Citations

Purpose To evaluate the agreement between a simple magnetic resonance imaging‐based measurement method for determining the patellar tendon‐to‐lateral trochlear ridge (PT‐LTR) distance using an external adhesive marker and a previously validated conventional measurement technique. Methods Patients diagnosed with patellofemoral instability before undergoing primary patellar stabilization surgery at a single institution between 2020 and 2024 were eligible for inclusion. PT‐LTR distances were measured in a blinded fashion by 2 musculoskeletal‐trained radiologists using the conventional technique and by an orthopaedic group using the simple technique. Interrater reliability between the musculoskeletal‐trained radiologists and between the orthopaedic groups was calculated using intraclass correlation coefficients (ICCs) and concordance correlation coefficients (CCCs) and subsequently intermethod reliability between the 2 groups. The measurements were plotted on concordance correlation graphs. Results One hundred knees (38 right, 62 left) from 97 patients (37 men, 60 women; mean age 22 ± 9 years) were included. The average distance for PT‐LTR measured by the radiologists using the conventional technique was 10.9 ± 7.5 mm and by the orthopaedic group using the simple technique was 9.3 ± 6.8 mm. Excellent interobserver agreement was noted for the radiologist group (ICC 0.941, 95% confidence interval [CI], 0.914‐0.960; CCC 0.941, 95% CI, 0.915‐0.959) and orthopaedic group (ICC 0.976, 95% CI, 0.964‐0.985; CCC 0.976, 95% CI, 0.965‐0.984). Excellent intermethod agreement was noted between the 2 techniques (ICC 0.903, 95% CI, 0.775‐0.942; CCC 0.902, 95% CI, 0.861‐0.932). Conclusions There was excellent interobserver reliability for measuring PT‐LTR distance using both the conventional radiologist‐based technique and the external adhesive marker technique. Excellent intermethod agreement was also shown between the 2 techniques, with comparable mean measurements between groups; thus, the simple technique can be used as a reproducible alternative for PT‐LTR distance. Level of Evidence Level III, retrospective comparative study.

Purpose To assess the reliability, predictability, and discriminative capacity of 3 anatomic measurements, tibial tubercle‐trochlear groove (TT‐TG), tibial tubercle‐posterior cruciate ligament, and patellar tendon‐lateral trochlear ridge (PT‐LTR), where PT‐LTR may offer a complementary approach to assessing recurrent patellofemoral instability (PFI) risk. Methods Patients diagnosed with PFI before primary patellofemoral stabilization surgery at a single institution between 2022 and 2024 were included. A control group without PFI was propensity matched 1:1 for age, sex, and laterality. Magnetic resonance images were evaluated to measure TT‐TG, tibial tubercle‐posterior cruciate ligament, and PT‐LTR. A priori power analysis determined the cohort size. Statistical analyses compared differences between the PFI and control groups with Student t‐tests, receiver operating characteristic analyses, and area under the curve with resultant sensitivity, specificity, and an optimal cutoff. Results Patients included 50 knees with PFI (28 women, 22 men; mean age 18 ± 5 years). The control group included 50 knees (27 women, 23 men; mean age 18 ± 4 years). Excellent inter‐ and intra‐rater reliability (intraclass correlation coefficient > 0.7) was shown for TT‐TG and PT‐LTR in the PFI and control groups. The distances for TT‐TG, tibial tubercle‐posterior cruciate ligament, and PT‐LTR were significant predictors ( P ≤ .025) of PFI. The average PT‐LTR distance difference for the PFI and control groups was 7.0 mm ( P < .001). PT‐LTR showed an area under the curve of 0.80 and, when ≥4.6 mm, was 66% sensitive and 92% specific for PFI. Conclusions The PT‐LTR distance is a reliable and discriminative metric for identifying PFI in both pediatric and adult populations. A PT‐LTR cutoff value of 4.6 mm showed diagnostic discrimination and substantially high specificity for recurrent PFI, indicating strong ability to identify patients with instability. Level of Evidence Level III, retrospective case control study.

Medial ulnar collateral ligament (MUCL) injuries of the elbow have increased over the past 2 decades, particularly among adolescent and young adult overhead throwing athletes. Over time, operative techniques for MUCL injuries have evolved, with the goals of improving time to return and rates of return to sport and meeting athlete-specific demands. The purpose of this review is to evaluate the state of surgical management of MUCL injuries, assessing indications, techniques, and outcomes. Surgical techniques reviewed included MUCL-augmented repair with internal bracing, traditional reconstruction, reconstruction augmented with internal bracing, and revision MUCL reconstruction. While MUCL reconstruction has been the gold standard of treatment, augmented reconstruction and repair techniques have shown promising outcomes; these strategies emphasize anatomic restoration, preservation of native tissue, and individualized patient selection.

Introduction In recent years collared femoral stems have been increasingly utilized in total hip arthroplasty (THA) for their ability to improve rotational stability, metaphyseal load transfer, and prevent periprosthetic femoral fracture (PFF). While literature has demonstrated their benefit over collarless stems, the clinical and biomechanical implications of a postoperative collar–calcar gap (CCG) after implantation remain incompletely understood. Objective The purpose of this scoping review was to evaluate existing literature around CCG in primary THA. Methods A PRISMA Scoping Review literature search was conducted across Ovid MEDLINE, Embase, Cochrane CENTRAL, and Scopus databases. Studies were included if they reported CCG incidence, subsidence, remodeling, or biomechanical performance in primary THA. Two independent reviewers screened studies and extracted data, and clinical study quality was assessed using the Newcastle–Ottawa Scale. Results A total of 408 studies were identified and 11 met inclusion criteria. The incidence of postoperative CCG varied from 18.7% to 53.9%. Most gaps demonstrated closure over time (66–76%). Biomechanical and finite element studies showed improved stability, reduced micromotion, and decreased periprosthetic fracture risk when direct collar–calcar contact was achieved. In contrast, stems with persistent gaps demonstrated increased subsidence (up to 19% vs 1.3%) and biomechanical behavior comparable to collarless designs. Conclusion CCG is common following THA. The majority of gaps resolve, however biomechanical evidence demonstrates that the advantages of collared stems depend on calcar contact. Preventing CCG may optimize early implant stability, though surgical technique must balance mechanical engagement with preservation of proximal femoral bone stock.

Abstract Introduction Periacetabular osteotomy (PAO) is performed in the setting of hip dysplasia to increase acetabular coverage of the femoral head and improve joint biomechanics and longevity. PAO fixation is generally achieved with two or three 4.5 mm screws, as compared to the generally more substantial plate and screw constructs used in the setting of acetabular fractures or pelvic ring injuries. The purpose of this study was to evaluate postoperative changes in hip joint center medialization and lateral acetabular coverage following PAO, understanding that these radiographic measures are generally used to guide intra-operative assessment of correction. Methods A retrospective chart review of 100 consecutive PAOs during 2021-2023 at a single academic institution by four surgeons was performed. Perioperative radiographs and fluoroscopy images were evaluated to measure lateral center edge angle (LCEA), Tönnis angle, and medialization of the hip joint center. The hip joint center was measured at one-third of the diameter of the femoral head from inferior to superior, to the ilioischial line, as previously validated by Fowler and colleagues. Results One hundred PAOs in 87 patients (87% female, mean age: 23.0 years) were included. Average preoperative radiographic parameters were 19.9° for LCEA, 12.5° for Tönnis angle, and 12.6 mm for distance from the femoral head to ilioischial line. Ninety-four cases (94%) used three screws, and 6 cases (6%) used two screws for unstable fragment fixation. On immediate postoperative films, average correction was to 28.3° for LCEA, 4.9° for Tönnis angle, and 1.9 mm of pre- to postoperative femoral head medialization (p≤0.001). Patients were radiographically followed for an average of 13.3 months, with an average time to radiographic union of 7.1 months. During the course of follow-up, LCEA increased to 29.3°, Tönnis angle remained to 5.0° (p=0.47), and medialization increased to 2.7 mm (p≤0.02), suggesting further significant but clinically modest increases in lateral coverage and femoral head medialization. Conclusion While the majority of lateral acetabular coverage and femoral head medialization occurs intra-operatively at the time of PAO, patients undergo modest but statistically significant postoperative increases in lateral coverage and medialization prior to radiographic union.

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&lt;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&gt;0.15) and no difference in PROMs between patients with residual overcoverage and pincer patients with a postoperatively normalized LCEA (p&gt;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 &lt;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 Introduction Understanding factors that impact outcomes of total hip arthroplasty (THA) can aid clinical decision-making and patient counselling. The purpose of this study was to investigate functional outcomes, complications, and reoperation rates among patients undergoing primary THA after hip arthroscopy (HA-THA) compared to a matched cohort of primary THA patients without prior arthroscopy (THA-only). Methods A retrospective review was performed to identify all patients who underwent primary THA after prior hip arthroscopy from 2009-2022 at a single institution. Patients with a history of revision arthroscopy were excluded. Cases were propensity-matched with primary THA controls in a 1:4 ratio by age at time of THA, sex, body mass index, surgical approach, and year of surgery. At minimum 2-year follow-up, patient-reported outcomes (PROs) including Forgotten Joint Score (FJS), Modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score Pain (HOOS pain), and Visual Analog Pain Scale (VAS) were analyzed. Results Sixty-three hips in 60 patients (age: 47.3±9.4 years, BMI: 29.8±6.2 kg/m2) were matched to 252 THA-only hips, with patients converting to THA at a mean 3.1 years (range 0.3-10.3) following hip arthroscopy. While both HA-THA and THA patients demonstrated significant (p&lt;0.001) postoperative improvements in PROs, HA-THA patients reported significantly lower postoperative FJS, mHHS, HOOS pain, and VAS pain scores (p&lt;0.001) as compared to THA-only controls. At mean 6.6±3.2 years follow-up, HA-THA patients with preoperative Tönnis grades 2-3 reported significantly increased FJS, mHHS, and HOOS pain compared to those with preoperative Tönnis grades of 0-1 (p≤0.03). Additionally, HA-THA patients with preoperative Tönnis grades 0-1 exhibited worse PROs (p&lt;0.001) as compared to THA-only controls. While there were no differences in complication rates between HA-THA patients and THA-only controls (8% vs. 5%, p=0.49), all-cause reoperation was greater amongst HA-THA patients compared to THA-only (10% vs. 2%, p=0.01). Conclusion While improved compared to preoperatively, patients undergoing THA after prior hip arthroscopy demonstrated inferior outcomes at mid-term follow up as compared to a demographically age-matched cohort without prior arthroscopy. When considering conversion to THA following arthroscopy, clinicians should consider counseling patients regarding improved outcomes in the setting of advanced radiographic osteoarthritis, and potentially increased all-cause reoperation.

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&lt;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.