Ortiz-Declet, Victor

Purpose To evaluate a delayed gadolinium‐enhanced magnetic resonance imaging of cartilage (dGEMRIC) index designed to predict focal acetabular articular cartilage damage in patients with femoroacetabular impingement (FAI). Methods The inclusion criteria were patients who underwent dGEMRIC and hip arthroscopy between April 2010 and August 2015 for FAI syndrome. The exclusion criteria were previous hip conditions, a Tönnis grade greater than 1, and a delay between magnetic resonance imaging and surgery greater than 180 days. The cutoff value for full‐thickness chondral damage was set to 350 milliseconds. The coronal anterolateral (CAL) index was designed to evaluate focal articular anterolateral chondral defects. We calculated the binary classification test of the CAL index for full‐thickness chondral damage, with arthroscopy as the gold standard. We calculated the correlation between the CAL index and the arthroscopically defined acetabular labrum articular disruption (ALAD) and Outerbridge grades and tested for differences between no or mild focal chondral damage and moderate or severe focal chondral damage. We repeated this analysis on the sagittal superior index, a combination of the sagittal anterior and posterior indices. Results A total of 195 hips (183 patients) were reviewed. The CAL index showed a sensitivity of 55% (95% confidence interval [CI], 32%‐76%), specificity of 81% (95% CI, 74%‐86%), positive predictive value of 27% (95% CI, 18%‐37%), and negative predictive value of 93% (95% CI, 90%‐96%). The CAL index showed a significant difference between no or mild focal chondral damage and moderate or severe focal chondral damage per both ALAD and Outerbridge groups ( P < .0001). The CAL index was moderately inversely correlated with ALAD and Outerbridge grades (ρ = –0.403, P < .0001). The sagittal superior index was not significantly different between the groups and showed a weak correlation with focal defects. Conclusions The CAL index may play a role in ruling out full‐thickness articular cartilage defects in patients with FAI syndrome. In addition, it may help in differentiating between no or mild focal chondral damage and moderate or severe focal chondral damage. Level of Evidence Level III, case‐control study.

Purpose To evaluate the minimum 2‐year postoperative clinical outcomes and the rate of return to sports in athletes who underwent capsular plication for the treatment of ligamentous laxity and/or borderline dysplasia during hip arthroscopy for the treatment of femoroacetabular impingement and labral pathology. Methods Since 2008, data were prospectively collected on patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement and/or labral tears. Inclusion criteria were as follows: athlete at the high school, collegiate, or professional levels preoperatively, underwent capsular plication, and preoperatively recorded patient‐reported outcome scores including modified Harris hip score (mHHS), nonarthritic athletic hip score (NAHS), hip outcome score—sports‐specific subscale (HOS‐SSS), and visual analog scale (VAS). Exclusion criteria were as follows: <16 years old, preoperative Tönnis grade >1, and previous hip conditions. Sports activity and competitive levels were collected at a minimum of 2 years postoperatively. Results Fifty‐one hips (49 patients) met the inclusion criteria, and 41 hips (39 patients) had minimum 2‐year follow‐up (80.4% follow‐up). Mean mHHS increased from 67.1 preoperatively to 83.5 ( P < .0001). Mean NAHS increased from 66.8 to 88.8 ( P < .0001). Mean HOS‐SSS improved from 46.8 to 80.1 ( P < .0001). Mean VAS decreased from 5.1 to 1.7 ( P < .0001). Thirty‐five (85.4%) hip arthroscopies allowed the patients to return to sports at follow‐up. Thirty‐four (82.9%) hip arthroscopies allowed the patients to maintain their competitive physical abilities at follow‐up. Conclusions Patient‐reported outcomes and VAS in athletes significantly improved at a minimum of 2 years after capsular plication as a part of hip arthroscopy addressing varying pathologies. In addition, most patients returned to sports at similar or higher competitive levels. These results suggest that capsular plication is a favorable treatment option in athletes with ligamentous laxity and/or borderline dysplasia. Level of Evidence Level IV, therapeutic case series.