bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanical Evaluation of Capsulotomy and Capsular Repair in the Hip
Authors: Wuerz Thomas H. , Song Sang Hoon , Grzybowski Jeffrey S. , Greenberg Mitchell , Espinoza Alejandro , Nho Shane Jay 
Published: August 2015

Objectives: The use of hip arthroscopy has increased over recent years to treat various forms of hip pathologies including femoroacetabular impingement. While a capsulotomy facilitates adequate visualization and access for diagnostic and interventional purposes, the current literature remains divided over the use of routine capsular closure to address the iatrogenic instability that may be induced by an excessive or unclosed capsulotomy. The purpose of this biomechanical study was to determine if hip capsulotomy creates significant alterations in rotational range of motion and stability measures. Additionally, does a capsular repair return these variables to normal? Methods: Eight fresh-frozen cadaveric hip specimens consisting of the hemipelvis, femur, and overlying soft tissues were used for this study. All specimens were screened by computed tomography (CT) to assess for the absence of significant bony pathology. Each hip was then tested under torsional loads of 6 N·m applied via a pulley system in conjunction with a vertical force exerted by a servohydraulic frame. Conditions tested were as follows: 1) neutral flexion with the capsule intact 2) neutral flexion with a 4 cm inter-portal capsulotomy 3) neutral flexion with a 6 cm inter-portal capsulotomy 4) neutral flexion with capsulotomy repair. Soft tissue was retained during all interventions. Range of motion (from external to internal rotation), hysteresis area, and neutral zones were the outcome measures for stability obtained in each condition. Results: While the data demonstrated a positive and statistically significant correlation between the sizes of the capsulotomy and measures of joint instability (range of motion (ROM), hysteresis area, and neutral zone), no significant differences were seen between the intact and repaired hips with regards to such measures (Table). Larger size capsulotomies were accompanied by significant increases in all three measures of joint instability while the repair effectively restored the capsule to conditions similar to its intact state. Conclusion: To the best of the authors’ knowledge, this study is the first to demonstrate the biomechanical consequences of sequentially increasing capsulotomy incisions and their repair on a hip joint that still contains its surrounding soft tissue. The results of this study not only confirm the notion of introducing iatrogenic joint instability with larger sized capsulotomies, but also propose the complete capsular closure as an appropriate solution.
Outcomes for Hip Arthroscopy Based on Sex and Age
Authors: Frank Rachel M. , Lee Simon , Grzybowski Jeffrey S. , Cvetanovich Gregory , Mather Richard C. , Bush-Joseph Charles A. , Salata Michael Jonathan , Nho Shane Jay 
Published: August 2015

Objectives: The purpose of this study was to compare the clinical outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) based on sex and age. Methods: A total of 150 patients undergoing hip arthroscopy for FAI by a single fellowship-trained surgeon were prospectively analyzed, with 25 patients categorized in each of the following groups: A) females ≤30 years,B) females 31-45 years, C) females >45 years, D) males ≤30 years, E) males 31-45 years and F) males >45 years. Primary clinical outcomes included the Hip Outcome Score Activity of Daily Living (HOS-ADL) and Sport-Specific Subscales (HOS-SS), the modified Harris Hip Score (mHHS), and clinical improvement at final follow-up. Statistical analysis was performed utilizing ANOVA with post-hoc Tukey HSD tests, with P<0.05 considered significant. Results: One-hundred forty of 150 patients (93%) were available for follow-up at an average 2.72±0.43 years (minimum, 2 years), with no differences in follow-up rates between the 6 groups (P<0.05). All groups demonstrated significant improvements in HOS-ADL, HOS-SS, and mHHS outcomes at final follow-up (P<0.001). Females >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to females ≤30 (P<0.0001, P=0.001, P<0.0001 respectively) and females 30-45 (P=0.015, P<0.0001, P=0.001 respectively). Similarly, males >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to males ≤30 (P=0.012, P=0.015, P=0.022 respectively) (Figure 1). Males >45 scored significantly better than females >45 on the HOS-SS (P=0.013) and the mHHS(P=0.024). Incorporating both sexes, patients >45 scored significantly worse on the HOS-ADL, HOS-SS, and mHHS compared to patients ≤30 (P<0.0001, P<0.0001, P<0.0001, respectively) and patients 30-45 (P=0.005, P<0.0001, P=0.008, respectively). Conclusion: While all patients had significant improvements in all outcomes following hip arthroscopy for FAI, patients >45 years performed worse compared to patients in younger age groups, with females >45 years demonstrating the poorest outcome scores. This data can be used to counsel patients preoperatively and to individualize care to optimize outcomes following hip arthroscopy for FAI.
Age-related Trends in Hip arthroscopy
Authors: Zhang Alan L. , Sing David C. , Feeley Brian T. 
Published: August 2015

Objectives: The rate of hip arthroscopy has increased dramatically in the past 5 years but there is a lack of information regarding patient demographics in a large cross-sectional population. The purpose of this study was to evaluate recent trends in hip arthroscopy from a large private payer population in the United States. Methods: We performed a retrospective analysis using the Pearldiver private insurance patient record database from 2007 through 2011. A search was performed for hip arthroscopy procedures including newly introduced codes such as osteochondroplasty of Cam and Pincer lesions and labral repair. Hip arthroscopy incidence, growth over time, and conversion rates to total hip arthroplasty (THA) were stratified by age. Chi-square analysis was used for statistical comparison. Conversion to THA was evaluated using Kaplan-Meier analysis with logrank and Wilcoxon tests. Results: From 2007 through 2011, 15,532,426 outpatient procedure records were analyzed. Hip arthroscopy was performed in 8,237 patients with females comprising 63% of cases. The number of hip arthroscopies increased over 250% from 981 cases in 2007 to 2,507 cases in 2011 (p<0.0001). Patients in age group 40-49 underwent the most number of hip arthroscopies, comprising 28% of cases followed by 30-39 (22%), 50-59 (19%), 20-29 (14%), 10-19 (12%) and 60-69 (5%). Patients under 30 years of age showed the greatest increase in incidence from 2007 to 2011 (335%) but patients over 60 still had over a 200% increase. Chondroplasty/labral debridement was the most common procedure, present in 6,031 cases and approximately 1.6 procedural codes were billed for every case performed. Older patients were more likely to receive labral debridement instead of repair. Within 24 months of hip arthroscopy, 17% of patients older than 50 years old required conversion to THA compared to less than 1% of patients under 30 years old (p<0.0001). Conclusion: Hip arthroscopy procedures are increasing in popularity across all age groups with patients aged 40-49 having the highest incidence in this population. A high rate of conversion to THA within 2 years of hip arthroscopy in patients over 50 suggests a need to better specify appropriate indications.
Revision Hip Arthroscopy in the Youth Athlete
Authors: Newman Justin T. , Philippon Marc J. , Saroki Adriana , Briggs Karen K. 
Published: August 2015

Objectives: Despite a dramatic increase in the numbers of primary and revision hip arthroscopy cases that are performed, there is limited literature focusing on the younger population of patients who undergo revision hip arthroscopy. Pathophysiology and post-procedural outcomes of pediatric patients has been demonstrated to differ from adults in many common sports related injuries, including those to the shoulder and knee. The purpose of this study was to describe the indications for and outcomes following revision hip arthroscopy in patients 18 years and younger. Our hypothesis was that these patients would present to revision surgery with different pathology and demonstrate significant improvement in outcomes and return to activity. Methods: A prospective data registry was queried for all patients 18 years and younger who underwent revision hip arthroscopy with a minimum of 2-year follow-up. Data included detailed surgical data and outcome scores (modified Harris hip (mHHS), Tegner activity scale, and patient satisfaction with outcome) at minimum 2 year follow-up. This study was IRB approved. Results: Thirty hips were included in 29 patients. 24 of the patients were female. Average age at revision was 16.6 (range 15-18). 21 of the patients had one prior surgery, 6 had 2 prior surgeries and 2 had 3 prior surgeries. Mean time from most recent surgery to revision surgery was 18.7 months (range 4.7 to 74 months). Surgeries prior to presentation included 13 with labral debridement, 11 with labral repair, 7 had both cam and pincer addressed, 4 had cam only, 1 had pincer only. 18 patients did not have femoroacetabular impingement (FAI) addressed. 5 patients had iliopsoas releases. At revision, lysis of adhesions was performed on all patients. 12 had labral reconstruction, including 9 of the initial labral debridement patients. 18 underwent cam and pincer resection, including 13 of those without FAI addressed initially. 8 patients had labral repair. 3 patients had iliopsoas release and 1 had iliotibial band release. One patient underwent a periacetabular osteotomy without further arthroscopy. At an average follow-up of 37 months (range 24 to 52 months), the mHHS improved from 57 (25 to 96) to 82 (45 to 96). Mean improvement was 22 points (p<0.001). The median satisfaction was 7 (1 to 10), median Tegner was 5 (1 to 9), SF12 PCS was 50.8 (37.2 to 58.3) and the SF12 MCS was 52.8 (45. to 63.6) Conclusion: Revision hip arthroscopy in patients under the age of 18 resulted in good outcomes scores. The majority of these patients were satisfied and all returned to activity. Failure to address FAI and the failure of labral debridement were the most common pathologies precipitating revision hip arthroscopy. This challenging population should be further studied to prevent revision surgery and possible additional irreparable damage.
Arthroscopic Management of Dysplastic Hip Morphologies
Authors: Larson Christopher M. , Ross James R. , Stone Rebecca M. , Samuelson Kathryn M. , Giveans Russell , Bedi Asheesh 
Published: August 2015

Objectives: Previous reports regarding arthroscopic management of dysplastic hip morphologies have conflicting results. Arthroscopy alone in the setting of dysplastic morphologies is controversial. Methods: We retrospectively reviewed 88 hips (77 patients, 71% female, mean age 33.9 years) with radiographic findings consistent with hip dysplasia and a mean 26.0 months follow-up (range 12-80 months) after hip arthroscopy. Procedures performed included 67 labral repairs (76%), 20 selective labral debridements (23%), 72 capsular repair /plications (82%), and management of associated cam-type morphology in 63 hips (72%). All radiographs were evaluated for parameters consistent with dysplasia including the LCE, Neck Shaft angle, Tonnis angle, Extrusion index, femoral head lateralization, and break in Shenton's line. Preoperative and post-operative function were evaluated prospectively using the Modified Harris Hip Score (MHHS), SF-12 scoring, and pain on a visual analog score (VAS). Patient demographics, procedures performed, and radiographic parameters were evaluated with regards to functional outcomes. In addition, the results of the dysplastic cohort were compared to an aged matched cohort of 231 hips (215 patients, 52% female, mean age 32 years) performed during the study period with a mean follow-up 22.7 months (12-60 months) that underwent arthroscopic FAI correction without the diagnosis of dysplasia. Results: The mean LCE was 20.8 degrees (range, 8.7 - 24.5), and mean Tonnis angle was 11.0 (range, 0 - 22.2 degrees). The dysplastic cohort had a mean latest MHHS of 81.3 (range, 34-100) and mean 15.6 point (range, -28 - 60) improvement in MHHS compared to 88.4 points and 24.4 points, respectively, in the FAI cohort (p<0.01). The dysplastic cohort had 60.9% good to excellent results and 32.2% failures, compared to 81.2% good/excellent results and 10.5% failures for the FAI cohort (p<0.01). Decreased head neck offset (cam-type morphology) trended towards being predictive of better scores in the dysplastic cohort (p=0.079). In addition, dysplastic hips that underwent capsular plications and labral repairs had greater good / excellent results and lower failure rates (p<0.05). Grade 4 chondral defects were predictive of lower scores (p=0.02). There were no statistically significant differences for functional outcomes regarding gender or age for either cohort (p>0.05). There were no iatrogenic subluxations / dislocations in either group. Conclusion: Although functional scores were improved post-arthroscopy in hips with mild to borderline dysplastic morphologies, Good/Excellent results were inferior and Failure rates were higher compared to an FAI cohort. These results were independent of gender. Associated cam-type FAI, and labral repair / capsular plications were predictive of better clinical outcomes in the dysplastic cohort. Outcomes after pelvic osteotomy in this borderline population are required to determine the optimal treatment.
Are Lesser Trochanteric Tenotomies More Effective than Labral-Level Releases for the Treatment of Iliopsoas Snapping and Impingement?
Authors: Steiner Samuel R. h. , Keene James S. 
Published: August 2015

Objectives: Currently arthroscopic iliopsoas tenotomies (AIT's) are performed at the level of the labrum to treat both painful snapping and labral injuries to impingement of the tendon. However, two recent studies found that although this labral-level procedure relieved painful labral impingement, recurrent snapping of the tendon occurred in 18 to 60% of the cases (1-2). The objective of this study was to determine if arthroscopic tenotomies done at the lesser trochanter would more effectively treat both central labral impingement and snapping of the tendon. Methods: From a review of the senior author's data base of 1150 hip arthroscopies, 30 patients that had AIT's at the lesser trochanter to treat both painful snapping of the tendon and labral injuries due to impingement of the tendon were identified (Figure 1). The location of the labral injuries was recorded on each patient's “hip sheet” at the time of their hip arthroscopy and the diagnosis of iliopsoas impingement was confirmed from a review of each patient's operative note and intra-operative photographs. All hips were examined and assessed with Byrd's 100-point modified Harris hip scoring system prior to the release and at 3, 6, 12, and 24 months after surgery. Results: Average age of the 30 patients (14 of which were competitive athletes) was 28 years, and their preoperative scores averaged 44 points. After surgery, the patients had hip flexor weakness, used crutches for 2 to 4 weeks and had six-week scores that averaged 77 points. Their scores continued to improve and at 6, 12, and 24 months after surgery, the scores averaged 88, 90, and 91 points, respectively. After an average follow-up of 30 months (range 24-42 months), none of the patients had recurrence of the painful snapping of their tendon, and all 14 competitive athletes returned to full participation in their sport which included Division 1-A crew and soccer (she played 90 mins/game), and high school basketball and softball (she played catcher), at an average of 8.8 months (range 4-12 months) after surgery. Conclusion: Arthroscopic iliopsoas tenotomies performed at the level of the lesser trochanter appear to be more effective than labral-level tenotomies for the treatment of patients that have both intra-articular labral impingement and a painful snapping of the tendon.
A Matched-Pair Controlled Study of Arthroscopic Psoas Tenotomy with Minimum 2-Year Follow-Up
Authors: Redmond John M. , Schwartz Aaron R. , Gupta Asheesh , Stake Christine E. , Finch Nathan , Domb Benjamin G. 
Published: August 2015

Objectives: It is unknown whether pateints undergoing tenotomy for painful internal snapping at the time of hip arthroscopy can expect equivalent functional outcome to patients undergoing hip arthroscopy without tenotomy. The contribution of the psoas tendon and hip capsule to hip stability is also currently debated. The purpose of this matched study is to (1) compare two-year outcome scores in a study group who underwent psoas tenotomy to a matched control group who did not have a psoas tenotomy, and (2) perform a subgroup analysis of the study group comparing capsular repair to capsular release. Methods: Between April of 2008 and December of 2012, we prospectively collected data and reviewed 694 hip arthroscopies with a minimum 2 year follow up. A total of 243 patients had undergone psoas tenotomy and comprised the study group available for matching. After a power analysis was performed we matched 50 patients in the control group to 50 patients in the study group. A subgroup analysis of the study group was then performed based on the capsular treatment performed. Twenty five patients who underwent capsular release were compared to 25 patients who underwent capsular repair. The protocol included pre- and post-operative administration of four hip-specific patient-reported outcome (PRO) tools, the visual analog scale (VAS), and patient satisfaction scores. Results: Both the study group (n=50) and control group (n=50) demonstrated a statistically significant improvement in patient-reported outcome (PRO) scores and pain scores at 2-year follow up (p<0.05). No statistical differences in PRO scores, pain scores, or patient satisfaction was observed at 2-years between the study group and the control group as well as between the capsular repair and capsular release subgroups. Conclusion: In patients with painful internal snapping and psoas impingement lesions arthroscopic psoas tenotomy appears to result in similar two-year outcomes to patients not undergoing psoas tenotomy at the time of labral treatment. We were unable to detect a significant role for capsular closure at the time of psoas tenotomy; however, this requires further study.
Operative vs. Non-Operative Treatment of Achilles Tendon Ruptures
Authors: Erickson Brandon J. , Mascarenhas Randhir , Saltzman Bryan Michael , Walton David , Lee Simon , Cole Brian J. , Bach Bernard R. 
Published: August 2015

Objectives: Background: Multiple meta-analyses have been published to in efforts to determine whether operative or non-operative treatment of Achilles tendon ruptures affords superior outcomes. The results, however, remain varied and inconsistent. Purpose: To perform a systematic review of overlapping meta-analyses comparing operative and non-operative treatment of Achilles tendon ruptures in order to determine which meta-analyses provide the highest level of evidence for treatment recommendations. Methods: Methods: A systematic review of the literature was performed to identify meta-analyses that fit our inclusion criteria. Data was extracted from these meta-analyses regarding patient outcomes and re-ruptures. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad algorithm was applied to determine the meta-analyses with the highest level of evidence. Results: Results: Nine meta-analyses met the eligibility criteria, with all but one study including level I evidence. A total of 5,842 patients were included. Seven studies found a higher rate of rerupture in the non-operative group but a higher rate of complications in the operative group. One study found no differences in rerupture or complication rates, and one study found surgery decreased rerupture rates only when compared to non-operative treatment without a functional brace. Three studies also identified an earlier return to work in the operative group. Almost all (8 out of 9) of the meta-analyses had Oxman-Guyatt scores (>3) indicating no major flaws. Conclusion: Conclusions: Operative treatment of Achilles tendon ruptures decreases rerupture rates but increases the risk for minor complications when compared to non-operative treatment. Additionally, surgical treatment may allow earlier return to work.
Clinical Assessment of the Dynamic Shear Test for SLAP Lesions
Authors: Sodha Sonal , Joseph Jacob , Borade Amrut , McFarland Edward G. 
Published: August 2015

Objectives: Making the diagnosis of superior labrum anterior posterior (SLAP) lesions with physical examination remains challenging. The dynamic shear test is a recently described physical examination test which has been shown in two previous studies to have a likelihood ratio of 31.6 and 1.1 for making the diagnosis of a SLAP tear. The goal of this study was to determine the clinical utility of the dynamic shear test for making the diagnosis of SLAP lesions. Methods: This is a consecutive case series of patients who were studied prospectively who had a diagnostic arthroscopy by the senior author between 2007 and 2013 (N=674). All had a thorough physical examination preoperatively which included a dynamic shear test. Only Type II through V SLAP lesions were considered positive for a SLAP tears. A type I tear was considered a degenerative lesion and included in the control group. For statistical analysis, the patients were divided into three groups: a control group (n = 528) consisting of patients with no SLAP lesion but with other pathologies, an Isolated SLAP lesion group (n = 7), and a Concomitant SLAP group (n=139) who had a SLAP tear and some other shoulder pathology such as a rotator cuff tear or instability of the shoulder. Statistical analysis included determining sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR), and diagnostic accuracy (DA) of the dynamic shear test with and without other tests for SLAP tears. Results: The dynamic shear test was positive for 242 (45.8%) control patients, 6 (85.7%) patients with isolated SLAP lesions, and 79 (56.8%) of the concomitant SLAP patients. For isolated SLAP tears the dynamic shear test had a sensitivity of 85.7, specificity of 51.9, PPV of 1.8, NPV of 99.7, LR of 6.4, and DA of 54.4. In comparison, the LR for the active compression test was 0.7 and for the relocation test was 1.5. For patients with combined SLAP lesions with other pathologies, the dynamic shear test had a sensitivity of 58.2, specificity of 54.2, PPV of 35.99, NPV of 82.4, LR of 1.5, and DA of 55.0. Combining all three tests did not improve the LR for either isolated SLAP lesions or lesions with concomitant pathology. Conclusion: This study demonstrates that the dynamic shear test is sensitive but not specific for isolated SLAP lesions. With a likelihood ratio of over 6, it is one of the better tests for diagnosing isolated SLAP tears. However, in patients who have concomitant pathologies it is not as useful for making the diagnosis of a SLAP lesion.