The Physics of Postless Hip Arthroscopy.

Hip arthroscopy is commonly performed to treat femoroacetabular impingement syndrome. A post-assisted arthroscopic hip preservation surgery approach provides joint distraction for central-compartment access. Owing to the location, compression of the post in the perineum may cause injuries to the pudendal nerve, perineal soft tissue, or genitourinary system.

The critical importance of recognition, evaluation, and management of mental health on outcomes following hip arthroscopy - A synthetic narrative review: Current concepts.

Mental health and wellness influence patients with hip pain and dysfunction secondary to Femoroacetabular Impingement Syndrome, acetabular dysplasia, and labral injury. Disorders of mental wellness may impact hip preservation surgery patients both before and after surgery. Major depression and generalized anxiety are the two most common diagnoses that affect hip preservation surgery patients.

Management of Proximal Hamstring Injuries: Non-operative and Operative Treatment.

Purpose Of Review: To evaluate the current evidence and literature on treatment options for proximal hamstring injuries.

Recent Findings: Patients with 3-tendon complete tears with greater than 2 cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up.

Editorial Commentary: Long-Term Follow-Up After Endoscopic Gluteal Repair Plus Hip Arthroscopy Shows Durable Results Using Validated Patient-Reported Outcome Scores That Largely Exceed the Minimal Clinically Important Difference and Patient Acceptable Symptom State.

Gluteus medius and minimus tendon pathology is a common cause of lateral hip pain. In patients who are dissatisfied with their hip condition following nonsurgical treatment, gluteal repair has demonstrated excellent short-, mid-, and, now recently, long-term subjective patient-reported and objective clinician-measured outcomes. In patients with peritrochanteric hip pain, the proportion of their overall hip pain may be influenced by the hip joint due to conditions like femoroacetabular impingement syndrome, acetabular dysplasia, labral tears, and arthritis.

Editorial Commentary: Artificial Intelligence Analysis of Biomedical, Large, Clinical Registry Data Using Machine Learning Requires Tens of Thousands of Subjects and a Focus on Substantial Clinical Benefit: Minimal Clinically Important Difference Is too Low a Bar.

As the field of arthroscopic hip preservation surgery grows, large high-quality registries represent a foundational study design for establishing whether hip arthroscopy is effective for patients with femoroacetabular impingement syndrome (FAIS). Original research publications from experienced high-volume surgeons tell us "Can it work". A registry tells us "Does it work?".

A High Incidence of Perineal Post-Related Complications After Hip Arthroscopy Is Self-Reported by Patients in Anonymous Online Forums.

Purpose: To evaluate online, self-reported pudendal nerve or perineal injuries related to the use of a perineal post during hip arthroscopy.

Methods: Public posts on Reddit and the Health Organization for Pudendal Education were searched to identify anonymous individuals reporting symptoms of pudendal nerve or perineal injury following hip arthroscopy. Included posts were by any individual with a self-reported history of hip arthroscopy who developed symptoms of pudendal nerve injury or damage to the perineal soft tissues.

Editorial Commentary: Femoral Version and Capsular Thickness Analysis in Hip Preservation Surgery-Surgical Indications Are as Important as Surgical Technique.

Optimal treatment of patients with femoroacetabular impingement syndrome requires both thoughtful decision-making and skillful operative technique. Traditional evidence-based literature and routine clinical practice overemphasize the role of the alpha angle on the femoral side and lateral center edge angle on the acetabular side. Femoral and acetabular version are critical values that influence outcomes and warrant measurement and consideration.

Evaluation and Management of the Athlete's Hip.

Hip and groin pain is common in athletes, and there are many possible underlying pathologies. It is important to describe athletic hip pathology in the context of sport-specific physiologic loads and biomechanical demands. Three distinct types of athletes with this pathology are collision athletes, hypermobility athletes, and endurance athletes.

Microfracture of Acetabular Chondral Lesions Is Not Superior to Other Cartilage Repair Techniques in Patients With Femoroacetabular Impingement Syndrome: A Systematic Review.

Purpose: To perform a systematic review to compare clinical outcomes of hip arthroscopy patients undergoing microfracture (MFx) versus other cartilage repair procedures for chondral lesions of the acetabulum.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify comparative studies that directly compared outcomes between MFx and other cartilage repair procedures for full-thickness chondral lesions of the acetabulum identified during hip arthroscopy. The search phrase used was: hip AND arthroscopy AND microfracture.

Comparison of the PROMIS and iHOT-12 in Determining Satisfaction Levels After Hip Arthroscopy for FAIS.

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) has not been fully evaluated for outcomes assessment after hip arthroscopy to correct femoroacetabular impingement syndrome (FAIS).

Purpose/hypothesis: The purpose of this study was to compare the accuracy of the PROMIS Physical Function (PF) and Pain Interference (PI) subscales with the 12-Item International Hip Outcome Tool (iHOT-12) to define patients with 3 unique substantial clinical benefit (SCB) scores-patients who reported ≥80%, ≥90%, and 100% satisfaction at 1 year after hip arthroscopy for FAIS. We hypothesized that the iHOT-12 would be more accurate than the PROMIS-PF and PROMIS-PI subscales in identifying these 3 patient groups.

Postless Arthroscopic Hip Preservation Can be Adequately Performed Using Published Techniques.

Purpose: To identify and evaluate techniques used for postless hip arthroscopy.

Methods: A narrative review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify surgical technique articles or clinical studies describing techniques for the use of postless hip arthroscopy. Specific items sought for analysis included hip arthroscopy for femoroacetabular impingement including cam or pincer-type lesions, surgical time, traction time, traction force, bed Trendelenburg angle, intraoperative techniques, and postoperative outcomes, including complications.

Addition of Pericapsular Nerve Group and Transversus Abdominis Plane Blocks Significantly Reduces Opioid Use in Patients Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy.

Introduction: Previous studies have evaluated the effect of the pericapsular nerve group block for hip arthroscopy and the transverse abdominis plane block for periacetabular osteotomy and have shown decreased narcotic consumption in both groups. No published study has evaluated the effectiveness of combining the blocks when performing hip arthroscopy and periacetabular osteotomy under the same general anesthesia. It was hypothesized that patients treated for hip dysplasia with hip arthroscopy and concomitant periacetabular osteotomy using a pericapsular nerve group block, transverse abdominis plane block, and general anesthesia would have decreased postoperative pain and require less narcotic consumption than those undergoing the procedure with general anesthetic alone.

Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis.

Background: Routine hip magnetic resonance imaging (MRI) before arthroscopy for patients with femoroacetabular impingement syndrome (FAIS) offers questionable clinical benefit, delays surgery, and wastes resources.

Purpose: To assess the clinical utility of preoperative hip MRI for patients aged ≤40 years who were undergoing primary hip arthroscopy and who had a history, physical examination findings, and radiographs concordant with FAIS.

Study Design: Cohort study; Level of evidence, 3.

Guidelines for Proper Reporting of Clinical Significance, Including Minimal Clinically Important Difference, Patient Acceptable Symptomatic State, Substantial Clinical Benefit, and Maximal Outcome Improvement.

Patient-reported outcome measures (PROM) need to be responsive, reliable, and validated for the specific condition or treatment. PROMs also need to exhibit a dose-dependent response across a diverse patient population, unlimited by floor and ceiling effects. Statistically significant differences between compared groups might not always represent clinically important differences.

Current Trends in the Use of Postless Hip Arthroscopy: A Survey of the International Society for Hip Arthroscopy Membership.

Background: Previous studies have demonstrated the risks of pudendal nerve and/or soft tissue complications due to the use of a perineal post during hip arthroscopy. Recently, various postless hip arthroscopy techniques have been described in the literature.

Purpose: To assess the current international trends in the use of postless hip arthroscopy among hip preservation specialists.

Quantitative high-resolution 7T MRI to assess longitudinal changes in articular cartilage after anterior cruciate ligament injury in a rabbit model of post-traumatic osteoarthritis.

Objective: To demonstrate an ultra-high field (UHF) 7 ​T delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) protocol for quantitative post-traumatic osteoarthritis (PTOA) detection and monitoring in a rabbit anterior cruciate ligament transection (ACLT) model.

Design: ACL transections were performed unilaterally in 5 rabbits (33-weeks-old, 3.5 ​± ​0.

Acetabular Paralabral Cyst Causing Obturator Nerve Compression in the Setting of Femoroacetabular Impingement Syndrome: A Case Report.

Case: Large acetabular paralabral cysts can cause compression of the surrounding neurovascular structures leading to sensory and motor deficits. We present a 68-year-old man with obturator nerve denervation from a paralabral cyst secondary to a labral tear associated with femoroacetabular impingement syndrome. Resolution of symptoms and return to full activities were achieved at 3 months and maintained beyond 1 year through open cyst excision, obturator neurolysis, arthroscopic femoral osteoplasty, and labral repair in the same surgical setting.

Editorial Commentary: The Pelvis is the Lowest Vertebral Level: Diagnostic Approach to Hip-Spine Syndrome.

The human pelvis represents a wonderful example of apparent idealistic simplicity overwhelmed by realistic complexity. Traditionally, the pelvis has been termed a "ring" linking the lower extremity to the spine via the sacroiliac joint. In essence, the pelvis is the lowest vertebral level-"the hip bone's connected to the spine bone.

Treatment of a descending thoracic mycotic aneurysm secondary to disseminated aspergillosis infection with thoracic endovascular aortic repair.

Mycotic aortic aneurysms are a rare and potentially fatal aortic pathology. Advancements in vascular technology have allowed endovascular repair to be a durable and less invasive option for the treatment of mycotic aortic aneurysms. We have presented the case of a 51-year-old man with a mycotic aneurysm of the descending thoracic aorta secondary to chronic, disseminated aspergillosis infection after liver transplantation.