Jairo Triana

Purpose: To investigate the relationship between postoperative activity levels, measured via a smartphone application, and the incidence of iliopsoas tendinitis (IPT) following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). We hypothesized that lower postoperative activity levels across the monitored 12-week period would be associated with increased IPT risk. Methods: This prospective cohort study enrolled patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) from June 2022 to February 2023. Average weekly step counts across the 12-week postoperative monitoring period were tracked via a smartphone application. Patients were stratified into IPT and non-IPT groups, and preoperative and postoperative outcomes, including the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Visual Analog Scale (VAS), were compared. Activity levels were categorized into low, moderate, and high groups based on percentile distributions. Results: A total of 54 patients (mean age 37.8 ± 11.6 years, 59.3% female) were included, with 16 (29.6%) developing IPT at an average of 2.5 ± 1.2 months postoperatively. IPT patients had lower preoperative mHHS (62.2 vs. 74.9, p = 0.026) and NAHS (53.9 vs. 66.9, p = 0.023), and greater pain (VAS 6.3 vs. 5.0, p = 0.054). Mean weekly step counts were lower in the IPT group in every postoperative week, reaching statistical significance at Weeks 3 and 12 (p = 0.042 and p = 0.012). In penalized regression adjusted for preoperative mHHS and age, each additional 1000 steps per day during Weeks 1–3 was associated with lower odds of IPT (OR 0.63, 95% CI 0.32 to 0.98, p = 0.037); associations for later periods were in the same direction but did not reach statistical significance (Weeks 10–12: OR 0.89, 95% CI 0.66 to 1.10, p = 0.29). Functional improvements at 3 months did not differ between groups. Conclusions: Lower postoperative step counts were associated with a higher risk of IPT development, with the most robust association observed in the immediate postoperative period (Weeks 1–3), highlighting the potential importance of monitored, progressive rehabilitation following hip arthroscopy. These findings are exploratory and hypothesis-generating and require prospective interventional validation.

Purpose: The aim of this study was to assess the inter‐rater reproducibility and inter‐method comparability of hip alpha angle measurements on magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA) and plain radiographs in patients with femoroacetabular impingement syndrome (FAIS).Methods: A cross‐sectional study of patients who were diagnosed with symptomatic FAIS underwent preoperative MRI/MRA with axial oblique and/or radial plane imaging and had preoperative radiographs with anterior‐posterior (AP), 45° Dunn and 90° Dunn views. Alpha angle measurements were performed independently by two musculoskeletal radiologists. Inter‐rater reproducibility and inter‐method comparability between MRI/MRA images and radiographic views were assessed using the intraclass correlation coefficient (ICC) with 95% confidence interval (CI).Results: Ninety‐seven patients were included of whom 93 (95.8%) received axial oblique plane images and 54 (55.6%) had radial plane MRI/MRA images. Inter‐rater reproducibility was excellent (ICC > 0.9) for all planes on MRI/MRA and radiographs. MRI/MRA axial oblique images had poor (ICC 0.39, 95% CI [0.09, 0.59]), moderate (ICC 0.57, 95% CI [0.18, 0.75]) and moderate (ICC 0.64, 95% CI [0.20, 0.81]) comparability with AP, 45° Dunn and 90° Dunn, respectively. MRI/MRA radial plane images had equivocal (0 included in all CIs) comparability with AP (ICC 0.66), 45° Dunn (ICC 0.35) and 90° Dunn (ICC 0.14) radiographs. On average, alpha angle measurements were significantly higher with radial images and lower with axial oblique images, when compared to all radiographic views (p < 0.05), except axial oblique versus 45° Dunn views, where angles measured on axial oblique were significantly larger.Conclusion: Alpha angle measurements taken on axial oblique MRI/MRA images show moderate comparability to radiographic 45° Dunn and 90° Dunn views despite negative bias to measurements taken on radiographic AP and 45° Dunn view. Larger alpha angles were appreciated on MRI/MRA radial and axial oblique views compared to radiographic views supporting the inclusion of MRI/MRA alpha angle measurements to properly identify deformity.Level of Evidence: Level II.

Purpose: The purpose of this study is to assess the association between sagittal tibial tuberosity‐trochlear groove (sTT‐TG) distance and patellofemoral chondral lesion size in patients undergoing cartilage restoration procedures.Methods: A retrospective cohort analysis of patients who underwent an osteochondral allograft transplantation or matrix‐induced autologous chondrocyte implantation in the patellofemoral compartment, from 2010 to 2020, were included if they had patellofemoral high‐grade lesions, magnetic resonance imaging (MRI) and minimum 2‐year follow‐up. The preoperative sTT‐TG distance was measured independently on axial T2‐weighted MRI sequences by two authors, each at least two weeks apart. Intraoperative lesion size was reported according to operative report measurements by the attending surgeon. An interclass correlation coefficient (ICC) was calculated to assess intra‐ and inter‐rater reliability, and categorical data analysis and linear regression models were used to assess the relationship between sTT‐TG and lesion size.Results: A total of 80 patients (50 females) with a mean age of 31.5 ± 10.4 years, body mass index of 27.0 ± 5.9 kg/m² and follow‐up of 61.5 ± 21.4 months were included. A total of 107 lesions were present: 63 patients with unipolar (patella = 41, trochlea = 22) and 22 with bipolar lesions. The mean MRI defect size was 1.6 ± 1.0 cm² and the mean intraoperative defect size was 3.8 ± 2.4cm². Intra‐ (ICC: 0.99,0.98) and inter‐rater reliability (ICC: 0.96) were excellent for both MRI defect size and sTT‐TG measurements. The mean sTT‐TG was −4.8 ± 4.9 mm and was significantly inversely related to MRI defect size (−0.45, p < 0.01), intraoperative patellar lesion size (−0.32, p = 0.01), total lesion area (−0.22, p = 0.04), but not trochlear lesion size (−0.09, p = 0.56). Multivariable regression demonstrated a more negative sTT‐TG remained an independent variable correlated with larger MRI‐measured patellofemoral defect sizes and intraoperative patellar lesions.Conclusion: A more negative sTT‐TG was an independent variable correlated with larger patellofemoral lesions in patients undergoing patellofemoral cartilage restoration.Level of Evidence: Level III, Diagnostic.

Purpose: To assess clinical outcomes and return to sport (RTS) rates among patients who undergo osteochondral allograft (OCA) transplantation and autologous chondrocyte implantation (ACI) or matrix‐induced autologous chondrocyte implantation (MACI), for patellofemoral articular cartilage defects. Methods: A retrospective review of patients who underwent an OCA or ACI/MACI from 2010 to 2020 was conducted. Patient‐reported outcomes collected included visual analog scale for pain/satisfaction, Knee Injury and Osteoarthritis Outcome Score (KOOS), and RTS. The percentage of patients that met the patient acceptable symptom state for KOOS was recorded. Logistic regression was used to identify predictors of worse outcomes. Results: A total of 95 patients were included (78% follow‐up) with ACI or MACI performed in 55 cases (57.9%) and OCA in 40 (42.1%). A tibial tubercle osteotomy was the most common concomitant procedure for OCA (66%) and ACI/MACI (98%). Overall, KOOS pain was significantly poorer in OCA than ACI/MACI (74.7, 95% confidence interval 68.1‐81.1 vs 83.6, 95% confidence interval 81.3, 88.4, P = .012), whereas the remaining KOOS subscores were nonsignificantly different (all P > .05). Overall, RTS rate was 54%, with no significant difference in return between OCA or ACI/MACI (52% vs 58%, P = .738). There were 26 (27%) reoperations and 5 (5%) graft failures in the entire group. Increasing age was associated with lower satisfaction in OCA and poorer outcomes in ACI/MACI, whereas larger lesion area was associated with lower satisfaction and poorer outcomes in ACI/MACI. Conclusions: Clinical and functional outcomes were similar in patients who underwent OCA or ACI/MACI for patellofemoral articular cartilage defects at a mean follow‐up of 5 years. Patients who received OCA had a greater proportion of degenerative cartilage lesions and, among those with trochlear lesions, reported greater pain at final follow‐up than their ACI/MACI counterparts. Overall, increasing age and a larger lesion size were associated with worse patient‐reported outcomes. Level of Evidence: Level III, retrospective cohort study.

Females of reproductive age constitute one of the largest demographics of the hip arthroscopy population, but it is unclear as to how pregnancy planning affects decision-making regarding surgery or vice versa. The purpose of this study was to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive-age females who underwent arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving females aged 18–44 years who underwent hip arthroscopy for the treatment of FAIS, with a single surgeon included in the study. Subjects completed a survey that assessed obstetric and gynecologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery (Group 2), or pregnant at least once following hip surgery (Group 3). A total of 85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. The mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9%), 20 in Group 2 (23.5%), and 26 in Group 3 (30.6%). About half of all subjects expressed “some” to “a lot of” concern that their hip pain could get worse during pregnancy (49.4%), and about half had “no concern” that hip arthroscopy would affect the health of their fetus/baby (54.1%). Reproductive-age females undergoing hip arthroscopy for FAIS generally consider the procedure to be safe with respect to future pregnancy outcomes.

Purpose: The purpose of this study is to describe the postoperative psychological state of patients following osteochondral allograft (OCA) transplantation in the knee and to determine whether patient‐perceived kinesiophobia is associated with the rate of return to sport (RTS).Methods: A retrospective review of the electronic medical record at a single institution was conducted for all patients that underwent OCA transplantation from January 2010 to 2020. Patient‐reported outcomes including the visual analog scale (VAS), knee injury and osteoarthritis outcome score (KOOS) and the Tampa scale of kinesiophobia‐11 (TSK‐11) were collected. Patients were surveyed regarding their postoperative RTS status.Results: A total of 38 patients (52.6% female) were included in our analysis. Overall, 24 patients (63.2%) returned to sport with 12 (50%) of these patients returning at a lower level of play. When comparing patients that return to sport to those that did not, patients that return had significantly superior KOOS pain (p = 0.019) and KOOS QOL (p = 0.011). Measures of kinesiophobia (TSK‐11) were significantly higher among patients that did not return to sport (p = 0.014), while satisfaction (n.s.) and pain intensity (n.s.) were comparable between groups. Logistic regression models controlling for demographic factors, VAS pain scores and lesion size showed that for every one‐point increase in TSK‐11 kinesiophobia score, patients were 1.33 times more likely to return to sport at a lower level (p = 0.009). For every one‐point increase in TSK‐11 scores KOOS QOL decreased by 2.4 points (p < 0.001).Conclusion: Fear of reinjury decreases the likelihood that patients will return to their preoperative level of sport after OCA transplantation. Patients that do not return to sport report significantly greater fear of reinjury and inferior clinical outcomes, despite similar levels of satisfaction and pain compared to those that return.Level of Evidence: Level III.

Purpose: To investigate the rate of return to sports and sport psychological readiness between patients who underwent isolated MPFLR (iMPFLR) compared to a matched cohort of patients who underwent MPFLR with anteromedializing tibial tubercle osteotomy (MPFLR/TTO).Methods: Patients who underwent primary MPFLR with or without TTO for recurrent patellar instability were retrospectively reviewed from 2012 to 2020 at a single institution. Preinjury sport and work information, Kujala, Tegner, Visual Analogue Score for pain, satisfaction and MPFL‐Return to Sport after Injury (MPFL‐RSI) score were collected. Two readers independently measured the tibial tuberosity‐trochlear groove distance, Caton–Deschamps index and Dejour classification for trochlear dysplasia. Patients in iMPFLR and MPFLR/TTO groups were matched 1:1 on age, sex, body mass index and follow‐up length. Multivariate regression analysis was performed to determine whether the MPFL‐RSI was associated with a return to sport.Results: This study included 74 patients at mean follow‐up of 52.5 months (range: 24–117). These groups returned to sport at similar rates (iMPFLR: 67.6%, MPFLR/TTO: 73.0%, not significant [ns]), though iMPFLR patients returned more quickly (8.4 vs. 12.8 months, p = 0.019). Rates of return to preinjury sport level were also similar (45.9% vs. 40.5%, ns). Patients with Dejour B/C took more time to return to sport compared to patients with mild/no trochlear pathology (13.8 vs. 7.9 months, p = 0.003). Increasing MPFL‐RSI score was significantly predictive of the overall return to sport (odds ratio [OR]: 1.08, 95% confidence interval [CI] [1.03, 1.13], p < 0.001) and return to preinjury level (OR: 1.07, 95% CI [1.04, 1.13], p < 0.001). Most patients in iMPFLR and MPFLR/TTO groups resumed work (95.7% vs. 88.5%, ns), though iMPFLR patients who returned to preinjury work levels did so more quickly (1.7 vs. 4.6 months, p = 0.005).Conclusion: Patients who underwent MPFLR with anteromedializing TTO demonstrated similar rates of return to sport and psychological readiness compared to an isolated MPFLR matched comparison group, though iMPFLRs returned more quickly. Patients with more severe trochlear pathology required more time to return to sports.Level of Evidence: Level III.

Objective: To evaluate the effect of fear of reinjury on return to sport (RTS), return to work (RTW), and clinical outcomes following autologous chondrocyte implantation (ACI). Design: A retrospective review of patients who underwent ACI with a minimum of 2 years in clinical follow-up was conducted. Patient-reported outcomes collected included the Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Kinesiophobia and pain catastrophizing was assessed using the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS), respectively. Patients were surveyed on their RTS and RTW status. Results: Fifty-seven patients (50.9% female) were included in our analysis. Twenty-two (38.6%) patients did not RTS. Of the 35 patients (61.4%) who returned, nearly half (48.6%) returned at a lower level of play. TSK-11 ( P = 0.003), PCS ( P = 0.001), and VAS pain scores ( P < 0.001) were significantly greater in patients that did not RTS than in those who returned. All KOOS subscores analyzed were significantly lower ( P < 0.001) in patients that did not RTS than in those who returned at the same level or higher. Of the 44 (77.2%) patients previously employed, 97.7% returned to work. Increasing TSK-11 scores were associated with lower odds of returning to sport ( P = 0.003). Conclusion: Fear of reinjury decreases the likelihood that patients will return to sport after ACI. Patients that do not return to sport report significantly greater levels of fear of reinjury and pain catastrophizing and lower clinical knee outcomes. Nearly all patients were able to return to work after surgery. Level of Evidence: IV case series.

Purpose of Review Numerous cartilage restoration techniques have proven to be effective in the treatment of articular cartilage defects. The ultimate goal of these procedures is to improve pain and function, thereby increasing the likelihood of a patient’s return to physical activity. Postoperative rehabilitation is a key component for a successful and expedient return to activities. The purpose of this article is to review the current literature regarding common surgical options, rehabilitation protocols, and performance outcomes after operative treatment of articular cartilage defects. Recent Findings Studies have demonstrated improved short- to long-term outcomes in a majority of techniques. However, the clinical benefits of microfracture are short-lived, which has led to the use of alternative procedures. Rehabilitation protocols are not standardized, but emphasis has been placed on bracing, weightbearing, early continuous passive range of motion, and strengthening to improve function. There is growing evidence to suggest that accelerated rehabilitation after matrix-induced autologous chondrocyte implantation may result in superior outcomes compared to delayed rehabilitation. Overall, most techniques result in satisfactory rates of return to play, though existing comparative studies typically include patients with heterogeneous pathology, complicating effective synthesis of outcomes data. Summary In appropriately selected patients, cartilage restoration procedures after articular cartilage injury result in favorable patient-reported clinical outcomes and high rates of return to play. While studies emphasize the critical role that rehabilitation plays with respect to outcomes after surgery, there are substantial inconsistencies in protocols across techniques.