BACKGROUND:Despite the growing clinical relevance of obesity in the context of multiligament knee injuries, there remains a paucity of data evaluating patient-reported outcomes in this population. PURPOSE:To compare clinical and functional outcomes, including postoperative patient-reported outcome measures (PROMs) and complication/revision rates, of multiligament knee reconstruction (MLKR) in individuals with a body mass index (BMI) >30 kg/m2 versus <30 kg/m2 at a minimum 2-year follow-up. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:A retrospective review was performed to identify all patients who underwent MLKR between 2001 and 2022 at a single institution. Patients with a BMI >30 kg/m2 were propensity-matched to patients with a BMI <30 kg/m2 on a 1:1 basis by age, sex, laterality, and Schenck classification (knee dislocation). Medical records were reviewed for patient characteristics, time to surgery, year of surgery, number and type of ligament interventions, graft choice, single versus staged reconstruction, and concomitant injuries. Postoperative clinical examination findings and PROMs for each cohort, including visual analog scale score, Tegner activity scale score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective score, were analyzed and compared. Postoperative complication and revision rates were evaluated and compared. RESULTS:Of 158 patients, 79 patients with a BMI <30 kg/m2 (mean age, 31.0 ± 11.5 years; mean BMI, 25.8 ± 3.0 kg/m2) were matched to 79 patients with a BMI >30 kg/m2 (mean age, 32.8 ± 9.5 years; mean BMI, 37.1 ± 5.8 kg/m2). There were no significant differences between cohorts regarding age, sex, laterality, and Schenck classification (P≥ .100); however, patients in the BMI >30 kg/m2 group had greater numbers of posterior cruciate ligament reconstruction. The mean follow-up was 7.5 ± 4.8 years for the BMI <30 kg/m2 cohort and 7.2 ± 4.8 years for the BMI >30 kg/m2 cohort (P = .229). Patients with a lower BMI (<30 kg/m2) had significantly better postoperative mean IKDC (79.3 ± 18.7 vs 67.9 ± 21.2; P = .004), Lysholm (85.1 ± 17.1 vs 75.7 ± 21.0; P = .007), and Tegner (5.1 ± 2.0 vs 4.4 ± 1.7; P = .041) scores. The BMI >30 kg/m2 group also had significantly more postoperative complications (P = .028). However, there was no significant difference between the 2 cohorts in terms of reoperation rate or conversion to total knee arthroplasty (P≥ .189). CONCLUSION:Patients who undergo MLKR and have a BMI >30 kg/m2 demonstrate significantly decreased postoperative PROMs when compared to patients with a BMI <30 kg/m2. Increasing BMI significantly increased the incidence of complication rates after MLKR.

PURPOSE:Knee dislocations (KDs) can be limb-threatening injuries that may require a temporising knee-spanning external fixator (KSEF) for stabilisation. Precise indications for this commonly utilised invasive immobilisation technique remain controversial and poorly defined. The purpose of this study was to establish consensus-driven indications for temporising KSEF use in the initial management of KDs. METHODS:A working group of fellowship-trained orthopaedic surgeons generated clinical scenarios reflecting commonly debated indications for temporising KSEF application. Utilising a modified Delphi technique, 23 surgeons from the International Knee Dislocation Study Group completed two anonymous online survey rounds. Consensus was defined a priori as ≥70% agreement or disagreement. RESULTS:Response rates were 100% for Round 1 and 96% for Round 2. Four scenarios achieved unanimous consensus: (1) KD without post-reduction instability (100% disagreement), (2) inability to maintain tibiofemoral reduction in the sagittal/coronal plane with non-invasive knee immobilisation (NIKI) after initial reduction (i.e., redislocation/subluxation) (100% agreement), (3) tibial plateau fracture-dislocation with post-reduction subluxation (100% agreement), and (4) in bilateral closed KDs where one limb is indicated and the other is NOT, span ONLY the indicated limb (100% agreement). Two scenarios achieved strong positive consensus (90%-99.9% agreement): (1) morbid obesity (BMI ≥ 40) without NIKI of sufficient size (91.3% agreement), and (2) extensor mechanism injury with post-reduction subluxation (91.3% agreement). Four and one additional scenarios achieved positive and negative consensus, respectively. CONCLUSIONS:This modified Delphi study established consensus-driven indications for temporising KSEF application in the initial management of KDs, which advocate for more selective use than what is demonstrated in the literature. LEVEL OF EVIDENCE:Level V.

Background: Femoroacetabular impingement (FAI) is a common injury experienced by basketball players. Surgical management with arthroscopic labral repair and femoral osteochondroplasty can lead to successful outcomes for athletes whose nonoperative management fails. Recent studies have demonstrated that athletes undergoing hip arthroscopy in the setting of FAI had favorable return-to-sport (RTS) and sport continuation outcomes. Purpose: To evaluate patient-reported outcome measures (PROMs) and RTS rates at minimum 5-year follow-up in basketball players after hip arthroscopy for FAI. Study Design: Case series; Level of evidence, 4. Methods: All active basketball players at the recreational, high school, and collegiate levels who underwent primary hip arthroscopy with labral repair for FAI between August 2009 and December 2019 were identified. Postoperative RTS, revision rates, and surgery satisfaction at final follow-up were evaluated. PROMs were also analyzed as follows: visual analog scale, Tegner Activity Scale, modified Harris Hip Score, Hip Outcome Score–Activities of Daily Living, and Hip Outcome Score–Sport. Results: Fifty-three patients (64 hips) were included with a mean ± SD age of 21.2 ± 6.0 years. Most athletes played recreational or high school basketball (85%), while 15% played college basketball. Forty-three patients attempted to return to basketball. Of these patients, 35 (81%) returned to basketball after surgery, with 32 (91%) returning to the same level of play. Patients who returned to basketball had significantly improved outcomes on the modified Harris Hip Score ( P = .006), Hip Outcome Score–Activities of Daily Living ( P = .007), Hip Outcome Score–Sport ( P = .004), Tegner Activity Scale ( P = .010), and visual analog scale with use ( P = .041) as compared with those who did not return. High school athletes had decreased odds of RTS when compared with recreational athletes ( P = .01). There was significant improvement in all PROMs from baseline to minimum 5-year follow-up ( P < .05). Conclusion: At minimum 5-year follow-up, basketball players demonstrated durable improvements in PROMs and an RTS rate of 81% after hip arthroscopy for FAI. The majority of athletes returned to the same level of competition. There were significantly improved PROMs in patients who returned to sport versus those who did not. High school athletes had decreased odds of RTS when compared with recreational athletes. However, body mass index, sex, age, alpha angle, and basketball position did not significantly correlate with RTS outcomes.

Femoroacetabular impingement with cam morphology that fails nonoperative management can be addressed with hip arthroscopy and cam resection. There exists a wide variation of cam morphology due to various etiologies that can make some cam lesions more challenging to address. A thorough preoperative evaluation and the utilization of a variety of intraoperative techniques can allow for adequate arthroscopic resection of these otherwise challenging cam lesions. In this technique video, we describe a systematic approach for the preoperative assessment of femoroacetabular impingement due to a cam lesion and consideration of different approaches for arthroscopic resection based on cam-specific morphology.

A posterior tibial slope (PTS) greater than 12° is an established risk factor for anterior cruciate ligament graft reconstruction failure. Reducing PTS is thus considered protective to the anterior cruciate ligament graft, and it can be achieved through an anterior closing-wedge osteotomy. Prior to the procedure, PTS should be accurately measured to determine the amount of correction that is needed. Radiographic films remain the gold standard for measuring PTS. The purpose of this presentation is to show validated and reproducible step-by-step techniques for measuring PTS and anterior tibial translation for anterior closing-wedge osteotomy using monopedal full-length weight-bearing tibia standing radiographs.

PURPOSE:To evaluate return-to-sport (RTS) rates and patient-reported outcome measures (PROMs) following hip arthroscopic labral repair for femoroacetabular impingement in active basketball players with a minimum of 2-year follow-up. METHODS:All patients who were active basketball players and underwent hip arthroscopy with labral repair for femoroacetabular impingement from 2009 to 2022 were identified. Patients were evaluated for postoperative RTS and revision surgery at a minimum 2-year follow-up. RTS was defined as resuming basketball participation, at any level. Modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport (HOS-Sport), and surgery satisfaction were also collected. RESULTS:Sixty-seven hips in 54 athletes (29 male, 25 female) with a mean age of 22.2 years (range 13-39 years) were included. Eighty-six (86%) were recreational or high school basketball players. There was significant improvement in all PROMs from baseline to a minimum 2-year follow-up (all P < .001). After excluding for athletes who did not RTS for nonmedical reasons, 78% of athletes returned to basketball following hip arthroscopy. Including patients who cited nonmedical reasons for not returning, the overall RTS rate was 65%. Athletes who RTS had significantly higher mHHS (P = .012), HOS-ADL (P = .006), and HOS-Sport (P = .002), as well as lower visual analog scale pain (2.2 vs 3.4, P = .037) than those who did not RTS. Calculated minimal clinically important difference values were 8.3 for mHHS, 7.2 for HOS-ADL, and 13.4 for HOS-Sport. Anchor-based patient acceptable symptom state calculations yielded thresholds of 83.5 for mHHS, 92.6 for HOS-ADL, and 79.2 for HOS-Sport-with 70%, 63%, and 67% of patients achieving these thresholds, respectively. CONCLUSIONS:Basketball players who undergo hip arthroscopic labral repair for femoroacetabular impingement show significant improvements in PROMs with 78% RTS rate at a minimum 2-year follow-up. Although many athletes discontinued basketball for reasons unrelated to the hip, 18% cited hip issues. Basketball players who successfully return to basketball report higher PROMs than nonreturners, and cohort-specific minimal clinically important difference analysis indicates that most athletes achieve clinically meaningful improvements. LEVEL OF EVIDENCE:Level IV, therapeutic retrospective case series.

Meniscal preservation through repair and transplantation is fundamental to modern orthopaedic surgery, with the goal of restoring knee biomechanics and delaying degenerative joint disease. Despite generally favorable outcomes, these procedures are associated with a range of complications and reoperations. This review aims to comprehensively evaluate the current literature on complications and reoperations following meniscal repair and meniscal transplantation, with emphasis on failure mechanisms, risk factors, and management strategies. Recent literature reports wide variability in complication and reoperation rates following meniscal repair and transplantation, reflecting heterogeneity in tear morphology, surgical techniques, patient selection, and definitions of failure. Common complications include persistent pain, recurrent mechanical symptoms, repair failure, chondral injury, stiffness, infection, and neurovascular injury. Meniscal transplantation is associated with distinct risks and failure modes, including graft extrusion, sizing mismatch, immunologic response, and progression of osteoarthritis. Advances in repair devices, root repair techniques, and biologic augmentation have improved clinical outcomes but have not eliminated procedure-related complications. Increasing attention has been placed on patient-specific factors such as age, activity level, limb alignment, and concomitant pathology. Complications and reoperations following meniscal repair and transplantation remain clinically relevant and multifactorial. Optimizing outcomes requires appropriate patient selection, meticulous surgical technique, and recognition of procedure-specific risk profiles. Standardization of outcome measures and failure definitions is necessary to improve study comparability. Future research should focus on long-term outcomes, biologic optimization, and strategies to reduce reoperation rates while preserving meniscal function

Injuries to the posterior cruciate ligament (PCL) are relatively common knee injuries often seen in the setting of multiligamentous knee injuries. Operative treatment for PCL injuries has been described using both single and double bundles with both open and arthroscopic techniques. Proper surgical technique is imperative to prevent residual instability and reduce the risks for graft failure. Our technical note outlines tips to successfully perform an all-inside arthroscopic single-bundle PCL reconstruction. We provide a reproducible technique that simplifies graft preparation, improves arthroscopic visualization, and optimizes tunnel positioning while adequately protecting neurovascular structures.

Purpose:To evaluate return-to-sport (RTS) outcomes and patient-reported outcomes in soccer players after primary hip arthroscopic labral repair for femoroacetabular impingement syndrome. Methods:All patients undergoing primary hip arthroscopy with labral repair for femoroacetabular impingement syndrome from 2011 to 2022 were retrospectively reviewed. Patients who had a minimum 2-year follow-up, played soccer, and had no prior hip surgery were included. Patient-reported outcome measures and RTS were collected at the final follow-up. Logistic regression was used to assess associations between potential covariates (e.g., age, sex, and level of play) and RTS. Results:Forty-eight hips in 41 patients (21 men [51%]) with a mean age at surgery of 21.9 years (range 13-41 years) were included. Thirty-two out of the 41 patients (78%) played at either the recreational or high school level. After removing those who did not return for nonmedical reasons, 29 out of 36 (81%) patients were able to return to soccer. Among patients with available patient-reported outcome measures, significantly greater postoperative scores were seen in the RTS group for Hip Outcome Score-Activities of Daily Living (95 vs 85) and Hip Outcome Score-Sport (88 vs 71, both P < .05). Soccer players younger than 25 years had significantly higher odds of RTS compared with those aged 25 years or older (odds ratio = 8.8, P = .006). Five hips (10%) underwent revision at the final follow-up. Conclusions:Soccer players undergoing primary hip arthroscopic labral repair for femoroacetabular impingement syndrome reported an 81% RTS rate at a minimum 2-year follow-up, with most returning at the same or higher level of play. At a mean follow-up of 5.5 years, most patients achieved Patient Acceptable Symptom State thresholds. Younger age was associated with a higher likelihood of return to sport. Level of Evidence:Level IV, therapeutic retrospective case series.

BACKGROUND:Patients who have symptomatic iliopsoas tendonitis after total hip arthroplasty (THA) often describe a prolonged time to diagnosis and subsequent surgical management. The purpose of this study was to quantify time from symptom onset to diagnosis and subsequent arthroscopic iliopsoas fractional lengthening, including number of providers seen, in patients diagnosed with iliopsoas impingement. METHODS:Patients undergoing arthroscopic iliopsoas fractional lengthening after THA were prospectively identified between 2023 and 2025 at two academic institutions. Time from symptom onset to iliopsoas tendonitis/impingement diagnosis and subsequent arthroscopic lengthening was determined. Number of providers seen, diagnostic relief from preoperative iliopsoas bursal injections, and postoperative satisfaction were evaluated to quantify indications and outcomes of arthroscopic intervention. A total of 59 hips in 56 patients (33 men and 23 women) were included (mean age 66 years [range, 25 to 87]; mean BMI: 29.8 [range, 19 to 46]). RESULTS:There were 13 patients (22%) who had undergone revision THA prior to symptom onset. Patients had on average 2.1 years of symptoms (range, 0.3 to 9.8) and saw 2.2 providers (range, one to eight) prior to being diagnosed with iliopsoas impingement. The mean total time between initial symptom onset and fractional lengthening was 3.0 years (range, 0.3 to 15). At a mean of 10.1 months postoperatively, mean surgical satisfaction was 8.0 ± 2.7 on a scale of one to 10, with 88% stating that they would undergo fractional lengthening again. CONCLUSIONS:Patients often experience a protracted period of symptoms and see multiple clinicians prior to being diagnosed with iliopsoas impingement and undergoing arthroscopic management. For symptoms refractory to nonoperative management and confirmed with diagnostic injection, arthroscopic fractional lengthening can provide high surgical satisfaction. These findings highlight the importance of increased recognition and appropriate referral of patients who have iliopsoas impingement following THA.

Multiple ligament knee injuries (MLKIs) often result in persistent pain, residual disability including post-traumatic osteoarthritis, and high healthcare costs. Although nonrandomized and retrospective research supports operative management, evidence informing the optimal timing of MLKI surgery and subsequent rehabilitation is lacking. In addition, return to preinjury military duty, work, and sports after MLKI is poorly understood. The Surgical Timing and Rehabilitation (STaR) Trial for MLKIs was designed to address these gaps in evidence for surgery and postoperative rehabilitation for military personnel and civilians that have a MLKI. The purpose of this protocol paper is to describe the rationale and methodology for the first randomized trials to investigate the impact of timing of surgery and rehabilitation for individuals with a MLKI on time to return to preinjury levels of military duty, work, and sports. The outcomes of the STaR Trial for MLKIs are of paramount importance from the personal and societal perspective of the impact of MLKIs. The optimal time for surgery and timing of postoperative rehabilitation may also reduce residual knee impairments and complication rates that contribute to the development of long-term disability after MLKI.

Background: The origin of arthrofibrosis of the knee is multifactorial; however, it is more commonly seen in patients with arthritis, prolonged immobility, or a history of trauma or surgery to the knee. Arthrofibrosis that results in a flexion contracture of the knee is commonly attributable to scarring and shortening of the posterior joint capsule as seen in the setting of operative intervention, such as anterior cruciate ligament reconstruction (ACLR). Indications: Arthroscopic posterior capsular releases of the knee are indicated in patients with recalcitrant arthrofibrosis who have (1) failed nonoperative management and (2) a flexion contracture of ≥10°. Technique Description: This arthroscopic technique utilizes posteromedial and posterolateral portals in addition to the standard anteromedial and anterolateral portals. A transpatellar tendon portal may also be used to create the posterolateral portal. Both a 30° and a 70° arthroscope are used to better visualize the posteromedial and posterolateral inferior and superior releases. In addition to releases of the capsule both inferiorly and posteriorly, the medial and lateral gastrocnemius tendons can be partially released from the femur to allow for a more adequate release. The 70° arthroscope is necessary to access the capsule posterior to the posterior cruciate ligament to ensure complete release. Results: This procedure is typically reserved for patients who have failed conservative management with extension splinting, physical therapy, and the use of corticosteroids. Persistent arthrofibrosis with flexion contracture can occur after ACLR, with an incidence as high as 38% in some series. The specific technique described in this video has documented patient-reported outcomes of achieving full extension in >90% of patients after an arthroscopic posterior capsular release at final follow-up. Discussion/Conclusion: Recalcitrant arthrofibrosis leading to a persisting extension deficit can be devastating for a patient, as it results in increased pain and stiffness, as well as a significant decrease in functionality. Performing a posterior capsular release in addition to the standard manipulation under anesthesia and lysis of adhesions/synovectomy will allow for greater knee range of motion, particularly greater knee extension. 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.

Radial meniscal tears pose a particularly difficult challenge, in terms of both management options and surgical techniques. A recent literature has sought to establish a consensus on risk factors, diagnosis, nonsurgical and surgical treatment options, rehabilitation, and outcomes on radial meniscal tears. A Level V expert opinion study came to ≥80% consensus on 42 statements, 7 of which had 100% agreement from the panelists. We agree that, for degenerative tears, tissue quality, limb alignment, and degree of osteoarthritis need to be factored into decision-making. Furthermore, for acute traumatic complete radial tears (medial or lateral), meticulous surgical planning is necessary, and surgeons need to be familiar with all the different suturing techniques required to anatomically repair these challenging tears.

PURPOSE:To investigate outcomes among patients undergoing total hip arthroplasty after hip arthroscopy (HA-THA) compared with a matched cohort undergoing primary THA without prior arthroscopy (Only-THA). METHODS:Patients who underwent THA after primary hip arthroscopic labral repair from 2009 to 2022 at a single institution were identified. Cases were propensity-matched 1:4 to primary THA controls by age at THA, sex, body mass index (BMI), surgical approach, and year of surgery. At minimum 2-year follow-up, patient-reported outcomes (PROs)-Forgotten Joint Score (FJS), modified Harris Hip Score (mHHS), and Hip Disability and Osteoarthritis Outcome Score Pain (HOOS-Pain)-were analyzed. RESULTS:Sixty-two hips (age: 47.5 ± 9.3 years, BMI: 29.7 ± 6.2 kg/m2) were matched to 248 Only-THA hips (age: 47.9 ± 10 years, BMI: 29.5 ± 5.8 kg/m2). Although both HA-THA and Only-THA patients showed significant (P < .001) postoperative improvements in PROs, HA-THA patients reported significantly lower postoperative FJS, mHHS, HOOS-Pain, and inferior Visual Analog Scale pain scores (P < .001) compared with Only-THA controls. A cohort-specific minimal clinical important difference for mHHS was calculated as 9.6 points, with 75.7% of HA-THA and 87.5% Only-THA patients achieving this threshold (P = . 077). At mean 6.6 ± 3.3 years follow-up, HA-THA patients with preoperative Tönnis grades 1 reported significantly decreased FJS, mHHS, and HOOS-Pain compared with HA-THA patients with preoperative Tönnis grade 2-3 (P ≤ .05). HA-THA patients with Tönnis grade 1 also exhibited worse PROs (P < .001) compared with Only-THA controls. Although there were no differences in complication rates between HA-THA and Only-THA patients (8% vs. 5%, P = .49), all-cause reoperation was greater amongst HA-THA (10% vs. 2%, P = .01). CONCLUSIONS:Patients undergoing THA after prior hip arthroscopy showed modestly inferior subjective outcomes at mid-term follow up compared with an age-matched cohort without prior arthroscopy. Although both groups showed meaningful improvement, a smaller proportion of HA-THA patients achieved the cohort-specific MCID for mHHS compared with Only-THA controls. LEVEL OF EVIDENCE:Level III, retrospective cohort study.

Background: Arthroscopic treatment of excessive acetabular coverage with pincer morphology or coxa profunda can be challenging. In patients with excessive acetabular coverage with nondistractible hips, an outside-in capsuolotomy can be considered to gain safe and efficient intra-articular access to the hip. Indications: The indications for an outside-in capsulotomy include patients with acetabular retroversion, a lateral center-edge angle >40°, coxa profunda or protrusio, or stiff, older male patients who remain hip preservation candidates. Technique Description: The outside-in capsulotomy is performed once it is recognized that traction on the operative extremity will not provide adequate working space for safe intra-articular access. Traction is taken off the operative extremity, and an anterolateral portal is localized to the 12:00 position on the hip joint with the use of fluoroscopy. The camera is then placed in a juxta-capsular location, and a modified anterior portal is created under direct arthroscopic visualization. We then proceed with extracapsular dissection to identify the indirect head of the rectus. An outside-in capsulotomy is then performed parallel to the indirect head of the rectus, approximately 5 mm distal to its insertion on the acetabular rim. Prior to deep completion of the capsulotomy, the hip joint is flexed to 30° to protect the articular cartilage of the femoral head. Once intra-articular access is obtained, traction can be reapplied, and one can proceed with hip arthroscopy in a standard fashion. Results: This technique decreases the traction time needed, given that the capsulotomy is performed without traction applied. Additionally, the amount of force required for hip distraction is decreased once the capsuolotomy has been completed, through usual sectioning of the iliofemoral ligament. The presented technique is both safe and efficacious, with no published difference in complications as compared to standard inside-out access. A published series of patients with severe pincer morphology and lateral overcoverage who undergo hip arthroscopy with outside-in access demonstrates satisfactory postoperative improvements in patient-reported outcome measures. Discussion/Conclusion: The outside-in capsulotomy provides a means for safe access to the hip joint in otherwise limited or nondistractible hips.

Anterior cruciate ligament graft selection requires an individualized approach and shared decision-making based on age, activity level, and numerous other patient- and knee-specific factors. Advantages and disadvantages exist with all graft types. Clinically, many studies have shown similar patient-reported outcomes, return-to-sport, and graft failure rates when comparing bone-patellar tendon-bone and quadriceps tendon grafts. Recently, there has been emerging evidence that quadriceps tendon autografts may offer a donor-site morbidity advantage over bone-patellar tendon-bone grafts while maintaining comparable clinical outcomes. However, the literature has been filled with inconsistencies on how donor-site morbidity is reported. Therefore, further research that explores donor-site morbidity for different graft types using a standardized tool could significantly contribute to optimal graft selection.

BACKGROUND:Acetabular overcoverage (pincer morphology) has been suggested to be both a source of pain and dysfunction and potentially protective against osteoarthritic change. PURPOSE:To compare the minimum 5-year clinical outcomes of patients undergoing primary hip arthroscopic labral repair with a lateral center edge angle (LCEA) of ≥40° as compared with nondysplastic controls with an LCEA of 25° to 40°. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:A retrospective review was performed to identify all patients who underwent primary hip arthroscopic labral repair between 2009 and 2019 at a single academic institution. Patients with an LCEA of ≥40° (pincer) were propensity-matched to nondysplastic controls with an LCEA of 25° to 40° on a 1-to-2 basis by sex, age, body mass index, and surgery year. Patient-reported outcome measures (PROMs)-including visual analog scale, Tegner activity score, modified Harris Hip Score, International Hip Outcome Tool (iHOT-12), and Hip Outcome Score were analyzed-as were reoperations and conversions to total hip arthroplasty (THA). RESULTS:A total of 55 patients with pincer morphology (preoperative LCEA: 41.9°± 2.1°) were matched to 110 nondysplastic controls (LCEA: 31.2°± 4.1°), resulting in a total of 165 hips in 163 patients (67% women, mean age: 37.7 ± 9 years). Pincer patients were corrected to a mean postoperative LCEA of 38.7°± 4.1º (P < .001), with 22 pincer patients having residual overcoverage; namely, a postoperative LCEA ≥40° (range, 40°-45.8°). There were no differences between cohorts regarding intraoperative characteristics-including femoral and acetabular Outerbridge grade-as well as capsulotomy type and the presence of capsular repair (P≥ .210). At a mean 8-year follow-up (range, 5.1-13.2), there was no difference in any postoperative PROMs between pincers and controls (P≥ .215) and no difference in PROMs between patients with residual overcoverage and pincer patients with a postoperatively normalized LCEA (P≥ .291). At final follow-up, 4 patients in the pincer cohort (7%) and 21 controls (19%) converted to THA (P = .046). CONCLUSION:Patients with lateral acetabular overcoverage demonstrated similar and satisfactory postoperative PROMs at a minimum 5-year follow-up compared with propensity-matched nondysplastic controls, regardless of whether the LCEA was corrected to <40°. Of note, nondysplastic controls demonstrated a higher rate of conversion to THA, suggesting a potentially chondroprotective role for acetabular overcoverage.

Objective: Traditionally, meniscal horizontal cleavage tears have been treated with partial meniscectomy or debridement with single leaflet preservation, but increasing recent attention has been turned to repair (Figure 1). While circumferential meniscus repair has been described in the literature, clinical outcomes for this technique remain underreported. The purpose of the present study was to report and compare clinical outcomes for patients with isolated meniscal horizontal cleavage tears who underwent either circumferential repair or partial meniscectomy. Methods: Patients with isolated meniscal horizontal cleavage tears undergoing primary circumferential repair at a single institution between 2015 and 2022 were included. Patient demographics, surgery details, and clinical findings were retrospectively extracted from the institutional electronic medical records. A control group of patients with isolated meniscal horizontal cleavage tears undergoing primary partial meniscectomy was propensity matched 1:1 for age, sex, body mass index, knee laterality, and meniscal laterality. Visual Analogue Scale (VAS) for pain with rest and with use, Tegner Activity, and International Knee Documentation Committee (IKDC) scores, and return to sport data were collected at a minimum 2-year follow-up and analyzed. Differences between the circumferential repair and partial meniscectomy groups were assessed with 2-tailed independent-samples Student t-tests and a non-parametric permutation test (R v 4.4.1; RStudio). Results: Thirty-six knees (22 right, 14 left; 19 lateral menisci, 17 medial menisci) in 36 patients (25 male, 11 female; mean age, 30 ± 12 years) who underwent circumferential repair of a meniscal horizontal cleavage tear were followed for a mean of 5.9 years (range, 2.1-8.2 years) (Table 1). The partial meniscectomy group consists of 36 knees (18 right, 18 left; 23 medial menisci, 13 lateral menisci) in 36 patients (26 male, 10 female; mean age 35 ± 12 years) and were followed for a mean 4.1 years (range, 2.2-6.9 years). Circumferential repair patients were significantly more likely ( p = 0.016) to play sports preoperatively compared to partial meniscectomy patients. Intraoperative characteristics can be found in Table 2. At a minimum of 2-years postoperative, 4 (15%) of the circumferential repair patients had reoperations or failures; 5 (19%) of the partial meniscectomy patients had reoperations or failures. At the time of final follow-up, circumferential repair patients had significantly superior IKDC scores ( p = <0.001), and Tegner Activity Scale scores ( p = 0.046) compared to partial meniscectomy patients. After a non-parametric permutation test, circumferential repair patients performed significantly better for all patient reported outcome measures ( p = 0.029) compared to partial meniscectomy patients (Figure 2). Eighteen (86%) circumferential repair patients and 9 (90%) partial meniscectomy patients returned to sport. Conclusions: At a minimum of 2-years of follow-up, patients who underwent circumferential repair of meniscal horizontal cleavage tears demonstrated superior knee function (IKDC) while also having a higher activity level (Tegner) compared to patients who underwent partial meniscectomy. The circumferential repair group demonstrated an acceptable all-cause reoperation rate of 14%, like repair of other meniscus tear configurations, and a lower failure rate compared to the partial meniscectomy group. Therefore, circumferential meniscus repair should be considered at the time of surgery in select patients with symptomatic tears amenable to repair.

Purpose:To prospectively investigate subjective anterior groin pain, patient-reported outcome measures, complications, reoperation rates, and hip flexion strength after arthroscopic iliopsoas fractional lengthening. Methods:From 2023 to 2025, patients with persistent groin pain after total hip arthroplasty refractory to conservative management undergoing arthroscopic iliopsoas fractional lengthening were prospectively identified at 2 tertiary referral centers. Pre- and postoperative outcomes at a minimum 6-month follow-up including the Visual Analog Scale, Tegner activity scale, Single Assessment Numeric Evaluation, and subjective anterior groin pain and hip flexion strength were analyzed. Results:Fifty-nine hips in 56 patients were included (age: 64.9 ± 9.8 years, 59% women, body mass index: 30.0 ± 5.8 kg/m2) and followed for 10.0 ± 6.9 months postoperatively (range: 4-25 months). Patients experienced significant (P < .001) postoperative improvements in the Visual Analog Scale at rest (1.4 ± 2.2 vs 2.8 ± 2.1), Visual Analog Scale with use (3.0 ± 2.9 vs 7.8 ± 1.8), Tegner activity scale (2.8 ± 1.2 vs 2.0 ± 1.0), and Single Assessment Numeric Evaluation score (73.8 ± 22.5 vs 47.7 ± 22.2). Postoperative surgical satisfaction was 8.0 ± 2.7 (scale: 0-10). Nearly 90% of patients reported feeling much or slightly better regarding their anterior groin pain postoperatively at 2-week (91%), 6-week (88%), 3-month (91%), and final follow-up (92%). Regarding hip flexion strength, ≥66% reported feeling much or slightly better at 2-week (73%), 6-week (95%), 3-month (89%), and final follow-up (66%). Three hips (6%) underwent reoperation at the final follow-up (1 acetabular screw removal with open revision release, 1 revision total hip arthroplasty for loosening, and 1 two-stage exchange for nonacute periprosthetic joint infection). Conclusions:Nearly 90% of patients who underwent arthroscopic iliopsoas fractional lengthening after primary total hip arthroplasty reported improved anterior groin pain, whereas two-thirds reported increased subjective hip flexion strength throughout the follow-up. Of note, clinically meaningful improvement in pain at rest was achieved by 50% of patients based on cohort-specific minimal clinically important difference criteria. Level of Evidence:Level IV, retrospective therapeutic case series.

Background: Increased posterior tibial slope (PTS) and anterior tibial translation (ATT) result in a higher risk of anterior cruciate ligament reconstruction failure. Accurate measurement of PTS and ATT is essential to guide surgical planning in these patients. Full-length weightbearing lateral tibial radiographs yield the most accurate measurement of PTS and ATT compared with short-film tibial radiographs, computed tomography scans, and magnetic resonance imaging. Indications: We aim to demonstrate a validated, reproducible technique in a stepwise fashion to accurately measure PTS and ATT using full-length weightbearing lateral tibial radiographs. This presentation adds to the field by offering a precise measurement technique for surgical planning purposes. Technique Description: To precisely measure PTS using a full-length weightbearing lateral tibial radiograph, first, perpendicular lines are drawn 5 cm proximal to the ankle joint and 5 cm distal to the knee joint. A line is then extended proximally from the center of the perpendicular line near the ankle through the center of the perpendicular line near the knee, and then extended up to the tibial articular surface. Next, a line is drawn along the medial tibial plateau. The angle measured between these 2 lines is subtracted from 90° to yield the PTS. To precisely measure ATT, a line is drawn along the diaphysis of the tibia and approximated to the posterior aspect of the proximal tibia. Then, another parallel line is drawn and approximated to the posterior aspect of the distal femur. The distance between these lines is measured to yield anterior tibial translation. Results: We measured a PTS of 14.2° and an ATT of 12.6 mm using the technique described in this presentation. Discussion/Conclusion: This technique demonstrates an accurate and reproducible method to precisely measure PTS and ATT using full-length weightbearing lateral tibial radiographs. This technique yields greater accuracy in PTS and ATT than other imaging modalities. As a result, there is a direct benefit for surgical planning when using this technique. 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.