primary hip arthroscopy improves both short‐ and long‐term patient‐reported outcomes, revision rates, and conversion to arthroplasty. Specifically, capsular insufficiency is a source of recurrent pain and microinstability. In this context, far medial labral tears pose a challenge for suture fixation, given the historic need of extending the interportal capsulotomy to obtain adequate trajectory for suture anchors and subsequent passage. Given the suboptimal stability consequences of extending the capsulotomy medially, here we present a novel approach for suture fixation of the medial labrum. This technique provides an effective method for suture fixation of the medial labrum, without necessitating extension of the interportal capsulotomy. Technique Video video See video under supplementary data.

Abstract Hip arthroscopy is a technically demanding procedure that can require a substantial volume of irrigation fluid. Techniques should be explored to optimize fluid use while ensuring satisfactory surgical instrumentation and labral repair. In this technical note, we present a method for performing a dry arthroscopic labral repair. This technique can be used in the treatment of a variety of labral pathologies, including primary labral repair with knotless or hand‐tied anchors, revision labral repair, and labral reconstruction, without the need for irrigation fluid. Additionally, we discuss supplemental techniques that can be used during other portions of the arthroscopic hip procedure to limit irrigation fluid use. Technique Video video See video under supplementary data.

Abstract The standard of care for hip labral tears is arthroscopic repair, with labral reconstruction performed more commonly for irreparable tears in order to avoid isolated labral debridement. However, labral reconstruction can be technically demanding. We provide a concise step‐by‐step guide for performing labral reconstruction or augmentation using a modified retrograde pull‐through technique, including tips, tricks, and surgeon pearls, and pitfalls. Despite the procedure's technically challenging nature, we believe our technique highlights several important steps to improve the practicality and efficiency of the case and produce satisfactory patient outcomes. Technique Video video See video under supplementary data.