bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Contact Pressures Between Partial and Complete Femoral Osteoplasty Treatment in Hips with CAM Impingement
Authors: Suppauksorn Sunikom , Beck Edward , Cancienne Jourdan , Shewman Elizabeth , Chahla Jorge , Krivicich Laura , Nho Shane , Rasio Jonathan 
Published: July 2020

Objectives: To determine hip biomechanical properties in three conditions including 1) native cam deformity 2) cam deformity with incomplete resection and 3) cam deformity with complete resection. Methods: A cadaveric study was performed using 8 frozen hemi-pelvises with cam-type deformity (alpha angle >55 degrees) with an intact labrum. Intraarticular pressure maps were produced for each specimen under the following conditions: 1) native cam deformity, 2) cam deformity with incomplete resection and 3) cam deformity with complete resection. A 5.5-mm burr was used to resect the lateral portion of the cam deformity. The specimen was placed in a custom-designed jig in the MTS electromechanical test system to create pressure and area map measurements. In each condition, contact pressure, contact area, and peak force within a region-of-interest (ROI) were obtained. Repeated measurements were performed three times in each condition and the average value of each parameter was used for statistical analysis. Repeated measures ANOVA was used to compare biomechanical parameters between three conditions. Results: Contact pressures averages of hips with complete resection of cam lesions were significantly lower when compared to averages of hips with incomplete femoral cam lesion and intact cam deformity (2.48+0.56 kg/cm3 vs 2.32+0.50 kg/cm3 vs 2.02+0.54 kg/cm3, respectively; p-value<0.01). Percentage reduction of contact pressure in the complete and incomplete resection groups compared to the native CAM deformity groups were 18.49% and 1.58%, respectively. There was no statistically significant difference in contact pressures between the incomplete resection and unoperated group. Contact area and peak force showed no statistically significant differences across three conditions. Conclusion: There are lower intraarticular hip contract pressures in complete resection of the cam lesions when compared to an incomplete resection and intact hip without resection. These observations underscore the importance of ensuring complete resection of femoral cam lesions in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. [Table: see text]
Proximal Over-Resection During Femoral Osteochondroplasty Negatively Affects the Distractive Stability of the Hip Joint
Authors: Lim Daniel , Nelson Trevor , Eberlein Samuel , Banffy Michael , Metzger Melodie , Lazaro Lionel 
Published: July 2020

Objectives: Hip microinstability is an increasingly recognized source of hip pain and disability. Femoral osteochondroplasty is usually performed with direct visualization through the arthroscope, assisted with repeated fluoroscopic view for orientation and feedback. However, a two-dimensional representation of a three dimensional structure can be misleading compromising the precision of the planned osteochondroplasty. Sometimes the resection can extend proximally into the Femoral Head (FH) diminishing the surface area of the articular cartilage available to be in contact with the labrum, in order to create the suction effect (suction seal) that maintains the stability of the femoral head in the acetabulum. The purpose of the study is to evaluate the role of proximal over-resection of femoral osteochondroplasty in the rotational and distractive stability of the hip joint. We hypothesis that proximal over resection will result in decrease stability, specially at higher degrees of flexion and internal rotation where the contact between labrum and articular cartilage will be lost, and breaking the suction seal. Methods: Six hemi-pelvises were repeatedly tested in the following five conditions: (a) intact, (b) T-capsulotomy, (c) Osteochondroplasty to the level of the physeal scar, followed by a (d) 5mm and (e) 10mm proximal extension of the resection. The pelvis was secured to a metal plate and the distal portion of the femur was potted and attached to a multi-axial hip jig. (Fig.1) Specimens were axially distracted with a load from 0-150N followed by 5Nm of internal and external torque at 0 o, 15 o, 30 o, 60 o, 90o of flexion while the resultant displacement/rotation was recorded using a 3D motion tracking system. Repeated measures ANOVA was used with statistical significance set at p<0.05. Results: Proximal extension of the resection by 5mm and 10mm increased axial instability (decreased force required for hip distraction) at every angle of flexion tested, with the greatest increase observed at higher angles of flexion (60 deg and 90 deg), p<0.05. T-capsulotomy alone increased both internal and external rotation at all angles of flexion, p<0.05. (Fig. 2) Subsequent resection and extension of the resection did not significantly increase rotational instability compared to the capsulotomy state. Conclusion: Extending the osteochondroplasty proximally into the femoral head compromised the distractive stability of the hip joint. It is important to be precise when performing femoral osteochondroplasty to minimize proximal extension that can lead to iatrogenic instability of the hip joint and poor postoperative outcomes. [Figure: see text][Figure: see text]
Borderline Dysplasia with Acetabular Retroversion: Key Findings from a Large Hip Arthroscopy Study Group
Authors: Kivlan Benjamin , Nho Shane , Wolff Andrew , Salvo John , Christoforetti John , Ellis Thomas , Carreira Dominic , Matsuda Dean 
Published: July 2020

Objectives: The radiographic crossover sign (COS) is an indicator of acetabular retroversion, classically representing anterosuperior overcoverage often treated with acetabuloplasty which could exacerbate acetabular hypovolemia in dysplasia. No prior study has investigated the prevalence of acetabular retroversion in patients with dysplasia undergoing hip arthroscopy, acetabuloplasty rates, and outcomes in this setting. Study objectives are to report the prevalence of acetabular retroversion in dysplasia, the influence of the COS on arthroscopic acetabuloplasty rates, and relative outcomes compared with control groups. Methods: A retrospective cohort study was performed from a prospectively collected multi-center database. Patients undergoing isolated hip arthroscopic surgery were assigned to dysplasia (lateral center-edge angle (LCEA) ≤ 25°) or one of two control groups: normal(LCEA 26-38°), or pincer femoroacetabular impingement (FAI)(LCEA ≥ 39°). The prevalence of COS and acetabuloplasty rates between and within study and control groups were compared (Chi square analysis). Minimum 2 year outcomes utilizing iHOT-12 were compared (analysis of variance). Results: Of 401 study patients, 64 (16%) comprised the dysplasia group, 273 (68%) normal group, and 64 (16%) pincer group. Mean LCEAs were 22.3°, 31.5°, and 42.4°, respectively (p<0.001). COS prevalence was similar between groups at 31%, 26%, and 33%, respectively (p=0.873). Acetabuloplasty rates were dependent on the amount of acetabular coverage with lowered rate in the dysplasia group(40%) and increasing rates in the normal(52%) and the pincer(90%) groups (p=0.013). Post-operative iHOT-12 scores improved in all groups (68, 74, and 77, respectively, p=0.222). Patients with a COS plus rendered acetabuloplasty reported similar scores that improved to 77, 74, and 79, respectively,(p=0.949). Patients with dysplasia with COS averaged 73.1(SD 23.3) iHOT-12 score compared to 67.1(SD: 28.7) for the patients with dysplasia without COS (p=0.466). Within the dysplasia with COS subgroup, there was no significant difference in iHOT-12 scores between the group with acetabuloplasty (77.0;SD:17.1) and without acetabuloplasty (70.4;SD:27.4,p=0.580). Conclusion: Acetabular retroversion occurs with similar prevalence in borderline dysplasia compared with non-dysplastic hips undergoing hip arthroscopy but with lower acetabuloplasty rates not influenced by the COS. Arthroscopic outcomes of dysplasia with retroversion are similarly successful and comparable with those of dysplasia and non-dysplastic hips. Although infrequently performed, acetabuloplasty did not compromise outcomes in dysplasia with retroversion.
Prolonged Postoperative Opioid Use after Arthroscopic Femoroacetabular Impingement Syndrome Surgery: Predictors and Outcomes at Minimum Two Year Follow-up
Authors: Beck Edward , Nwachukwu Benedict , Drager Justin , Jan Kyleen , Nho Shane , Rasio Jonathan 
Published: July 2020

Objectives: To identify preoperative predictors for patients requiring at least one postoperative opioid refill after undergoing hip arthroscopy for femoroacetabular impingement and 2) to determine 2-year reported outcomes in those requiring opioid refills. Methods: Data from consecutive patients undergoing hip arthroscopy for FAIS from January 2012 to December 2016 was analyzed. Baseline demographics were recorded, including preoperative opioid use, as well as pre- and 2-year postoperative functional scores specifically the Hip Outcome Score-Activity of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified hip Harris score (mHHS), international hip outcome tool (iHOT-12), and visual analog score (VAS) for pain and satisfaction were recorded. A correlation analysis was used to identify preoperative demographic and clinical variables associated with requiring postoperative opioid refill. Variables with a statistically significant association (p<0.05) were included in a final logistic regression model. Results: A total of 775 patients with postoperative opioid use and 2-year follow-up were included in the analysis. 141 (18.2%) patients required at least one preoperative opioid prescription refill in addition to the routine opioid total prescription postoperatively to every patient after hip arthroscopy. Patients requiring opioid refills had significantly lower HOS-ADL (79.9+20.3 vs 88.7+14.9), HOS-SS (64.6+29.5 vs 78.2+23.7), mHHS (74.2+21.1 vs 83.6+15.9), iHOT-12(63.6+27.9 vs 74.9+24.8), and VAS satisfaction (73.4+30.3 vs 82.2+24.9) averages, as well as higher pain (26.8+23.4 vs 17.9+21.8) when compared to patients without additional opioid refills with p<0.001 for all outcomes. Logistic regression analysis demonstrated that preoperative predictors of requiring additional postoperative opioids included patients with a history of opioid use prior to surgery (OR: 4.04; 95%CI: 1.99-8.19) and larger preoperative alpha angles (OR:1.04; 95%CI: 1.01-1.07). Sub-analysis by past versus current opioid use at the time of surgery demonstrated that current use was a predictive of requiring additional postoperative opioids (OR:3.12; 95%CI: 1.06-9.21; p=0.039), while past opioid use for was not. Conclusion: Patients requiring at least one postoperative opioid refill after undergoing hip arthroscopy for FAIS have lower 2-year functional scores when compared to patients not requiring refills. Additionally, active pre-operative opioid use at the time of surgery, as well as larger preoperative alpha angles are predictors of requiring additional opioids for pain management.
Is there a gender gap in outcomes after hip arthroscopy for femoroacetabular impingement? Assessment of clinically meaningful improvements in a prospective cohort
Authors: Flores Sergio , Chambers Caitlin , Borak Kristina , Zhang Alan 
Published: July 2020

Objectives: Although patients have been found to have significant improvements after hip arthroscopy for femoroacetabular impingement (FAI), prior studies suggest women have worse outcomes compared to men. These previous studies lack comparisons of patient reported outcome (PRO) scores based on gender with respect to clinical significance measurements, including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Therefore, the purpose of this study is to evaluate outcomes following hip arthroscopy for FAI based on patient gender by prospectively assessing changes in PRO scores, MCID, and PASS. Methods: Women and men undergoing hip arthroscopy for FAI were prospectively enrolled and preoperative radiographic and intra-operative findings were collected. The cohort was stratified based on self-identified patient gender so the term gender as well as the terms women and men were used to describe the patients as opposed to sex and the terms female and male. Patients completed the following PRO surveys before surgery and 2-years postoperatively: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and the 12-Item Short Form Health survey (SF-12). Mean scores and the percentage of patients reaching MCID and PASS were analyzed. An a priori power calculation was performed which determined 42 hips in each group were needed to adequately power the study to 95%. Results: A total of 131 hips, from 72 women and 59 men were included. The mean ± SD age for women and men was 34.2 ± 9.5 vs 35.8 ± 10.3 years, respectively; P= .347 and body mass index (BMI) of 24.9 ± 4.4 vs 25.5 ± 3.3 kg/m2, respectively; P= .379. Women had smaller preoperative alpha angles (59.1 vs 63.7, respectively; P< 0.001) and lower acetabular cartilage injury grade (6.9% vs 22.0% with grade 4 injury, respectively; P= 0.013). Both women and men achieved equivalent significant improvements in PRO scores after surgery (PRO scores increased 18.4 to 45.1 points for mHHS and HOOS). Women and men reached PASS for mHHS at similar rates (76.4% and 77.2%, respectively; P=0.915). MCID was also achieved at similar rates between women and men for all scores (ranged 61.4% to 88.9%) except HOOS-ADL in which a higher percentage of women reached MCID compared to men (79.2% vs 62.7%, respectively; P= .037). Additional stratification by age group using the median cohort age of 34 showed no significant differences in PRO improvement based on age group for each gender. Conclusions: Women can achieve clinically meaningful improvements in patient reported outcomes scores after hip arthroscopy for FAI. Compared to men, women demonstrated equivalent high rates of achieving MCID and PASS at 2 years following surgery. [Table: see text]
Effect of Sex and Age on Achieving Meaningful Clinical Outcomes at 5-years after Hip Arthroscopy for Femoroacetabular Impingement: A Comparative Match-Group Analysis
Authors: Beck Edward , Drager Justin , Nwachukwu Benedict , Jan Kyleen , Nho Shane , Rasio Jonathan 
Published: July 2020

Objectives: Non-modifiable factors including age and sex have been shown to effect outcomes following hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) at short-term follow-up. However, their effect on achieving long-term meaningful outcomes has not been evaluated. As such, the purpose of this study is to compare clinical outcomes, including achieving meaningful clinical important difference (MCID) and the patient acceptable symptomatic state (PASS) at 5-years, by age and sex. Methods: 150 patients undergoing hip arthroscopy for femoroacetabular impingement by a single fellowship trained surgeon were prospectively analyzed, with 25 patients in each of the following groups: female patients younger than 30 years of age, female patients 30 to 45 years of age, female patients older than 45 years of age, male patients younger than 30 years of age, male patients 30 to 45 years of age, and male patients older than 45 years of age. Pre and postoperative functional scores were collected including the Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), Hip Outcome Score Sport-Specific Subscale (HOS-Sport), the modified Harris hip score (mHHS), and visual analog scale (VAS) satisfaction and pain at 5-year follow-up. MCID and PASS was calculated for each functional measure and compared by gender and age category. Results: At 5-year follow-up, all groups demonstrated statistically significant improvement in the functional outcome score averages and pain (p<0.001 for all). Both within gender and within age category analysis of postoperative functional scores did not demonstrate any statistically significant differences (p>0.05).Analysis of achieving MCID and PASS demonstrated that females had a higher rate of reaching the HOS-SS and mHHS threshold for achieving MCID as compared to their male counterparts (48.3% vs 58%%; p=0.008 and 54% vs 75.4%; p=0.012, respectively). Furthermore, patients <30 years old had higher rates of reaching the HOS-ADL and mHHS for achieving PASS than the two older age groups (p>0.05 for both). Conclusions: Non-modifiable factors, including age and sex, influence the rate of achieving meaningful clinical outcomes at 5-year follow up. Female patients are more likely to reach the HOS-SS and mHHS threshold for achieving MCID, while those <30 years of age are more likely to reach the HOS-ADL and mHHS threshold for achieving PASS as compared to older patients.
Clinical Outcomes after Arthroscopic Repair of Gluteus Medius with a Two-year Minimum Follow-up
Authors: Bloom David , Kirby David , Youm Thomas , Fried Jordan 
Published: July 2020

Objectives: Hip arthroscopy has replaced the need for many open surgeries including repairs of gluteus medius tendon tear. There are only a few studies that have analyzed patient reported outcomes at 2 years for arthroscopic gluteus medius tendon repair. The purpose of the current study is to evaluate clinical outcomes in patients who underwent arthroscopic gluteus medius repair with at least 2 year follow-up. Methods: This was a single-center, retrospective IRB approved study. Between August 2010 and August 2016, patients who underwent hip arthroscopy with gluteus medius repair by a single surgeon were evaluated at baseline and two year follow-up via Modified Harris Hip Score (MHHS) and Non-arthritic Hip Score (NAHS). Inclusion criteria included all patients who received arthroscopic repair of the full or partial thickness tears of the gluteus medius tendon and had a minimum follow up of at least two years. Paired t-test was used for statistical comparison between baseline and follow-up for each respective outcome score and group. Results: 20 hips were evaluated, met the inclusion criteria and separated based on partial (group one) or full thickness tear (group two). The study population comprised of 15 (79%) females and 4 (21%) males. Group one presented with a mean age of 54.8 ± 11.3 years and an average BMI of 25.1 ± 4.0. Group two presented with a mean age of 46 ± 11.4 and an average BMI of 25.5 ± 4.0. Patients in group one reported an average preoperative MHHS and NAHS of 33.6 ± 11.3 and 40.4 ± 14.9, respectively. At 2 year follow-up, an average MHHS and NAHS of 72.9 ± 22.9 and 77.2 ± 19.7 was reported, respectively. Patients in group two reported an average preoperative MHHS and NAHS of 43.8 ± 14.7 and 46.4 ± 8.3, respectively. At 2 year follow-up, an average MHHS and NAHS of 80.1 ± 8.5 and 79.5 ± 10.1, respectively. There was significant clinical improvement at the 2 year follow-up, relating to both outcome measures in each subject group (p<0.0004). Conclusions: After a minimum of two years for follow-up, arthroscopic repair of gluteus medius tears proves to be an effective approach and treatment. In the future, studies looking at longer follow-up time would help determine if the current approach maintains long-term clinical improvement.
Alpha-2-Macroglobulin Not Significantly Better Than Regular PRP For Knee Arthritis Symptoms
Authors: Klein David , Bloom David , Campbell Kirk , Gonzalez-Lomas Guillem , Alaia Michael , Strauss Eric , Jazrawi Laith , Thompson Kamali 
Published: July 2020

Objectives: Osteoarthritis, a degenerative and debilitating joint disease, is one of the most prevalent diseases in the United States. Despite the significant burden osteoarthritis can place on an individual and society, nonoperative treatment options are still very limited. Little clinical data exists on the use of injectable macromolecules for the treatment of osteoarthritis of the knee. Alpha-2-macroglobulin (A2M), a naturally occurring macromolecule, inhibits the many endogenous and exogenous proteinases presenting in the pathogenesis of osteoarthritis. To date, no studies exist evaluating the effectiveness of A2M with other intra-articular injectables. The purpose of this study is to compare the clinical effectiveness of intra-articular injection of A2M against both platelet-rich plasma (PRP) and corticosteroids. Methods: This prospective randomized control trial was conducted at a single medical center. Seventy-five patients with symptomatic knee osteoarthritis with Kellgren-Lawrence grade 2 or 3 were randomized into one of three cohorts receiving intra-articular injection. One group was given PRP, one group was given A2M, and one group was given corticosteroids. All groups had blood drawn to simulate A2M preparation. Patient reported outcomes were collected prior to injection, 6 weeks and 12 weeks following injection. Several measures were used for clinical assessment including the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner scores. Results: Seventy-five patients with a mean age of 61.08 (± 8.48) were enrolled between June 2018 and February 2019. At six weeks, the A2M group had the greatest decrease in VAS (-1.60) and WOMAC (-10.9), however, the differences were not statistically significant. Between the injection and the twelve week visit, the A2M group had a statistically significant difference in WOMAC score compared with PRP (-18.43 vs -5.70, p <0.02). Overall, both corticosteroid (-1.57) and A2M (-1.70) had a similar improvement in VAS when compared with PRP (-0.61). These differences were also not statistically significant. Conclusions: Our study demonstrates Alpha 2 Macroglobulin shows similar effectiveness to corticosteroids in the treatment of knee osteoarthritis. Both A2M and corticosteroids appear to show marginally better effectiveness than PRP injection, however the differences are small and did not reach statistical significance in most outcome measures.