Abstract Gluteus medius tendinopathy encompasses a spectrum of injuries, from partial to full thickness tears, often associated with tendon retraction and fatty degeneration, and remains a common cause of lateral hip pain. This study aimed to describe an intraoperative classification system for gluteus medius tears that integrates focal degenerative lesions, tendon involvement, tear retraction, tissue quality, and fatty degeneration with corresponding surgical and rehabilitation strategies. A focused literature review identified five previously described classification systems and their limitations, including magnetic resonance imaging-based and intraoperative frameworks. Based on these findings, a novel classification was developed, categorizing tears from type 0 (normal) to type 4c (full-thickness tear with retraction and fatty degeneration), with each type linked to suggested surgical techniques, including single or double-row anchor repair, augmentation with bioinductive patches, or gluteus maximus transfer, and general postoperative rehabilitation considerations with proposed timelines for weight bearing and physical therapy. These recommendations reflect expert-guided considerations rather than evidence-based protocols. This classification is applicable to both endoscopic and open repairs. Compared with previous systems, this approach emphasizes intraoperative therapeutic guidance, potentially facilitating real-time intraoperative decision-making and more standardized surgical assessment, regardless of preoperative imaging availability. In conclusion, the proposed intraoperative classification provides a practical framework for the assessment and management of gluteus medius tears. By incorporating clinically relevant intraoperative and degenerative features, the system may facilitate more standardized surgical assessment and support future investigation of functional and clinical outcomes. This classification has not yet undergone validation; further studies should assess reproducibility, interobserver reliability, and prognostic utility.
Abstract Background Femoroacetabular impingement (FAI) is a common clinical syndrome with a high prevalence among athletes. Arthroscopy for FAI boasts excellent patient-reported outcomes (PROs) and return to sport (RTS), but predictors of outcomes have been identified. Existing studies suggest that delayed arthroscopy may be associated with inferior PROs, but evidence for sport-specific outcomes is lacking. Aim Our aim was to analyze the impact of timing on (i) postoperative outcomes and (ii) return to sport following primary hip arthroscopy for FAI through a systematic review. Methods Our systematic review queried Pubmed, Embase, and Cochrane Library. Studies examining patients aged 16 or older underdoing primary arthroscopy for FAI that stratified outcomes based on time to surgery were included. Studies that were unavailable in English, not primary research, or analyzing revision procedures or FAI secondary to other lesions were excluded. The heterogeneity inherent to the populations studied precluded meta-analysis. Results Of 849 studies identified, 24 met inclusion criteria, representing a population of 23 742. Late surgery was associated with lower rates of RTS, RTS at lower play levels, and lower HOS-SS scores but not with time to RTS. Studies reported inferior improvements in non-sport PROs in delayed arthroscopy compared to earlier intervention. Later surgery was associated with greater postoperative opioid use and greater rates of total hip arthroplasty. Conclusions Delayed arthroscopy for FAI may be associated with inferior sport-related outcomes and improvements in PROs compared to earlier intervention. Substantial heterogeneity existed between the included studies, but these associations were consistent across analytic methods.
Abstract Anteroposterior (AP) pelvic and lateral hip radiographs are the first-line diagnostic imaging used for athletes with longstanding hip/groin pain. Reliable radiographic parameters are essential for research and clinical decision-making; however, relative and absolute reliability data for these procedures are lacking. This study investigated relative and absolute intra- and inter-rater reliability of hip- and pubic-related radiographic parameters in male athletes. AP and cross-table lateral radiographs from 46 footballers with hip/groin pain and 40 asymptomatic athletes were independently rated by two blinded radiologists. Hip-related parameters included alpha angle, lateral center-edge angle, acetabular index angle, hip joint space width, ischial spine sign, cross-over sign, and posterior wall sign. Pubic-related parameters included bone lucency, proliferation, fragmentation, sclerosis, and pubic joint space width. Relative reliability was quantified using intraclass correlation coefficients (ICC) and Cohen’s κ; absolute reliability with minimal detectable change (MDC) and overall agreement. Relative reliability for hip-related parameters ranged from ICC: 0.69–0.78 and κ: 0.51–0.81 for intra-rater, and ICC: 0.17–0.77 and κ 0.53–0.86 for inter-rater reliability. Relative reliability for pubic-related parameters ranged from κ: 0.49–0.63 (intra-rater) and κ: 0.34–0.45 (inter-rater). Absolute reliability for hip-related parameters ranged from MDC: 7.2°–14.7° (intra-rater) and 6.5°–33.1° (inter-rater). For pubic-related parameters, overall agreement ranged from 82%–93% (intra-rater) and 64%–89% (inter-rater). Most hip- and pubic-related radiographic parameters showed relative intra- and inter-rater reliability sufficient for use in group-level and research. However, absolute reliability shows considerable variability for hip-related parameters, which warrants caution when using radiographic measurements and cut-offs for individual clinical decision-making.
Abstract To evaluate return to military duty service, radiographic correction, and early clinical outcomes following periacetabular osteotomy (PAO) with or without concomitant hip arthroscopy in active duty personnel. Active duty service members undergoing PAO for symptomatic acetabular dysplasia performed by a single surgeon between November 2020 through December 2022 were retrospectively reviewed. Return to duty (RTD) was defined as the ability to remain on active duty without medical separation, recognizing branch-specific duty standards. Preoperative and postoperative Single Assessment Numeric Evaluation (SANE) score and modified Harris Hip Score (mHHS) were compared. Radiographic parameters were assessed by two independent raters. Twenty consecutive hips (19 patients) were included with a mean follow-up of 28 months (standard deviation [SD] 8). Mean patient age was 30.8 years (SD 8.1), 53% of patients were female, and seventeen patients (85%) received concomitant hip arthroscopy. Significant improvement was observed in postoperative SANE (P = .002) and mHHS (P = .002). Fourteen patients (74%) were able to remain on active duty service. Higher postoperative mHHS (P < .001) and SANE scores (P = .002) were associated with successful RTD. Radiographic correction was achieved in 80%–90% of measured parameters. Adverse events were common, reflecting an inclusive complication definition and early surgical experience. PAO in active duty military personnel is a feasible hip preservation strategy that allows a substantial proportion of patients to remain in service despite high occupational demands.
Abstract Background Core decompression is a common joint-preserving intervention for early-stage osteonecrosis of the femoral head (ONFH). The purpose of this study was to evaluate arthroplasty-free survival and the complication profile following core decompression for ONFH, and to identify preoperative predictors of conversion to arthroplasty. Methods This retrospective cohort study used the TriNetX Research Network to identify patients ≥ 18 years who underwent core decompression (Current Procedural Terminology 27299) for femoral head osteonecrosis diagnosis between January 2010 and June 2024 with a minimum of 2-year follow-up. Patients with prior ipsilateral hip surgery, concurrent arthroplasty, or non-ONFH indications were excluded. Arthroplasty-free survival was estimated using the Kaplan–Meier method, and predictors of total hip arthroplasty (THA) conversion were identified using multivariable Cox proportional hazards regression. Results The study cohort included 633 hips from 479 patients (mean age 43.4 ± 13.7 years; 42.2% female; 32.2% bilateral avascular necrosis). Over a maximum 13-year follow-up, 171 hips (27.0%) converted to THA. Arthroplasty-free survival was 85.9% at 1 year, 76.2% at 2 years, and 70.1% at 5 years. Obesity was associated with greater odds of conversion [hazard ratio (HR) 1.53; 95% confidence interval (CI): 1.01, 2.32; P = .046]. Female sex (HR 0.68; 95% CI: 0.47, 0.99; P = .043) and sickle cell disease (HR 0.25; 95% CI: 0.09, 0.69; P = .008) were associated with lower odds. Femoral neck fracture occurred in 2 (0.4%) hips at 90 days and 11 (2.3%) hips at 1 year. Conclusion Approximately 27% of patients converted to THA following core decompression. Obesity increased odds of conversion, while female sex and sickle cell disease were associated with lower odds.
