Matteo Giachino

Purpose: To determine whether capsular repair (CR) after hip arthroscopy for femoroacetabular impingement syndrome provides superior clinical outcomes, functional recovery, and complication profiles compared with nonrepair. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, a search of PubMed, Scopus, Embase, and MEDLINE identified 5 randomized controlled trials comparing CR with no capsular repair in patients with femoroacetabular impingement. Studies published between 2000 and September 2025 with a follow‐up of ≥12 months were included. Data on patient demographics, surgical techniques, postoperative protocols, patient‐reported outcome measures, complications, and revision rates were extracted. Standardized mean differences were calculated using random‐effects models. Heterogeneity was assessed using Cochran's Q statistics and Higgins’ I ² . Results: Five randomized controlled trials (n = 615) met the inclusion criteria: 334 patients in the no capsular repair group and 281 in the CR group. Most patient‐reported outcome measures, including the modified Harris Hip Score, the International Hip Outcome Tool‐12, and all subscales of the Copenhagen Hip and Groin Outcome Score, showed no significant differences between groups. However, the Hip Outcome Score showed a significant advantage for CR (standardized mean difference = 0.59; P < .001). Revision procedures were more frequent in patients who did not undergo CR (15 vs 8 cases). Heterogeneity was generally low across analyses. Conclusions: CR after hip arthroscopy for femoroacetabular impingement syndrome did not show significant advantages over nonrepair in most pooled patient‐reported outcome measures, including the modified Harris Hip Score, International Hip Outcome Tool‐12, and Hip and Groin Outcome Score subscales. However, CR was associated with superior Hip Outcome Score outcomes and lower rates of revision procedures and conversion to total hip arthroplasty. These differences were observed predominantly in studies including unrepaired T‐capsulotomy, whereas studies evaluating only interportal capsulotomy generally reported comparable outcomes between repair and nonrepair. Level of Evidence: Level II, systematic review and meta‐analysis of Level I and II studies.

Aims: In situ fixation for slipped capital femoral epiphysis (SCFE) prevents further displacement, but fails to correct the proximal femoral deformity, which may lead to femoroacetabular impingement (FAI) and early osteoarthritis (OA). The modified Dunn procedure (MDP) restores proximal femoral anatomy with the aim of improving long-term joint preservation. However, evidence beyond mid-term follow-up remains limited. This study evaluates the ten-year survivorship, functional outcomes, and radiological correction following MDP. Methods: A retrospective single-centre review was performed of patients treated with the MDP between 2007 and 2014 for stable or unstable SCFE of any severity. Patients with preoperative avascular necrosis (AVN) were excluded. Primary outcomes were ten-year survivorship free from conversion to total hip arthroplasty (THA) and from radiological OA progression (≥ 1 Tönnis grade). Secondary outcomes included patient-reported outcome measures, hip range of motion, clinical signs of FAI, and correction of the Southwick and α angles. Kaplan-Meier survival analyses were performed and stratified by slip severity. Results: A total of 35 hips (34 patients) completed ≥ ten years of follow-up (163 months (SD 34)). Ten-year THA conversion-free survivorship was 88.6%, decreasing from 100% in mild slips to 86.4% in moderate and 83.3% in severe slips. Ten-year OA progression–free survivorship was 82.9%, with rates of 100%, 81.8%, and 66.7% for mild, moderate, and severe slips, respectively. The mean ten-year functional scores were high (modified Harris Hip Score 88.9 (SD 4.4); University of California, Los Angeles Activity Scale 8.9 (SD 1.6); and Merle d’Aubigné-Postel 17.7 (SD 0.9)). Substantial radiological correction was observed, with the Southwick angle improving from 45.0° to 13.1° and the α angle from 85.8° to 50.9°. No postoperative AVN occurred. Conclusion: At ten-year follow-up, the MDP achieved excellent functional outcomes and effective deformity correction in SCFE, with high survivorship in mild and moderate slips. However, progression of hip OA was less favourable in severe slips. Cite this article: Bone Jt Open 2026;7(10):1295–1303.

Background: Osteitis pubis (OP) is a recognized contributor of anterior pelvic and groin pain, particularly in athletic populations, and is currently included within the wider spectrum of pubic-related groin pain. Despite the growing body of literature, clinical management is still challenging and controversial. Significant conceptual confusion persists among related clinical entities; few reviews address the real-world clinical decision-making process; and a poorly defined “grey area” exists between conservative and surgical treatment strategies. Objectives: This extensive narrative review aimed to clarify key unresolved issues in the management of osteitis pubis by examining the available evidence to: (1) distinguish osteitis pubis from other causes of pubic-related groin pain; (2) evaluate the clinical criteria guiding progression through conservative treatment strategies; and (3) define the role and limitations of intermediate interventions between conservative and surgical management. Methods: An extensive narrative search of PubMed/MEDLINE for publications dated through 4 August 2026 was performed. Clinical studies, consensus statements, systematic and narrative reviews, randomized and nonrandomized trials, observational studies, and case series addressing epidemiology, pathophysiology, diagnosis, imaging, conservative treatment, intermediate interventions, surgery, and return to sport were considered. Reference lists of relevant articles were also screened to identify additional studies. Eligibility criteria, evidence directness, and design-specific methodological limitations were described. Results: The current literature shows considerable heterogeneity in terminology, diagnostic criteria, and imaging interpretation, with inconsistent clinico-radiological correlation. Pubic-related groin pain is a clinical regional classification, whereas OP is used here as an author-proposed clinico-radiological phenotype. Conservative management remains the first-line treatment; however, uniform criteria for defining treatment progression and failure are lacking, and much treatment evidence is indirect or derived from mixed groin-pain populations. Injection-based and other interventional therapies are widely used as diagnostic and therapeutic tools despite limited and heterogeneous evidence. Surgical treatment is reserved for selected refractory cases, although indications and techniques vary considerably across studies. Recent evidence further stresses the frequent coexistence of adductor, aponeurotic, inguinal, and hip-related abnormalities and the need to identify a clinically concordant pain generator before treatment escalation. Conclusions: This review offers a decision-oriented synthesis and proposes an evidence-informed clinical framework. Organizing the available evidence within a coherent diagnostic and therapeutic framework supports individualized clinical decision-making and identifies priorities for future high-quality studies.

Background Deep gluteal syndrome (DGS) involves pain in the buttocks due to entrapment of the sciatic nerve (SN) in the deep gluteal space. This condition can be caused by various structures within this space, such as muscles and fibrous bands, which often cause significant pain and mobility problems. Diagnosis is based on clinical evaluation, diagnostic imaging and nerve conduction studies. At the same time, treatment ranges from physical therapy to surgery, with endoscopic treatment gaining popularity due to its reduced invasiveness and fewer side effects. Material and methods The systematic review was conducted in accordance with the guidelines established by the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The review involved an extensive search of five major databases: PubMed, Scopus, Embase, Medline and Cochrane. Articles that met the eligibility criteria were carefully evaluated according to predefined levels of evidence (LoE). Retrospective studies were specifically assessed using the Coleman Methodology Score (mCMS). This review was registered with the International Prospective Registry of Systematic Reviews (PROSPERO), ensuring the rigor and reliability of the study. Results The review identified 7 studies involving 312 patients (316 hips) with a mean age of 46.8 years and a mean follow-up of 25.1 months. The diagnosis was based on clinical, radiological and injection test results. Initial conservative treatment failed in all cases, necessitating surgery. Endoscopic sciatic nerve release showed success rates between 70 and 100%. Complications were minimal, with a recurrence rate of 2.5%, and revision surgery was required in 1.6% of cases. Postoperative results indicated a significant improvement in pain and function. Conclusion Endoscopic treatment of sciatic nerve entrapment in DGS is effective and safe when physical therapy has failed. Surgery offers significant pain relief and improved function with low complication rates. Despite limitations such as the predominance of retrospective studies and variability in patient management, the results support using this minimally invasive approach. Further high-quality research is needed to validate these results and optimize treatment protocols.

Introduction: Mild slipped capital femoral epiphysis (SCFE) was traditionally treated with in situ pinning (ISP), a technique that stabilizes the physis but does not restore the anterior-superior femoral head offset. This residual deformity can lead to femoroacetabular impingement and early joint degeneration. Therefore, immediate arthroscopic trimming was associated to in situ pinning (ISPAT). The primary goal is to assess the clinical and radiologic outcomes of patients treated with ISPAT. Secondarily, outcomes were compared with traditional in situ pinning (ISP) and modified Dunn’s procedure (MDP). Methods: Patients with Southwick 1 SCFE were included. Patients were divided in 3 groups according to surgical treatment: (1) pinning in situ associated to arthroscopic trimming (ISPAT), (2) pinning in situ (ISP), and (3) modified Dunn procedure (MDP). Outcomes were assessed with clinical parameters (range of motion (ROM), impingement test, mHHS and UCLA activity score) and radiologic parameters (Southwick angle, alpha angle). Early and late complications were recorded. Comparative analysis was performed. Results: A total of 47 patients (59 hips) were included in the study (ISPAT: 12, ISP: 34, MDP: 13). Preoperative Southwick slip angle (SA) was higher in the ISPAT and MDP groups compared with the ISP group (ISPAT vs. MDP, P=0.85; ISPAT vs. ISP, PPPPP=0.099). No differences were found in mHHS scores across groups (ISPAT 90.7±0.9, ISP 86.8±10.0, MDP 90.6±1.2, P=0.18)​. Postoperatively, the alpha angle of the ISPAT group demonstrated significant improvement postoperatively (preoperative 81.5±7.7 vs. postoperative 47.7±8.3 deg, PP=0.45)​. In ISPAT no major complications were recorded. In ISP 4 patients developed osteoarthritis (OA) (2 required total hip arthroplasty). In MDP 1 patient developed OA, but no further surgery was performed. Conclusions: ISPAT is a safe and effective option for managing mild SCFE, providing immediate intervention to address FAI. However, its long-term impact on hip function and osteoarthritis prevention requires further investigation.

Background: Hip replacement surgery is highly effective in relieving pain and improving mobility in patients with various hip conditions. However, some patients develop groin pain after surgery, often due to iliopsoas impingement (IPI), which can be challenging to diagnose. Conservative treatments are initially recommended, but when these are not effective, surgical options may be considered. This study aims to evaluate the clinical outcomes, success and failure rates, revision rates, and complications associated with arthroscopic and endoscopic surgery for IPI, thereby providing a comprehensive understanding of the effectiveness and risks of these surgical interventions. Materials and methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including a thorough search of five main databases: PubMed, Scopus, Embase, Medline, and Cochrane. Eligible articles were meticulously evaluated according to predefined criteria for levels of evidence (LoE), with retrospective studies assessed using the Coleman Methodology Score (mCMS). This systematic review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO). Results: Among the 16 included studies, 431 patients with 434 hips underwent either endoscopic or arthroscopic tenotomy. Both techniques showed favorable outcomes, with arthroscopic tenotomy demonstrating slightly higher success rates than endoscopic tenotomy. Common complications included mild pain and occasional infections, with recurrence observed in some cases. Both techniques offer direct visualization of prosthetic components and potential preservation of psoas function. Conclusions: Arthroscopic and endoscopic iliopsoas tenotomy are effective treatments for alleviating symptoms and improving hip function in patients with IPI post-total hip arthroplasty (THA). Level of evidence: IV.