Dominic S. Carreira

Greater trochanteric pain syndrome is increasingly being diagnosed in patients with lateral hip pain. Surgical repair of the gluteal tendon tears is generally indicated after a trial of nonoperative management. Both open and endoscopic techniques are used, each with potential advantages and limitations. The purpose of this study was to compare demographic, intraoperative findings, and early patient-reported outcome measures (PROMs) between open versus endoscopic hip abductor tendon repair using a multicentre registry. A retrospective analysis of prospectively collected data from the Hip Surgical Treatment Registry (HipSTR) (February 2023–March 2025) was performed. Adults (≥18 years) undergoing primary or revision open or endoscopic gluteal tendon repair were included. Demographics, intraoperative findings, and PROMs were compared, and logistic regression identified factors associated with open repair. A total of 171 patients were included (54 open, 117 endoscopic). Open repair patients were significantly older (67 vs 63 years; P = .02) and had a higher prevalence of osteoarthritis (70.4% vs 47.9%). Tear severity and size were similar, although open repairs trended towards larger anterior–posterior tears (3.3 ± 1.6 cm vs 2.6 ± 1.1 cm; P = .054). Open repairs used more anchors (4.3 vs 3.5) and more frequently involved double-row fixation (88.9% vs 58.1%) and augmentation (65.4% vs 41.0%). Both groups showed significant PROM improvement at 6 and 12 months. Larger proximal–distal tear size trended towards association with open repair (OR 2.26; P = .051), while higher Milwaukee grade was independently associated (P = .035). In this multicentre cohort, open and endoscopic techniques showed comparable early PROM improvements. Open repair was more common in older patients with greater degeneration, likely reflecting selection bias. Surgical approach appears driven by patient and intraoperative factors rather than expected outcome differences. Longer-term follow-up is needed to assess durability and repair integrity.

Purpose: To identify and evaluate the diagnostic criteria used to define and diagnose hip microinstability. Methods: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta‐Analyses guidelines. PubMed, Cochrane Central Register of Controlled Trials, and Scopus were searched using the keywords “hip” AND “microinstability.” Studies were included that reported diagnostic criteria for hip microinstability. Exclusion criteria included review articles, technique papers, biomechanical studies, cadaveric studies, and studies focused on traumatic instability. Diagnostic criteria were categorized into 4 primary domains: physical examination findings (16 studies), intraoperative findings (17 studies), radiographic criteria (6 studies), and clinical history (1 study). Results: Twenty‐three studies met inclusion criteria (Levels II‐IV). The most frequently cited criteria were ease of hip distraction during arthroscopy (14 studies), a positive hyperextension‐external rotation test (13 studies), and a positive prone external rotation test (8 studies). Substantial variability in diagnostic approaches was observed, with no universally applied diagnostic framework. Conclusions: There remains substantial variability in the diagnostic criteria for hip microinstability. Ease of intraoperative distraction and physical examination findings are the most consistently cited. Level of Evidence: Level IV, systematic review of Level II to IV studies.

Background: Insertional Achilles tendinopathy (IAT) is a common yet challenging condition that often resists conservative treatment. Traditional open surgical repair carries risk of complications including delayed wound healing and infection. This study compares the outcomes of a minimally invasive surgical (MIS) technique using arthroscopic-assisted double-row repair vs open repair. Methods: Fifty-six patients with IAT underwent surgical intervention between June 2021 and September 2024 (32 MIS, 24 open). Patient-reported outcomes (PROs) were assessed pre- and post-operatively with a minimum 1-year follow-up. Six patients were excluded from analysis for comparability between groups. Statistical analysis used 2-tailed t tests with a Bonferroni adjustment (α = 0.05/3 = 0.0167). The proportion of each cohort reaching the minimal clinically important difference (MCID) was compared via χ ² analysis, and complications were correlated to body mass index (BMI) and age using logistic regression analyses. Sensitivity analyses using multiple linear regressions, adjusted for follow-up time, were performed on the full cohort (α = 0.05). Results: The MIS group had significantly worse preoperative scores compared with the open group. But at a mean follow-up of 2.2 years for the MIS group and 2.0 years for the open group, the MIS group demonstrated significantly greater improvements in Patient-Reported Outcomes Measurement Information System physical function and visual analog scale scores ( P < .001 for both) and a significantly greater proportion of patients at MCID ( P < .05 for both). Foot and Ankle Ability Measure activities of daily living subscale showed similar findings without significance detected. All PROs retained significance on sensitivity analysis. Complication rates were 0% in the MIS group and 5.0% in the open group with no correlation to BMI or age. Conclusion: Despite limitations necessitating further studies, our results begin to suggest superior functional outcomes following MIS repair for IAT compared to traditional open repair, supporting MIS as a potentially safer and more effective alternative for appropriate patients. Level of Evidence: Level III, retrospective comparative study.

Background: The role of arthroscopy in the management of ankle fractures is controversial. This study aims to evaluate the prevalence of intra-articular pathologies detected during arthroscopically assisted reduction and internal fixation (ARIF) of ankle fractures, stratified by fracture classification, for indirect comparison to current literature. We also present short- to mid-term patient-reported outcomes (PROs) for a subset of the participant cohort. Methods: We retrospectively analyzed the intra-articular findings of 134 patients who underwent ARIF of ankle fractures. A statistical analysis was performed to assess for significant differences in the proportions of affected patients across fracture types for each intra-articular pathology. PROs included Visual Analog Scale (VAS) ratings and Foot and Ankle Ability Measure scores for Activities of Daily Living (FAAM ADL). Results: Intra-articular pathologies were noted in 92.5% of patients including sources of anterior impingement such as synovitis (52.2%), soft tissue (29.9%), and loose bodies (33.6%), as well as syndesmotic injury (47.0%), deltoid injury (26.1%), and osteochondral defects (29.1%) (Figure 1). Deltoid injury was more frequently detected in Weber C fractures than in any other fracture type. Syndesmotic injury occurred significantly more frequently in Weber C fractures than in Weber A (P < .01) and Weber B fractures (P < .001) (Table 1, Figure 2). PROs obtained for a subset of patients at the final follow-up reflected low VAS scores (mean = 1.78, n = 49) and high FAAM ADL scores (mean = 71.1, n = 14). Conclusion: Arthroscopy during ankle fracture surgery is valuable in the detection of intra-articular pathologies that may require treatment to ensure positive patient outcomes. Furthermore, fracture type may be correlated with higher incidence of certain intra-articular pathologies. While future direct comparison is necessary between open reduction and internal fixation (ORIF) and ARIF, our study proposes that ARIF detects issues that may otherwise remain undetected during ORIF and suggests that concomitant arthroscopy is beneficial for ankle fracture fixation. Level of Evidence: Level IV—Case series

Purpose: The present study aims to describe epidemiological, diagnostic and surgical data for a large group of patients undergoing hip arthroscopy between 2018 and 2023. We also explore how these trends compare to previous cohorts, particularly the 2014–2017 Multicenter Arthroscopic Study of the Hip (MASH) study. In response to the rapid growth of hip arthroscopy literature, we hypothesize that surgeons are operating on patients with a lower average body mass index (BMI), younger age, less severe reported symptoms at the time of surgery, and shorter preoperative symptom duration.Methods: The MASH database was searched for patients who underwent hip arthroscopy for treatment of FAI between 2018 and 2023, and had demographic data available in the registry. Standardized data included demographics, symptoms, imaging, intraoperative diagnoses (labral tears, cartilage lesions) and patient‐reported outcome measures (International Hip Outcome Tool 12‐item [iHOT‐12], modified Harris Hip Score [mHHS], HOS, Visual Analogue Scale, 12‐item Short Form Health Survey, Patient‐Reported Outcomes Measurement Information System).Results: Our study found that patients who elected to undergo hip arthroscopy between 2018 and 2023 at eight different US‐based sites were, on average, 34.3 years old with a body mass index of 25.0 kg/m². The majority experienced symptoms for at least 4 months (91.4%), with 33.4% reporting symptoms lasting over 2 years. Symptoms were frequently exacerbated by athletic activities (86.6%) and sitting (63.8%). Prior to surgery, patients reported substantial functional limitations and impaired well‐being, with a mean iHOT‐12 score of 38.7 and a mHHS of 56.0. At 2‐year follow‐up, 85.9% and 76.4% of patients reached our distribution‐based minimal clinically important difference value for mHHS and iHOT‐12, respectively.Conclusion: This multicenter data set has demonstrated improved patient‐reported symptoms at the time of surgery, a decrease in mean patient BMI, and an increase in symptom duration reported prior to surgery. This data provides a contemporary benchmark for hip arthroscopy patient characteristics, reaffirms the efficacy of hip arthroscopy, and indicates earlier and more effective diagnosis of abnormal hip morphology.Level of Evidence: Level IV.

The main aim of this study was to analyze correlations between individual international hip outcome tool 12 (iHOT-12) items and overall iHOT-12 score within and across timepoints. A retrospective multicenter hip arthroscopy registry was queried for patients from January 2014 to October 2023 with completed iHOT-12 reports. Pearson coefficient analysis was used to identify correlations between individual iHOT-12 items and overall iHOT-12 score at each timepoint and between preoperative individual iHOT-12 items and postoperative overall iHOT-12 scores. Validity, reliability, and responsiveness of the iHOT-12 were analyzed at each timepoint. Within timepoints, correlations ranged in strength from fair (preoperative maintain fitness level, r = 0.52, P < .00001) to excellent (5-year hip pain after activity, r = 0.93, P < .00001). Correlations increased in strength over time. Across timepoints, correlations ranged in strength from no correlation (2-year maintain fitness level, r = −0.001, P = 0.94) to poor (6-month pushing or lifting heavy objects, r = 0.31, P < .00001). Correlations decreased in strength over time. No ceiling or floor effects were exhibited. The Cronbach alpha for the baseline, 6-month, 1-year, 2-year, and 5-year timepoints were 0.87, 0.96, 0.95, 0.96, and 0.97, respectively. Cohen’s d values at 6 months, 1 year, 2 years, and 5 years were 1.19, 1.43, 1.71, and 1.58, respectively. Within timepoints, hip pain after activity had the strongest correlations to overall iHOT-12 score. Across timepoints, correlations between preoperative individual iHOT-12 items and postoperative overall iHOT-12 score were poor and weakened over time, suggesting similar long-term postoperative iHOT-12 scores among both high- and low-scoring preoperative patients. The iHOT-12 demonstrated good validity, reliability, and responsiveness at all timepoints.

Background: To compare short-term outcomes of patients diagnosed with small and medium-sized osteochondral ankle defects who were treated with chondroplasty and microfracture. Materials and Methods: A retrospective multicentre ankle and foot arthroscopy registry was queried for patients from December 2017 to December 2022 who were diagnosed with a small or medium-sized osteochondral ankle defect and treated with an arthroscopic chondroplasty or microfracture. Demographic and intraoperative variables were collected. Foot and Ankle Ability Measure Sports Subscale (FAAM-S), Visual Analogue Scale (VAS), VR-12 Mental, VR-12 Physical and Foot Function Index (FFI) PROMs were completed by patients preoperatively and at a minimum of one year postoperatively. Data were compared between patients who were treated with chondroplasty and those treated with microfracture. The differences in continuous variables were assessed via paired-sample t-tests. χ ² analysis was performed on all categorical variables. Results: Thirteen patients were treated with chondroplasty, and 22 patients were treated with microfracture. There were no demographic differences between groups (P = 0.30, P = 0.68, P = 0.18). Microfracture patients had significantly deeper chondral defects than chondroplasty patients (P = 0.002), and their lesions had significantly higher International Cartilage Repair Society (ICRS) grades (P = 0.003). There were no differences in length, width or location of defect between groups (P = 0.50, P = 0.73, P = 0.12). Both cohorts saw significant improvement in FAAM-S, VAS, VR-12 Physical and FFI PROMs at a minimum of one year postoperatively (P = 0.00004, P = 0.008, P = 0.010, P = 0.0007; P < 0.00001, P = 0.0001, P = 0.00007, P = 0.0001). There were no differences in any PROM score between groups preoperatively or postoperatively (P = 0.93, P = 0.96, P = 0.57, P = 0.61, P = 0.12; P = 0.79, P = 0.52, P = 0.26, P = 0.46, P = 0.83). Conclusion: There were no significant outcome differences in patients treated with chondroplasty and microfracture for small to medium-sized chondral ankle defects. Patients in both groups saw significant improvements in PROMs at a minimum of one year postoperatively. In small and medium-sized chondral lesions, microfracture may be recommended over chondroplasty for lesions with greater depth or ICRS grade. Level of Evidence: III, retrospective cohort study.

Purpose: To compare intraoperative labral characteristics and minimum 2‐year functional outcomes of allograft labral reconstruction in primary versus revision hip arthroscopy across multiple orthopaedic centers. Methods: A retrospective multicenter hip arthroscopy registry was queried for patients with completed labral reconstruction surgeries from January 2014 to March 2023 with completed 2‐year international Hip Outcome Tool‐12 (iHOT‐12) reports. Age, sex, and major intraoperative variables also were collected. Patients were placed in cohorts based on whether their arthroscopic allograft labral reconstruction was a primary procedure or secondary procedure (reconstruction following failed hip arthroscopy). One‐way analysis of variance was performed on continuous variables. χ ² test was performed on categorical variables. Achievement of minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and Substantial Clinical Benefit (SCB) also was assessed. Results: In total, 77 patients met the inclusion and exclusion criteria and had complete information. The primary reconstruction group (n = 50) was significantly older than the secondary reconstruction group (n = 27) (47.5 ± 10.5 vs 39.1 ± 8.8 years; P = .001). In both cohorts, most patients had labral bruising, advanced labral degeneration, and/or grade III complexity of labral tearing. There was no difference in any recorded intraoperative findings ( P = .160, P = .783, P = .357, respectively). Each cohort experienced significant improvement in iHOT‐12 scores ( P < .0001). However, patients undergoing secondary labral reconstruction reported inferior iHOT‐12 scores (60.1 ± 29.2 vs 74.8 ± 27.0; P = .030). Patients undergoing primary reconstruction were more likely to reach MCID, PASS, and nearly normal SCB (92 vs 66.7%, P = .024; 68.0 vs 40.7%, P = .021; 76.0 vs 48.1%, P = .014, respectively). Conclusions: Primary and secondary allograft labral reconstruction show clinical improvement, but primary reconstruction demonstrates better outcomes and greater percentage of patients reaching MCID, PASS, and nearly normal SCB than reconstruction in the revision setting. Level of Evidence: Level III, retrospective comparative prognostic case‐control study.

According to the World Health Organization, obesity is a global health epidemic, which has nearly tripled in prevalence since 1975. Worldwide in 2016, 13% of adults 18 years and older had obesity (body mass index ≥ 30 kg/m²) and 39% were overweight (body mass index 25.0 to 29.9 kg/m²). In the United States, approximately 35% of adults have obesity and 31% are overweight. Obesity increases stress throughout the musculoskeletal system and carries a higher risk for the development of osteoarthritis and various other musculoskeletal conditions. When patients with obesity undergo orthopaedic procedures, weight loss is a critical aspect to appropriate preoperative counseling and treatment. Weight loss can improve obesity-related comorbidities such as metabolic syndrome, diabetes, cardiovascular disease, and obstructive sleep apnea, which in turn may reduce complications, minimize long-term joint stress, and improve outcomes among patients undergoing orthopaedic procedures. The effects of obesity on patients undergoing total joint arthroplasty has been previously described, with reported associations of increased risk of infection, revision, blood loss, venous thromboembolism, and overall costs. The purpose of this article was to provide orthopaedic surgeons with strategies for obesity treatment.