Samarth Venkata Menta

Purpose: To develop a reference ischiofemoral space (IFS) value for patients with proximal hamstring injuries (HSI) and to compare it with individuals without proximal hamstring pathology. Methods: We retrospectively collected the data from our institution. Patients aged 18 years or older with a proximal HSI were included. Patients with insufficient imaging data, those with prior hip surgery, those with concurrent femoroacetabular impingement syndrome, and those with concurrent ischiofemoral impingement as defined by quadratus femoris edema on magnetic resonance imaging (MRI) were excluded. A 1:2 matched‐cohort analysis was conducted. Two cohorts were (1) patients with proximal HSI and (2) patients with femoroacetabular impingement syndrome as a control cohort (Control). Both pelvic anteroposterior (AP) radiographs and axial MRI were used to assess IFS and were compared between the 2 cohorts. Additionally, the neck‐shaft angle was collected and compared. Results: There were 60 patients in the HSI cohort and 124 patients in the control cohort. The mean neck‐shaft angle, IFS from the AP pelvis, and IFS from the axial MRI for the HSI cohort were 136.35° ± 5.63°, 24.35 ± 8.60 mm, and 26.57 ± 7.96 mm, respectively. For the control cohort, these values were 135.30° ± 4.53°, 29.83 ± 9.84 mm, and 29.28 ± 8.54 mm, respectively. The IFS in the HSI group was significantly lower than that in the control group on both pelvic AP radiograph ( P < .001) and axial MRI ( P = .036). Conclusions: Patients with proximal HSI had a smaller IFS compared with those with femoroacetabular impingement syndrome. Level of Evidence: Level III, retrospective cohort study.

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.

Understanding the minimal clinically important difference (MCID) for a given procedure and its associated patient-reported outcome measures (PROMs) are critical for evaluating success in orthopedic surgery. The MCIDs for the International Hip Outcome Tool (iHOT-33) and Modified Harris Hip Score (mHHS) have been defined for open proximal hamstring repair (OPHR); however, the speed and reliability at which patients achieve these are unknown. A retrospective review of prospectively collected data from our institution’s hip preservation registry was performed, examining pre-operative and 6-, 12-, and 24 months post-operative mHHS and iHOT-33 scores. The percentage of patients achieving MCID at each time point was determined, and factors associated with achieving MCID were assessed. A total of 37 patients were included in this analysis (n = 36 for iHOT-33 and n = 32 for mHHS). At 6 months, 83% and 78% of patients achieved MCID for iHOT-33 and mHHS, respectively. Patients with chronic symptoms (pain >6 months) were significantly less likely to achieve at least one of the MCIDs at 6 months (60% vs. 12.5%, P = .04), while patients with more severe preoperative pain were significantly more likely to achieve at least one of the MCIDs at 6 months (P = .004). Most patients who achieve the MCID for iHOT-33 and mHHS following OPHR do so by 6 months postoperatively. Chronic symptoms were associated with failure to achieve either one of the MCIDs at 6 months post-operatively. Patients with more severe preoperative pain were more likely to successfully achieve one of the MCIDs at 6 months.

The aim of this study is to determine if post-operative patient-reported outcome measures (PROMs) are influenced by hip arthroscopy traction duration. Patients from a local prospective hip arthroscopy database were retrospectively analyzed. Four hip-specific PROMs were utilized: modified Harris Hip Score (mHHS), Hip Outcome Score—Activities of Daily Living (HOS-ADL), Hip Outcome Score—Sports Specific (HOS-SS), and international Hip Outcome Tool (iHOT). PROMs were collected pre-operatively and 6 months, 1 year and 2 years post-operatively. Two cohorts were created based on a cut-off corresponding to the 66th percentile for our patient cohort. Analyses were completed for each PROM at each post-operative interval with univariable statistics. Multivariable statistics were examined to identify the variables that were predictive of achieving post-operative minimal clinically important difference (MCID) at the 2-year follow-up. Overall, 222 patients met the inclusion criteria. The mean age was 32.4 ± 9.4 years, and 116 (52.3%) were female. The average traction time of the study population was 46.1 ± 12.9 min. A total of 145 patients were included in the short traction cohort (65%) with traction times of Level of evidence: Level III, cohort study

Background: Medial compartment osteoarthritis in young active patients presents a unique challenge with regard to joint preservation. Interventions, including cartilage restoration procedures, in the setting of high tibial osteotomy (HTO) have the potential to obviate or delay joint replacement if performed with a high degree of accuracy and avoidance of complications. Indications: The procedure is indicated in patients less than 65 years with isolated medial knee arthrosis, good range of motion, and no ligamentous instability. Technique Description: We present our technique for valgus producing opening wedge HTO with patient-specific instrumentation and implant with concomitant osteochondral allograft of the medial femoral condyle and tibial microfracture. Results: The goal of this intervention is to provide a minimally painful knee with durable (>10 year) outcome while minimizing the risk of perioperative complications including iatrogenic fracture and nonunion. Discussion/Conclusion: High tibial osteotomy with concomitant cartilage repair techniques can lead to high satisfaction and return to sport rates in appropriately selected patients. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.