Citations

Abstract Purpose Acetabular overcoverage (pincer morphology) has been suggested to be both a source of pain and dysfunction as well as potentially protective against osteoarthritic change. The purpose of this study was to compare minimum 5-year clinical outcomes of patients undergoing primary hip arthroscopic labral repair with a lateral center edge angle (LCEA) of ≥ 40° as compared to non-dysplastic controls with an LCEA of 25-40°. Methods We identified all patients that underwent primary hip arthroscopy with labral repair between 2009-2019 at a single academic institution. Patients with LCEA ≥ 40° (pincer) were propensity matched to non-dysplastic controls with LCEA 25-40° on a 1:2 basis by sex, age, body mass index (BMI), and year of surgery. Patient-reported outcome measures (PROMs) including Visual Analog Scale (VAS) for pain, Tegner activity score, modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and Hip Outcome Score (HOS) were analyzed, as were reoperations and conversions to total hip arthroplasty (THA). Results Fifty-five patients with pincer morphology (mean preoperative LCEA: 41.9°, Tonnis angle: -7.3°, alpha angle: 58.8°) were matched to 110 non-dysplastic controls (LCEA: 31.2°, Tonnis angle: 2.2°, alpha angle: 58.9°), resulting in a total of 165 hips in 163 patients (67% females, mean age: 37.7 years, BMI: 26.8 kg/m2). Pincer patients were corrected to a mean postoperative LCEA of 38.7° (p<0.0001), with 22 pincer patients having residual overcoverage, namely a postoperative LCEA ≥ 40° (range: 40.0-45.8°). At mean 7.8 years follow-up (range: 5.1-13.2), there was no difference in any postoperative PROMs between pincers and controls (p>0.15) and no difference in PROMs between patients with residual overcoverage and pincer patients with a postoperatively normalized LCEA (p>0.25). At final follow-up, 4 patients in the pincer cohort (7%) and 21 controls (19%) had converted to THA (p=0.046). Conclusion Patients with lateral acetabular overcoverage demonstrated similar and satisfactory postoperative PROMs at a minimum of 5-year follow-up compared to propensity-matched non-dysplastic controls, regardless of if the LCEA was corrected to <40°. Of note, non-dysplastic controls demonstrated an increased rate of conversion to THA, supporting the potentially chondroprotective role of acetabular overcoverage.

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.

Objectives: Historically, horizontal cleavage meniscus tears have been debrided with single leaflet preservation, but more recently this has been challenged by repair of these tear types. While circumferential meniscus repair with all-inside and inside-out instrumentation has been described, there remains a paucity of literature regarding the clinical outcomes of this technique. Our purpose was to assess clinical outcomes and reoperation rates of circumferential meniscus repair for horizontal cleavage tears at minimum 2-year follow-up. Methods: Patients with isolated horizontal cleavage tears of the meniscus (Fig. 1a) undergoing primary circumferential meniscus repair (Fig. 1b), including both inside-out and all-inside suturing techniques, at a single institution between 2015 and 2022 were eligible for inclusion and analyzed retrospectively. Arthroscopic images and operative notes were examined to confirm circumferential meniscal repair. Patient demographics, surgery details, and clinical findings were extracted from the institutional electronic medical records. Exclusion criteria consisted of patients not consenting for research, less than 2-years of clinical follow-up, and concurrent ipsilateral repair of a non-horizontal cleavage tear. Patients were not excluded if they had a concomitant anterior cruciate ligament reconstruction (ACLR). Thirty-seven patients met the criteria for inclusion in this study. Knees were analyzed for laterality, number of sutures, suturing technique, concurrent injuries, concurrent procedures, and surgical history. Visual Analogue Scale (VAS) for pain, Tegner, and International Knee Documentation Committee (IKDC) scores were collected at minimum 2-year follow-up and analyzed. Return to sport (RTS) and revision surgery were analyzed. Results: Thirty-seven patients (25 male, 12 female; mean age, 29.4 ± 12.4 years) who underwent circumferential meniscal repair of a horizontal cleavage tear were included in the study and followed for a mean of 6.2 years (range, 2.2-9.3 years, Table 1). There was a total of 38 knees (23 right, 15 left). One patient (3%) had bilateral circumferential meniscal repair surgeries done at separate times. Three (16%) patients failed primary repair and had secondary partial meniscectomy. Similar numbers of circumferential meniscal repairs were performed on lateral and medial menisci, 21 (55%) and 17 (45%), respectively. An average number of 3 ± 2 sutures were used at the time or repair with one of 38 menisci (3%) having a hybrid combination of both all-inside and inside-out suture technique, 24 menisci (63%) had all-inside technique, and 13 menisci (34%) had inside-out technique. Concurrent procedures included 4 ACL reconstructions (3 autograft, 1 allograft), and 8 chondroplasties (4 patella, 2 trochlea, 1 medial femoral condyle, and 1 unspecified, Table 2). At the time of final follow-up, patients reported mean Tegner activity scores of 6.2 ± 2.3, VAS pain with rest of 1.0 ± 2.0, VAS pain with use of 2.5 ± 2.7, and IKDC of 81.6 ± 18.6. When asked, using a VAS Five Point scale, how their knee is currently compared to before their surgery, 14 (74%) feel much better than before surgery, 2 (11%) feel slightly better than before surgery, 1 (5%) feels no change when compared to before their surgery, 2 (11%) feel slightly worse than before surgery, and no one felt much worse than before surgery. Sixteen patients were involved in sports before their surgery. Of those that played sports before their surgery, 14 (88%) returned to sport (Table 3). The most common sports played were hockey (19%), volleyball (19%), tennis (13%), and football (13%). Levels of sport played before surgery included 7 (44%) recreational, 6 (38%) high school, 2 (13%) college, and 1 (6%) club. Levels of sport played after surgery for those who returned to sport included 6 (43%) recreational, 2 (14%) high school, 5 (36%) college, and 1 (7%) club with a significant increase in levels of sport played after surgery ( p ≤ 0.006) compared to before surgery. Conclusions: At an average of 6-years of follow up, there was an 84% success rate of circumferential meniscal repair for horizontal cleavage tears. Most patients who play sports, return to sport and do so at the same or higher level and report successful PROMs. Circumferential meniscal repairs should be considered for patients with horizontal cleavage tears.

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.