Purpose:To determine if the setting of administration (home vs clinic) results in significant differences in patient scores from questionnaires assessing hip and general physical function in a hip preservation patient population. Methods:Adult patients presenting to a hip preservation clinic completed the Modified Harris Hip Score (MHHS), the Physical Function Computed Automated Test (PFCAT), and the sports subscore of Hip Outcome Score (HOS) twice: on an electronic tablet during a clinic appointment and at home via website within 3 to 5 days of the clinic appointment. Patients were randomized into 2 groups to complete the home questionnaires before or after their clinic appointment. Mixed-effects multivariable linear regression analysis, including order of completion as a covariate (i.e., home or clinic first), was used to determine differences in home and clinic scores. Intraclass correlation coefficients were calculated to evaluate reliability. A Bland-Altman analysis evaluated the agreement between completions. Results:A total of 52 patients were included, 26 in each group. Mean age was 39.3 ± 12.2 years, and 38 of 52 (73%) patients were female. There was no significant difference between home and clinic completions of all 3 questionnaires (all P > .270). The covariate representing order of completion was not significant (all P > .346). Reliability was almost perfect for all 3 questionnaires (all intraclass correlation coefficients >0.93). The Bland-Altman analysis indicated a very small bias of higher home than clinic scores for all 3 questionnaires. The PFCAT had the tightest limits of agreement (-5.9 to 5.5), followed by the MHHS (-16.8 to 14.4) and HOS (-24.2 to 21.7). Conclusions:The MHHS, PFCAT, and HOS have high repeatability and are, on average, not affected by settings of administration. When reviewing data on the level of the cohort, no distinction is required for patient-reported outcomes completed at home or clinic within 5 days of a clinical appointment. Level of Evidence:Level II, lesser quality randomized controlled trial.

Rapid genomic diagnostics in the Neonatal Intensive Care Unit represents a paradigm shift in medicine with increasing evidence of the utility of early diagnosis, impacting management. The goal of the Utah NeoSeq Project was to implement and evaluate a multidisciplinary and longitudinal rapid sequencing program while transitioning to CLIA-certified sequencing. Enrollment of 65 infants resulted in 26 (40%) with a diagnostic variant(s) and 7 (11%) harboring a strong candidate. This includes re-analyses resulting in four additional diagnoses. Parental surveys indicated that 7% (4/59) of parents had a decisional conflict after consent, and 3% (2/59) experienced decisional regret after the results. Fifty-two provider surveys were conducted. Seventy-nine percent (41/52) of results and 86% (19/22) of diagnostic results were “very useful” or “useful” and associated with management changes. The NeoSeq Project demonstrates that a multidisciplinary collaborative approach to diagnosis is feasible. We have developed a generalizable, collaborative protocol that addresses the need for expedited genetic evaluation with emerging technologies.

Objective: To evaluate the interest of primary care clinicians in utilizing CDS for PSA screening. Evidence suggests that electronic clinical decision support (CDS) may decrease low-value prostate-specific antigen (PSA) testing. However, physician attitudes towards CDS for PSA screening are largely unknown. Methods: A survey was sent to 201 primary care clinicians, including both physicians and Advanced Practice Providers (APP), within a large academic health system. Eligible clinicians cared for male patients aged 40 to 80 years and ordered = 5 PSA tests in the past year. Respondents were stratified into 3 groups, appropriate screeners, low-value screeners, or rare-screeners, based on responses to survey questions assessing PSA screening practices. The degree of interest in electronic CDS was determined via a composite Likert score comprising relevant survey items. Results: Survey response rate was 29% (59/201) consisting of 85% MD/DO and 15% APP respondents. All clinicians surveyed were interested in CDS (P < 0.001) without significant difference between screener groups. Clinicians agreed most uniformly that CDS be evidence-based. Clinicians disagreed on whether CDS would decrease professional discretion over patient decisions. Conclusions: Primary care clinicians are interested in CDS for PSA screening regardless of their current screening practices. Prioritizing CDS features that clinicians value, such as ensuring CDS recommendations are evidence-based, may increase the likelihood of successful implementation, whereas perceived threat to autonomy may be a hinderance to utilization. (c) 2022 Elsevier Inc. All rights reserved.

Rapid whole genome sequencing (rapid WGS) is a powerful diagnostic tool that is becoming increasingly practical for widespread clinical use. However, protocols for its use are challenging to implement. A significant obstacle to clinical adoption is that laboratory certification requires an initial research development phase, which is constrained by regulations from returning results. Regulations preventing return of results have ethical implications in cases which might impact patient outcomes. Here, we describe our experience with the development of a rapid WGS research protocol, that balanced the requirements for laboratory-validated test development with the ethical needs of clinically relevant return of results.

PURPOSE:Germline mutations in DNA repair (DR) genes and susceptibility genes CDKN2A and HOXB13 have previously been associated with prostate cancer (PC) incidence and/or progression. However, the role and prevalence of this class of mutations in metastatic PC (mPC) are not fully understood.PATIENTS AND METHODS:To evaluate the frequency of pathogenic/likely pathogenic germline variants (PVs/LPVs) in men with mPC, this study sequenced 38 DR genes, CDKN2A, and HOXB13 in a predominantly white cohort of 317 patients with mPC. A PC registry at the University of Utah was used for patient sample acquisition and retrospective clinical data collection. Deep target sequencing allowed for germline and copy number variant analyses. Validated PVs/LPVs were integrated with clinical and demographic data for statistical correlation analyses.RESULTS:All pathogenic variants were found in men self-reported as white, with a carrier frequency of 8.5% (DR genes, 7.3%; CDKN2A/HOXB13, 1.2%). Consistent with previous reports, mutations were most frequently identified in the breast cancer susceptibility gene BRCA2. It was also found that 50% of identified PVs/LPVs were categorized as founder mutations with European origins. Correlation analyses did not support a trend toward more advanced or earlier-onset disease in comparisons between carriers and noncarriers of deleterious DR or HOXB13 G84E mutations.CONCLUSION:These findings demonstrate a lower prevalence of germline PVs/LPVs in an unselected, predominantly white mPC cohort than previously reported, which may have implications for the design of clinical trials testing targeted therapies. Larger studies in broad and diverse populations are needed to more accurately define the prevalence of germline mutations in men with mPC.

PURPOSERecently developed clinical guidelines suggest that men in families with specific cancer syndromes, such as hereditary breast and ovarian cancer (HBOC), consider genetic testing, especially in the setting of aggressive disease. However, although a family history (FH) of the same disease among close relatives is an established risk factor for prostate cancer (PC), a direct comparison of PC risk for men with each syndrome in a single population is needed.METHODSThe Utah Population Database was used to identify 619,630 men, age ≥ 40 years, who were members of a pedigree that included at least 3 consecutive generations. Each man was evaluated for FH of hereditary PC (HPC), HBOC, and Lynch syndrome (LS) and for his own PC status. PC occurrences (N = 36,360) were classified into one or more subtypes: early onset (EO), lethal, and/or clinically significant. Relative risks (RRs) associated with each subtype, adjusted for important covariables, were calculated in STATA using a modified Poisson regression with robust error variances to obtain corresponding RR CIs for each FH definition.RESULTSAn FH of HPC conveyed the greatest relative risk for all PC subtypes combined (RR, 2.30; 95% CI, 2.22 to 2.40), followed by HBOC and LS (both with 1 < RR < 2 and statistically significant). The strongest risks associated with FH were observed for EO disease in all pedigree types, consistent with the contribution of genetic factors to disease occurrence.CONCLUSIONIn this large, population-based, family database, the risk of PC varied by cancer FH and was most strongly associated with EO disease. These results are critically valuable in understanding and targeting high-risk populations that would benefit from genetic screening and enhanced surveillance.

1505 Background: Recently developed clinical guidelines have suggested that men in families with Hereditary Prostate Cancer (HPC), Hereditary Breast and Ovarian Cancer (HBOC), and Lynch Syndrome (LS) be referred for consideration of genetic testing, especially in the setting of aggressive disease. However, while a family history (FH) of the same disease among close relatives is an established risk factor for prostate cancer (PC), a direct comparison of risk associated with specific FH, and particularly with respect to known familial cancer syndromes, in a single population is needed. Methods: The Utah Population Database was used to identify 569,320 men, 40+ years with a pedigree that included at least three consecutive generations. Each man was evaluated for FH of FPC, HPC, HBOC and LS, as well as their own PC status. PC cases (N=34,889) were identified from both the SEER Utah Cancer Registry and death certificates and classified into one or more subtypes: early-onset (EO [age of diagnosis <60 years]), lethal, and/or aggressive (Gleason Grade ≥7, metastatic, or lethal). Relative risks (RR) associated with each PC subtype, adjusted for important covariates, were calculated in STATA using a modified Poisson regression with robust error variances to obtain corresponding confidence intervals (CIs) for each FH definition. Results: A FH of HPC conveyed the greatest relative risk for all PC subtypes (RR=2.30; 95% CI 2.21-2.39), followed by HBOC and LS. Furthermore, the strongest risks associated with FH were generally observed for EO disease. No differences in risk by degree of FH were observed for either lethal or aggressive disease. Conclusions: In this large population-based family database, the risk of PC was shown to vary by cancer FH and was most strongly associated with EO disease. These results are critically valuable in understanding and targeting high-risk populations that would benefit from genetic screening and enhanced surveillance. [Table: see text]

Background: Distraction of the hip joint is a necessary step during hip arthroscopic surgery. The force of traction needed to distract the hip is not routinely measured, and little is known about which patient factors may influence this force. Purpose: To quantify the force of traction required for adequate distraction of the hip during arthroscopic surgery and explore the relationship between hip joint stiffness and patient-specific demographics, flexibility, and anatomy. Study Design: Case series; Level of evidence, 4. Methods: A total of 101 patients (61 female) undergoing primary hip arthroscopic surgery were prospectively enrolled. A load cell attached to the traction boot continuously measured traction force. Fluoroscopic images were obtained before and after traction to measure joint displacement. The stiffness coefficient was calculated as the force of traction divided by joint displacement. Relationships between the stiffness coefficient and patient demographics and clinical parameters were investigated using a univariable regression model. The regression analysis was repeated separately by patient sex. Variables significant at P < .05 were included in a multivariable regression model. Results: The instantaneous peak force averaged 80 ± 18 kilogram-force (kgf), after which the force required to maintain distraction decreased to 57 ± 13 kgf. In univariable regression analysis, patient sex, alpha angle, hamstring flexibility, and Beighton hypermobility score were each correlated to stiffness. However, patient sex was the only significant variable in the multivariable regression model. Intrasex analysis demonstrated that increased hamstring flexibility correlated with decreased final holding stiffness in male patients and that higher Beighton scores correlated with decreased maximal stiffness in female patients. Conclusion: Male patients undergoing primary arthroscopic surgery have greater stiffness to hip distraction during arthroscopic surgery compared with female patients. In male patients, stiffness increased with decreasing hamstring flexibility. In female patients, increased Beighton scores corresponded to decreased stiffness. The presence of a labral tear was not correlated with stiffness to distraction. These data may be used to identify patients in whom a specific focus on capsular repair and/or plication may be warranted.

This presentation will provide an overview of the interdisciplinary research program on hip pathomorphology at the University of Utah, including studies of dysplasia and femoracetabular impingement...

Background: Recently, germline PVs in 20 cancer predisposition genes were found in 11.8% of patients with aPC in a multi-center study (Pritchard et al, NEJM 2017).These PVs appeared to be predictive of response to PARP inhibitors (PARPi). We sought to evaluate the prevalence of clinically actionable PVs in a comparable aPC cohort and investigate possible associations of PVs with baseline patient and disease characteristics. Methods: Clinical data and germline DNA samples from 352 consecutive aPC patients were retrospectively collected. A custom target panel (Qiagen QiaSeq V3) composed of 35 genes deemed clinically actionable and/or included in the Pritchard publication were sequenced on an Illumina HiSeq2500. GATK best practices were followed for alignment and variant calling. Variants were filtered based on ClinVar pathogenicity and reviewed by genetic counselors to confirm clinical significance. Baseline patient characteristics were compared using the Chi-squared, Fisher's, and Mann-Whitney U tests. Results: Clinically actionable, germline PVs were found in 26/352 (7.4%) of this aPC cohort. 11 of the 26 mutation carriers had a PV in BRCA1, BRCA2, or ATM (overall prevalence 3.1%). 96.6% of men were Caucasian of North European descent. Baseline characteristics were similar in those with or without PVs in clinically actionable genes, including age at diagnosis (p = 0.77), Gleason score (p = 0.22), or presence of metastatic disease at diagnosis (p = 0.08). Conclusions: Our aPC cohort appears to have a lower prevalence of clinically actionable, germline PVs than previously reported studies. These findings may help inform recommendations for clinical genetic testing in this population, and help estimate the pace of enrollment on multiple ongoing clinical trials with PARPi in this population. Legal entity responsible for the study: Huntsman Cancer Institute and University of Utah. Funding: Has not received any funding. Disclosure: N. Agarwal: Consultancy: Pfizer, Novartis, Merck, Genentech, Eisai, Exelixis, Clovis, EMD Serono. All other authors have declared no conflicts of interest.

Develop a framework to quantify the size, location and severity of femoral and acetabular-sided cartilage and labral damage observed in patients undergoing hip arthroscopy, and generate a database of individual defect parameters to facilitate future research and treatment efforts.

Objectives: To quantify the force of traction required for adequate distraction of the hip during arthroscopy and explore the relationship between hip joint stiffness and patient-specific demographics, flexibility, and anatomy. Methods: 101 primary arthroscopy patients (61 females) and 23 patients undergoing revision arthroscopy for capsular repair (all female) were prospectively enrolled. A load cell attached to the traction boot continuously measured traction force. Fluoroscopy images were obtained before and after traction to measure joint displacement. The stiffness coefficient was calculated as the force of traction divided by joint displacement. Primary patients were analyzed in a univariable regression model and re-analyzed separately by gender. Variables significant at p<0.05 were included in a multivariable regression model. Stiffness was compared between female primary and revision patients using independent t-tests. Results: For primary arthroscopy, instantaneous peak force averaged 80 ± 18 kgf, after which the force required to maintain distraction decreased to 57 ± 13 kgf. In univariable regression analysis, gender, alpha angle, hamstring flexibility and Beighton hypermobility score were each correlated to stiffness. However, gender was the only significant variable in the multivariable regression model. Intragender analysis demonstrated increased hamstring flexibility correlated with decreased stiffness in males and higher Beighton scores correlated with decreased stiffness in females. Stiffness was significantly less in the revision cases than the primary cases (p=0.006). Conclusion: A substantial force is required to achieve and maintain hip distraction, with males requiring higher forces. Males with increased hamstring flexibility and females with higher Beighton scores are less stiff than their same gender counterparts. Patients indicated for revision capsule repair were less stiff, supporting the importance of the hip capsule on hip stability. These data may be used to identify patients with microinstability and patients where specific focus on capsular repair and/or plication may be warranted.

OBJECTIVES: PROPHET is a prospective study in order to clarify a diagnostic impact of laboratory-based and prostate volume-adjusted [-2] proPSA (p2PSA)-related indices on prostate cancer (PC) and a clinically significant PC with more than 2 positive biopsy cores or high Gleason Grade Group in the PSA below 10 ng/mL (Clinical trial No. UMIN000016934).METHODS: Between April 2015 and March 2017, 421 men aged 50 to 79 who conducted 12 to 20-core prostate biopsy in the PSA range above age-specific cut-offs (3.0ng/ml, 3.5 ng/ml and 4.0 ng/ml, respectively, for age 50-64, 65-69 and 70-79) and below 10 ng/ml were registered in the PROPHET.Among those participants, 398 eligible men were investigated a diagnostic impact of PSA density (PSAD), PSAD adjusted by transition zone volume (PSATZD) and various p2PSA-related total and transition zone prostate volume (PV)-adjusted indices on any grade, high volume and high Gleason grade group PC.RESULTS: Among 398 men, 179 (45%), 141 (35%) and 80 (20%) were diagnosed with prostate cancer, Gleason grade group !2 and !3 prostate cancer, respectively.Total AUC-ROC, partial AUC-ROC above 90% sensitivity (J Urol.2005; 173: 425-428) and false positive rate (FPR) at 90% sensitivity for PSA, PSAD, PSATZD, p2PSArelated indices adjusted by PV are shown in Table 1.Impacts of those various PV-adjusted indices on distinguishing non PC vs PC, Grade Group 1/ positive biopsy cores 0-2 vs remaining higher grade/ volume PC and Grade Group 1-2/ positive biopsy cores 0-2 vs remaining higher grade/ volume PC are indicated in Table 1.The total/ partial AUC-ROC above 90% sensitivity and FPR at 90% sensitivity in PV-adjusted p2PSA-related indices were superior to those in conventional PVadjusted indices, especially for detecting high grade and volume cancer.p2PSA/%f-PSA adjusted by transition zone PV would avoid unnecessary biopsy in 63% of men in the setting for detecting Grade Group 3-5 cancer with positive biopsy cores >2.CONCLUSIONS: PV-adjusted p2PSA-related indices would avoid in 47 to 63% of prostate biopsy in the setting not only for detecting any grade/ volume PC, but also especially for detecting clinically significant PC.

BackgroundFew genes have germline mutations which predispose men to more aggressive prostate cancer (PCa). This study evaluated the contribution of germline loss of function (LOF) variants in PPFIBP2 to risk of lethal PCa.MethodsA case‐case study of 1414 PCa patients with lethal PCa and low‐risk localized PCa was performed. Germline DNA samples from these patients were sequenced for PPFIBP2. Mutation carrier rates and association with lethal PCa were analyzed using the Fisher exact test, logistic regression, and Kaplan‐Meier survival analysis.ResultsIn the entire study population, eight patients, all of European ancestry, were identified as carrying PPFIBP2 pathogenic or likely pathogenic mutations. Seven (1.52%) of 462 lethal PCa patients were carriers compared with only one (0.12%) carrier in 810 low‐risk PCa patients, P = 0.0029. The estimated Odds Ratio (OR) of carrying PPFIBP2 mutation for lethal PCa was 13.8 in European American population. The PPFIBP2 loss‐of‐function mutation carrier rate in lethal PCa cases was also higher than in 33 370 non‐Finnish European individuals from the Exome Aggregation Consortium (ExAC) (carrier rate of 0.17%, P = 1.92 × 10−5) and in 498 men with localized PCa from The Cancer Genome Atlas cohort (TCGA) cohort (carrier rate of 0%, P = 0.0058). Survival analysis in European American lethal cases revealed PPFIBP2 mutation status as an independent predictor of shorter survival after adjusting for age at diagnosis, PSA at diagnosis, and genetic background (hazard ratio = 2.62, P = 0.034).ConclusionsWhile larger studies are needed, germline mutations in a novel gene, PPFIBP2, differentiated risk for lethal PCa from low‐risk cases and were associated with shorter survival times after diagnosis.

Background: Reports of low-value prostate-specific antigen (PSA) testing (testing in which the harms outweigh the benefits) generally employ population level data sources. While such results may be generalizable, they often lack the detail necessary to understand provider clinical decision making and guideline concordance. Using a retrospective study of PSA testing at our institution we intend to characterize the frequency and patterns associated with low-value PSA testing. Methods: We leveraged the electronic health record to determine guideline-defined low-value testing in our health system from 07/01/2012 to 06/30/2017. Secondarily, we measured the between-testing interval for repeat tests and the rates of prostate cancer risk factors and comorbidities among men receiving screening. Results: Overall, 21,145 PSA tests were performed on 12,303 men. The rate of low-value testing ranged from 23.4 to 56.8%, depending upon the specific guideline. For repeat tests, the median between-testing interval was 12.6 months. Risk factors for prostate cancer were uncommon, but more frequent in men age < 55 years compared to men age 55-69 years (17.6% vs. 13.5%, p < 0.001). Screened older men (age > 70 years) were more likely to have a Charlson Comorbidity Index >= 3, compared to the 55-69 reference group (31.4% vs. 17.3%, p < 0.001). Conclusion: Low-value prostate cancer testing is prevalent. Between-testing intervals were often times shorter than recommended. Screening among younger men was frequent despite low rates of risk factors. High rates of comorbidity may limit life expectancy among older men receiving screening. These findings highlight the need for improved guidance with prostate cancer screening.

BACKGROUNDProstate cancer has a significant heritable component, and rare deleterious germline variants in certain genes can increase the risk of the disease. The aim of the current study was to describe the prevalence of pathogenic germline variants in cancer‐predisposing genes in men with prostate cancer and at least 1 additional primary cancer.METHODSUsing a multigene panel, the authors sequenced germline DNA from 102 men with prostate cancer and at least 1 additional primary cancer who also met ≥1 of the following criteria: 1) age ≤55 years at the time of diagnosis of the first malignancy; 2) rare tumor type or atypical presentation of a common tumor; and/or 3) ≥3 primary malignancies. Cancer family history and clinicopathologic data were independently reviewed by a clinical genetic counselor to determine whether the patient met established criteria for testing for a hereditary cancer syndrome.RESULTSSequencing identified approximately 3500 variants. Nine protein‐truncating deleterious mutations were found across 6 genes, including BRCA2, ataxia telangiectasia mutated (ATM), mutL homolog 1 (MLH1), BRCA1 interacting protein C‐terminal helicase 1 (BRIP1), partner and localizer of BRCA2 (PALB2), and fibroblast growth factor receptor 3 (FGFR3). Likely pathogenic missense variants were identified in checkpoint kinase 2 (CHEK2) and homeobox protein Hox‐B13 (HOXB13). In total, 11 of 102 patients (10.8%) were found to have pathogenic or likely pathogenic mutations in cancer‐predisposing genes. The majority of these men (64%) did not meet current clinical criteria for germline testing.CONCLUSIONSMen with prostate cancer and at least 1 additional primary cancer are enriched for harboring a germline deleterious mutation in a cancer‐predisposing gene that may impact cancer prognosis and treatment, but the majority do not meet current criteria for clinical genetic testing. Cancer 2017;123:3925‐32. © 2017 American Cancer Society.

Background: The lateral center-edge angle (LCEA) is an important measurement in understanding acetabular morphology and has had multiple interpretations. Misunderstanding of the LCEA and its relationship with acetabular 3-dimensional (3D) morphology may result in misdiagnosis and poor outcomes. Purpose: To determine the discrepancy between bone-edge and sourcil-edge LCEA measurements on anteroposterior (AP) radiographs and to determine the 3D anatomic location of the sourcil-edge and bone-edge LCEA measurements. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The LCEA was measured on radiographs to both the sourcil-edge and bone-edge on AP images of 60 symptomatic hips. On computed tomography (CT), coronal slices producing an LCEA matching the magnitude of each AP LCEA were identified. These coronal slices were mapped to a sagittal image of the acetabulum, which was divided into a standard clockface (3 = anterior, 12 = superior). We identified clockface locations corresponding to the AP sourcil-edge and bone-edge LCEA measurements. Paired t tests identified differences in magnitude and location of the bone and sourcil LCEAs. Limits of agreement were calculated for the differences between measures. Intraclass correlation coefficients (ICCs) assessed inter- and intraobserver repeatability. Results: On the AP radiographs, the bone-edge LCEA was a mean 4.7° (95% CI, −4.0° to 13.3°) greater than the sourcil-edge LCEA ( P < .001). On CT, the sagittal clockface location of the sourcil-edge LCEA was more anterior compared with the sagittal clockface location of the maximum bone-edge LCEA (1:03 ± 0:42 vs 12:06 ± 0:30, respectively; P < .001). In hips with a difference >5° between sourcil-edge and bone-edge measurements, the coronal CT slice corresponding to the sourcil-edge LCEA was significantly more anterior (1:26 ± 0:35) than the CT slice corresponding to the bone-edge LCEA (11:46 ± 0:29; P < .001). This significant difference was similar in location but less pronounced in hips with a difference ≤5°: the sourcil-edge LCEA occurred at 12:50 ± 0:40, while the bone-edge LCEA occurred at 12:00 ± 0:11 ( P < .001). Interobserver repeatability was excellent for all LCEA and clockface location measurements (all ICCs >0.82). Conclusion: The sourcil-edge LCEA represents anterosuperior acetabular coverage while the bone-edge LCEA represents superior/lateral coverage. This information can be used in preoperative evaluation of and perioperative planning for hip preservation procedures.

release from the peripheral compartment, found equally favorable Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at final follow-up. These studies and others suggest that given the correct indication (ie, painful internal snapping), iliopsoas release is both safe and effective, either in isolation or as part of the comprehensive management of intra-articular abnormalities. We commend the authors for bringing up strength loss and atrophy as important areas for future study. Furthermore, the authors employed an elegant imaging methodology to measure the volume of the iliopsoas and a useful strength measurement apparatus, both of which may prove useful in future studies. The current study is limited by a low percentage of follow-up and significant potential for selection bias and response bias. Because of these limitations, no conclusions can or should be made regarding efficacy, clinical outcomes, or adverse effects. Future studies that include a rigorous study design, consecutive matched or randomized cohorts, and a high rate of clinical followup may enable us to better assess the usefulness, and the risks, of iliopsoas lengthening.

Background: Arthroscopic release of the iliopsoas tendon may alleviate pain associated with internal snapping hip, but previous reports of physical function, hip strength, and muscle atrophy after surgery are mixed. Hypothesis: The hips of patients who underwent arthroscopic iliopsoas release would demonstrate significantly reduced hip flexion strength and iliopsoas muscle volume when compared with their contralateral hips and the hips of patients who underwent hip arthroscopy without psoas release. Study Design: Cohort study; Level of evidence, 3. Methods: Eighteen patients who underwent hip arthroscopy with iliopsoas release for symptomatic internal snapping hip and concomitant femoroacetabular impingement (FAI) and/or chondrolabral damage (release group) and 18 patients who underwent arthroscopy for FAI and/or chondrolabral damage without iliopsoas release (control group) were evaluated at a mean of 21 months (range, 16-30 months) postoperatively. Magnetic resonance images were performed and segmented to calculate iliopsoas volume. Isometric hip flexion strength was evaluated in the supine and seated positions with a custom testing apparatus. Differences between groups and differences between the operative and nonoperative limbs within groups were compared with unpaired and paired t tests, respectively. Results: In the release group, the iliopsoas muscle of the surgical limb was significantly smaller (288 ± 98 vs 384 ± 113 cm3, P < .001) and weaker in the seated position (13 ± 4.7 vs 17 ± 5.8 kg, P < .001) than the contralateral limb. Compared with the control group, the release group demonstrated a greater percentage decrease in iliopsoas volume on magnetic resonance imaging (−25% ± 9.1% vs −0.6% ± 4.6%, P < .001) and seated hip flexion strength (−19% ± 16% vs −3.9% ± 20%, P = .018) between the operative and contralateral limbs. There were no significant differences in supine strength between limbs or groups (all P > .168). Conclusion: Arthroscopic iliopsoas release results in iliopsoas atrophy with a 25% volume loss and a 19% reduction in seated hip flexion strength.