Andrew R. Schab

Purpose: To report short‐term outcomes of primary hip arthroscopy in skeletally immature adolescents with open physes (OP) and to compare their results with a propensity‐matched group of skeletally mature adolescents with closed physes (CP). Methods: Data were reviewed for patients undergoing arthroscopy for the treatment of femoroacetabular impingement syndrome and labral tears between February 2008 and June 2021. Patients were excluded if they had previous ipsilateral hip conditions, hip dysplasia (lateral center‐edge angle < 18°), previous ipsilateral surgery, preoperative Tonnis grade >1, or were older than 19 years. Patients were included in the OP group if they had open proximal femoral growth plates, Risser stage ≤4, and minimum 2‐year follow‐up. OP hips were matched to CP hips in a 1:1 ratio by age, sex, and body mass index. Patient‐reported outcomes (PROs), clinically meaningful thresholds, secondary surgeries, and complications were compared. Results: Thirty OP hips were matched with 30 CP hips. The mean age of the OP group and control group was similar (OP 14.96 yr; CP 15.01 yr, P = .94). Significant and similar improvement was seen for all PROs in both groups ( P < .05). The OP group had higher preoperative values for modified Harris Hip Score and Hip Outcome Score Sport‐Specific Subscale than the CP group ( P < .05), yet both groups achieved similar postoperative values for all evaluated PROs ( P > .05). The OP and CP groups met clinically meaningful thresholds and underwent revision arthroscopy at similar rates ( P > .05). No complications, bony regrowth, or growth disturbances were reported. Conclusions: Skeletally immature adolescents with OP showed favorable short‐term outcomes after primary hip arthroscopy. When compared with a propensity‐matched control group of CPs, OPs had similar PROs, met clinically meaningful thresholds, and underwent revision hip arthroscopy at similar rates. Longitudinal radiographic analysis indicated no bony regrowth to occur in both groups. Level of Evidence: Level III, retrospective case control study.

Purpose: To compare radiographic parameters obtained from supine versus standing pelvic radiographs in patients with femoroacetabular impingement (FAI) and acetabular dysplasia (AD). Methods: This study was registered on the International Prospective Register of Systematic Reviews and performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, Cochrane Central Register of Controlled Trials, and Scopus were queried in June 2025. Included studies compared supine versus standing radiographic parameters in patients with FAI or AD. Articles were excluded if they failed to provide extractable radiographic data for both positions. Demographics, study design, and radiographic parameters, including lateral center‐edge angle (LCEA), pelvic tilt, Tönnis angle, femoral head translation, Sharp angle, joint space width, and femoroepiphyseal acetabular roof index, were analyzed. Meta‐analyses with a random‐effects model were performed to evaluate mean differences in supine versus standing measurements for LCEA, Tönnis angle, and pelvic tilt, stratified by FAI and AD cohorts. Results: Twelve studies were analyzed, comprising 824 hips in 675 patients. Statistically significant differences in individual‐study supine versus standing comparisons were identified for pelvic tilt (10/10 studies), Tönnis angle (7/8), and LCEA (6/10). Four studies reported sex‐disaggregated data. Meta‐analyses showed greater pelvic tilt in supine in FAI (+1.38 cm, 95% confidence interval [CI]: 0.92, 1.84; P < .001) and AD (+1.98 cm, 95% CI: 0.37, 3.59; P = .020) populations. Tönnis angle was smaller in supine in FAI (−1.14°, 95% CI: −2.19, −0.09; P = .030) and AD (−1.93°, 95% CI: −3.20, −0.65; P = .003). LCEA measurements were not significantly different in FAI (+0.97°, 95% CI: −0.80, 2.74; P = .28) and AD (+1.03°, 95% CI: −0.70, 2.76; P = .24). Conclusions: Supine pelvic radiographs resulted in greater pelvic tilt measurements, decreased Tönnis angles, and similar LCEA compared with standing radiographs. Supine and standing radiographic parameters should not be considered interchangeable. Level of Evidence: Level IV, systematic review of Level II to IV studies.

Labral reconstruction is a surgical procedure in which a graft is used to replace irreparable acetabular labral tissue. Biologic augmentation with bone marrow aspirate concentrate harvested from the ipsilateral iliac crest is increasingly used to enhance graft incorporation and potentially improve functional outcomes, especially in patients with concomitant chondral injury. Recent prospective data indicate that bone marrow aspirate concentrate augmentation during labral repair or reconstruction is associated with greater improvements in patient‐reported outcome measures at intermediate‐term follow‐up. The described technique integrates these advances into segmental labral reconstruction using a presutured iliotibial band allograft, highlighting a reproducible and biologically enhanced treatment for challenging labral pathology.

Purposes: To compare minimum 2‐year patient‐reported outcomes measures (PROMs) between adolescents undergoing primary and revision hip arthroscopy. Methods: Data were prospectively collected and retrospectively reviewed for adolescents who underwent revision hip arthroscopy from November 2008 and November 2021. Patients with baseline and minimum 2‐year PROMs were included. Exclusion criteria were patients over 19 years old or dysplastic. A propensity‐matched comparison was performed to a primary control group in a 1:2 ratio based on age at surgery, sex, body mass index, and acetabular Outerbridge grade. PROMs, clinical benefit achievement rates, and secondary surgeries were reported and compared. Results: Thirty‐five adolescents (37 revisions hips) were included and propensity‐matched. Significant improvement was noted for modified Harris Hip Score, Non‐Arthritic Hip Score, Hip Outcome Score Sport‐Specific Subscale, International Hip Outcome Tool, patient satisfaction, and visual analog scale for pain in both groups ( P < .01). The revision group had significantly lower postoperative values for all the PROMs ( P < .01); however, improvement (delta value) was similar. Revision hips underwent secondary arthroscopy at higher rates when compared with primary hips (21.6% vs 5.4%; P < .05) and were 4.83 times as likely to receive an additional rerevision surgery. Conclusions: Adolescents undergoing revision arthroscopy showed significant improvement in all PROMs (modified Harris Hip Score, Non‐Arthritic Hip Score, Hip Outcome Score Sport‐Specific Subscale, International Hip Outcome Tool, and visual analog scale for pain) at a minimum 2‐year follow‐up. When compared with a propensity‐matched primary control group, revision hips had lower preoperative and postoperative values, but similar improvement magnitude for all PROMs, but met clinically meaningful thresholds at lower rates, and were 4.83 times more likely to require a subsequent hip arthroscopy. Level of Evidence: Level III, retrospective comparative study.

Purpose: To report minimum 2‐year outcomes of iliopsoas tunnel deepening (ITD) during hip arthroscopy and compare their results to propensity‐matched hip arthroscopies performed with iliopsoas fractional lengthening (IFL) in patients with combined femoroacetabular impingement syndrome and iliopsoas impingement with painful internal snapping. Methods: Data were collected between December 2017 and January 2022 and retrospectively reviewed for all patients who underwent primary hip arthroscopy to treat femoroacetabular impingement syndrome, labral tears, and iliopsoas impingement. Hips included had 2‐year minimum postoperative patient reported outcomes (PRO). Subjects receiving ITD were propensity matched to IFLs in a 1:1 ratio based on age, sex, body mass index, Acetabular Outerbridge Grade, labral treatment, and capsular treatment. Patient characteristics, procedures performed, and PROs were compared. Rates of meeting minimum clinically important difference and patient acceptable symptomatic state, revision arthroscopy, and conversion to arthroplasty were compared. Results: A total of 33 ITD hips (30 patients) and 33 IFL hips (33 patients) were included in each group. Patients in the IFL cohort had longer follow‐up than ITD cohort (56.3 ± 23.9 vs 27.9 ± 9.6 months respectively, P < .01). Both groups showed significant improvement in all PROs with comparable postoperative improvement ( P > .05). Similar resolution of painful internal snapping was seen, with 26 (78.79%) ITD and 27 (81.82%) IFL hips seeing resolution ( P = .76). For ITD and IFL groups, rates of achieving minimum clinically important difference and patient acceptable symptomatic state were similar rates ( P > .05). ITDs and IFLs underwent revision arthroscopy at comparable rates (9.1% vs 9.1%; P > .99). No conversions to arthroplasty were reported. Conclusions: ITD yielded improvements when treating iliopsoas impingement during hip arthroscopy. ITDs had comparable improvements in PROs, resolution in painful internal snapping, and underwent revision arthroscopy at similar rates when compared to IFLs. Level of Evidence: Level III, retrospective comparative study.

Background: Previous lumbar spine surgery (LSS) may restrict spinal mobility, impacting pelvic mechanics and potentially increasing hip motion demands. Purpose: To evaluate the effect of previous LSS on the outcomes of primary hip arthroscopic surgery at a minimum 5-year follow-up. Study Design: Case control; Level of evidence, 4. Methods: A retrospective analysis was conducted on patients who underwent hip arthroscopic surgery with previous LSS. Patients had completed a minimum of 5-year follow-up. A subanalysis based on the type of LSS was also conducted. Patients were matched to a control group that underwent hip arthroscopic surgery without previous LSS in a 1:3 ratio based on age at surgery, sex, acetabular Outerbridge grade, and body mass index. Comparisons of patient-reported outcome (PRO) scores, clinically relevant outcome thresholds, complications, revision hip arthroscopic surgery, and conversion to total hip arthroplasty (THA) were performed. Results: A total of 424 hips were included in the study: 106 hips with previous LSS and 318 control hips. Patients with previous LSS displayed improvements across all PRO measures. There were no differences in improvements in PRO scores or the percentage of patients reaching clinically relevant outcome thresholds based on the type of LSS. Compared with the control group, the LSS group started with significantly lower preoperative PRO scores. Yet, both groups experienced equivalent improvements in all PRO scores. Furthermore, the LSS group had worse postoperative scores for all PRO measures. Additionally, the LSS group reached the Patient Acceptable Symptom State at significantly lower rates for the mHHS (modified Harris Hip Score), NAHS (Non-Arthritic Hip Score), and HOS-SSS (Hip Outcome Score–Sports-Specific Subscale). There was no difference in the rates of complications and secondary surgery, but the LSS group converted to THA sooner, with the LSS and control groups converting to THA at 27.43 ± 24.32 and 48.02 ± 37.61 months, respectively ( P < .05). Conclusion: Hip arthroscopic surgery for the treatment of femoroacetabular impingement and labral tears in patients with previous LSS yielded significant improvements at midterm follow-up, which were equivalent to those of a matched control group with no history of lumbar abnormalities. However, the LSS group had lower postoperative PRO scores and met the Patient Acceptable Symptom State for PRO measures at lower rates. Importantly, LSS did not influence the risk of revision arthroscopic surgery and conversion to THA. However, the LSS group converted to THA sooner than the control group.