Background:OpenCap, an open-source research platform for estimating 3D joint kinematics from videos captured with two iOS devices, has the potential to enable remote rehabilitation tracking and reduce travel burden associated with in-person orthopedic evaluation. However, it is unknown whether orthopedic patients have adequate iOS technological access required for OpenCap data collection, particularly in rural or resource-limited settings in which getting to clinic for rehabilitation management is most difficult. This study sought to evaluate orthopedic patient access to the necessary technology and perceived comfort level with performing an OpenCap data collection. Methods:Three orthopedic patient cohorts were prospectively enrolled: (1) 200 pediatric patients (and their caregivers), (2) 200 adult sports medicine patients, and (3) 200 adult joint arthroplasty patients. Participants completed a REDCap questionnaire regarding their access to a computer, internet, and iOS devices, and their perceived comfort level performing a remote musculoskeletal biomechanics assessment. Results:Of the orthopedic patients enrolled, 65.5-83.5% indicated access to the necessary technology resources for an OpenCap data collection, and geographic residential location did not significantly affect technological access. 71.7%-95.8% of patients indicated that they were "definitely" or "probably" comfortable performing activities needed for an OpenCap data collection, and 68.3%-82.3% of patients felt that the OpenCap technology would "definitely" or "probably" reduce their travel burden associated with in-person clinical assessment. Conclusions:While both kinematic and implementation validation in specific orthopedic patient populations is still required, these findings suggest the perceived feasibility of using OpenCap for future remote musculoskeletal biomechanics assessment among orthopedic patients, including those in predominantly rural settings.

Objective To assess the inter- and intra-observer reliability of measuring medial and lateral posterior tibial slope (PTS), medial and lateral anterior tibial translation (ATT), and tibiofemoral rotation (TFR) in non-injured and ACL-reconstructed knees using weight-bearing CT in fully extended and semi-flexed poses. Methods Bilateral weight-bearing CT scans were obtained from 92 patients approximately three months after ACL reconstruction. For 38 patients, medial and lateral PTS, ATT, and TFR were measured on both extended and flexed scans of the non-injured and reconstructed knees by two independent observers to assess inter-observer reliability. Ten extended and ten flexed scans were reanalyzed by each observer to determine intra-observer reliability. Intraclass correlation coefficients (ICCs) were calculated for all parameters. Results ICCs demonstrated good to excellent inter-observer reliability for all parameters in both non-injured and ACL-reconstructed knees across positions. Lateral and medial ATT and TFR showed particularly high reliability, while medial ATT in extension was slightly lower. Intra-observer reliability was also good to excellent across nearly all measures, except for lateral PTS, which showed moderate reliability for one observer. Conclusion Weight-bearing CT provides a reliable method for measuring PTS, ATT, and TFR in both non-injured and ACL-reconstructed knees.

Femoroacetabular impingement syndrome is a motion-related clinical disorder of the hip with a triad of symptoms, clinical signs, and imaging findings. Patients with femoroacetabular impingement syndrome are at risk of developing early onset osteoarthritis of the hip joint if not properly identified and managed which may lead to need for early total hip arthroplasty. Given this, interest in hip arthroscopy for surgical correction of cam and pincer deformities and concomitant evaluation and repair of associated soft tissue injuries such as labral tears or chondral defects has grown significantly. Studies have demonstrated improved patient reported outcomes and decreased risk for the development of early osteoarthritis after these procedures. Hip arthroscopy has been shown to have a steep learning curve and therefore a comprehensive understanding of the technical aspects of this surgery is needed to provide optimal care. Here, the methods of clinical and imaging-based evaluation and surgical management of these patients are discussed.

Purpose:To identify whether chondral pathology is associated with an increase in failure rates of isolated meniscal root repairs. Methods:We retrospectively reviewed meniscus repairs from 2012 to 2022 at the author's institution. Nonroot repairs and cases with total or same compartment meniscectomy, cartilage restoration, osteotomy, or other concurrent ligament repair or reconstruction were excluded. Chondral pathology was defined as any abnormal finding in the articular cartilage of the medial, lateral, or patellofemoral compartments. We defined repair failure as clinical evidence of retear with magnetic resonance imaging confirmation, subsequent reoperation, or conversion to total knee arthroplasty (TKA). No minimum follow-up time was established, but each case was followed to the most recent pertinent orthopaedic follow-up. Fisher's two-tailed exact test was used to determine significance. Results:Sixty-three isolated meniscus repairs (63 medial, 0 lateral) were included, of which 51 (81.0%) had existing chondral pathology. Five patients (7.9%) underwent reoperation, six (9.5%) had evidence of retear, and three (4.8%) had a subsequent TKA. Medial tears accounted for 100% (6/6) of retears. There was a failure rate of 11.8% (6/51) for repairs with existing chondral pathology. There was no significant difference in clinical retear rate (11.8% vs 0%, P = 1.000), reoperation rate (9.8% vs 0%, P = 1.000), or subsequent TKA rate (5.9% vs 0%, P = .476) with or without existing chondral pathology at the time of repair, respectively. 100% (3/3) of subsequent TKAs had existing chondral pathology at the time of repair. Conclusions:In this study, we did not find a statistically significant difference in meniscal root retear, reoperation, or subsequent TKA rates with or without existing chondral pathology. Level of Evidence:Level IV, retrospective therapeutic case series.

Introduction: Hip preservation surgery and postoperative restrictions can cause loss of skeletal muscle that is not easily recovered. The amount of skeletal muscle lost after hip preservation surgery has not been quantified. This study aims to document pre- to post-operative changes in body composition for patients undergoing hip arthroscopy (HA), periacetabular osteotomy (PAO), and femoral osteotomy (FO). Methods: We prospectively enrolled patients indicated for hip preservation surgery. Body composition was measured pre-operatively and at 3 weeks, 6 weeks, 12 weeks, and 24 weeks post-operatively using bioelectrical impedance analysis (skeletal muscle mass (SMM), fat mass (FM), lean body mass (LBM)). Additionally, patients completed baseline international Hip Outcome Tool (iHOT) score. Changes in body composition were evaluated using generalized linear mixed models. Correlations between iHOT scores and body composition were described using Pearson correlation coefficients. Results: 79 participants (23.9±8.3 years) were enrolled and completed at least one follow up measurement. Participants were predominantly female (85%), white (96%), and 52% underwent PAO/FO. Sensitivity analyses determined no difference in arthroscopy vs osteotomy procedures in baseline characteristics or changes in body composition over time. Participants lost a mean of -0.59 (-0.94 - -0.25)kg of SMM by 6-weeks (27.5 (26.1-28.9)kg to 26.9 (25.9-28.6)kg, p=0.003) with significant recovery by 12-weeks (p=0.142). Lower pre-operative iHOT score was associated with higher pre-operative FM (r= -0.25, p=0.019) and lower SMM (r=0.25, p=0.028). Discussion: We found an early significant loss of SMM in the first 6 weeks after hip preservation surgery that was similar between arthroscopic and osteotomy surgeries. This early loss of skeletal muscle recovered by 12 weeks after surgery. Lower pre-operative iHOT score was associated with a low SMM and high FM. Future studies should assess the impact of nutrition supplementation and early rehabilitation on early loss of SMM after hip preservation surgery.

Background: Resilience, quantified by the brief resilience scale (BRS), has been recognized for its role in pain and symptomatology in musculoskeletal conditions. The role of psychological factors in the clinical presentation and outcomes of FAI surgery continues to be poorly understood. Methods: This is a prospective multicenter study of FAI patients undergoing primary hip arthroscopy. PROMs were administered at baseline, 3-, and 6-months post-op and included the Patient Reported Outcomes Measurement Information System (PROMIS) domains of anxiety and depression, as well as Hip Disability and Osteoarthritis and Outcome Score (HOOS), modified Harris Hip Score (mHHS), and International Hip Outcome Tool (iHOT-12). Resilience was characterized by BRS score and divided into low (“L”, score<3), normal (“N”, score 3-4.3), and high resilience (“H”, score>4.3). Results: 675 patients were included with a mean age of 24.9±7.8 years and female predominance (56%). Mean BRS scores were 3.7±0.7 (1.5-5.0). 13.8% (n=93) had low resilience, 65.9% (n=445) had normal resilience, and 20.3% (n=137) had high resilience. Lower resilience had more severe symptoms in HOOS pain (p<0.001), HOOS sports (p=0.003), HOOS ADL (p<0.001), HOOS QoL (p<0.001), iHOT-12 (p=0.002), and mHHS (p<0.001). Anxiety (L: 50.5%/N: 14.4%/H: 2.2%) and depression (L: 38.7%/N: 8.8%/H: 2.9%) were higher in lower resilience groups (all p<0.001) and this trend stayed consistent in female and male sub-analyses with females having greater anxiety and depression symptoms. The follow-up cohort with 3- and 6-months follow-up was 487 patients and had similar baseline characteristics as the baseline cohort. Lower resilience had lower postoperative PROs (with similar change) (p<0.05). After treatment, rates of anxiety or depression decreased from 22.1% to 15.6% with the low resilience group having the highest change from 62.9% to 45.9%. Conclusion: Low resilience correlates with more severe symptoms and predicts anxiety/depression in FAI. 13.8% had low resilience while 20.3% had high resilience. Lower resilience had worse postoperative PROs. Particularly in patients with low resilience at presentation, rates of anxiety or depression symptoms decreased postoperatively. Further studies are needed to understand the role of resilience in longer-term outcomes of FAI and whether concurrent psychological treatment will help improve patient outcomes after hip arthroscopy for FAI.

To perform a systematic review that identifies the percentage of arthroscopic hip surgery publications that obtain postoperative plain radiographs (and type, and when) and the accuracy of the osseous corrections performed. A systematic review was conducted utilizing PRISMA guidelines. Arthroscopic hip preservation surgery publications were included over a 20-year publication eligibility period. Synthetic reviews were excluded. Studies reporting accuracy of correction based on intra-operative fluoroscopic and/or dynamic arthroscopic examination alone, but without postoperative plain radiographs, were excluded. Publications were screened for the presence, type, and timing of postoperative radiographs and measurements performed quantifying femoral head-neck junction sphericity. Descriptive statistics and logistic and multivariate regression analyses were performed. Two-hundred fifty-six publications (29 381 hips; 14 692 female; mean age range 14.8-65.8 years). The most common surgical indication was labral tear (13 112 hips [44.7% of hips]). There was an inverse correlation between publication year and obtaining postoperative radiographs (r = -0.128, P < .05). Only 69 publications (27%) reported obtaining postoperative radiographs. Among those, 40 publications (16%) specified the type of radiographs. Only 22 publications (9%; 1538 hips [5% of hips]) reported that patients had an accurate osseous correction. This systematic review has shown that only 9% of arthroscopic hip preservation surgery publications (5% of hips) reported an accurate osseous correction on postoperative radiographs. Given this finding, writers, reviewers, editors, and publishers of hip preservation surgery literature should necessitate the transparent reporting of the accuracy of osseous corrections performed on standardized radiographs. Level IV, systematic review and/or meta-analysis of studies with Levels I to IV.

Background:To determine the accuracy of preoperative magnetic resonance arthrogram (MRA) in detecting capsulolabral adhesions in patients undergoing revision hip arthroscopy. Methods:We retrospectively reviewed revision hip arthroscopies performed by a single surgeon between 2019 and 2022. Patients without preoperative MRA were excluded. Musculoskeletal radiologists blinded to surgical variables assessed pre-operative axial T1 FS MRA for adhesions and graded adhesions as mild (length <5 mm), moderate (5-10 mm), or severe (> 10mm). Paralabral sulcus effacement increased the grade one level beyond adhesion length. Intraoperative arthroscopy images were evaluated for the incidence and severity of adhesions. Adhesions were graded intraoperatively as mild (rare, small adhesions), moderate (multiple or large adhesions), or severe (many adhesions disrupting labral function). A grade of 0 was assigned if no adhesions were present. Graders were blinded to each other, and Wilcoxon signed-rank test compared diagnosis methods. Sensitivity, specificity, and predictive values (PPV, NPV) were also calculated. Results:We identified 42 patients, 45 hips with pre-operative MRA undergoing revision hip arthroscopy. On MRA grading, there were 41 patients with adhesions (93%), of which 14 were considered severe (33%), 22 moderate (52%), and 6 mild (14%). On intraoperative grading (ICC 0.73, Kappa 0.35), there were 32 cases (71%) with 14 considered severe (31%), 10 moderate (22%), and 8 mild (18%). There was no difference in severity assessment between pre-operative MRA and intraoperative findings (P<0.001). Pre-operative MRA was moderately able to predict intra-operative adhesions (sensitivity 90.6%, PPV 69%). Specificity could not be calculated. Conclusion:Axial T1 FS MRA is a sensitive tool to assess for capsulolabral adhesions in the revision arthroscopy setting. MRA best predicts severe adhesions and is moderately predictive of mild and moderate adhesions. Level of Evidence: IV.

Background: The role of generalized joint hypermobility (GJH) in the setting of femoroacetabular impingement (FAI) and how it affects clinical presentation has begun to be investigated. It is possible that GJH and hip instability are contributors to the symptoms in this population. Elevated Beighton scores represent GJH. The study purpose was to investigate GJH prevalence in patients with symptomatic FAI and correlate this with complaints of pain, mobility, or stability. Methods: A prospective multicenter study of FAI patients undergoing primary hip arthroscopy was reviewed. Inclusion criteria were patients aged 14-45 years with idiopathic FAI. Exclusion criteria were previous ipsilateral hip procedures, associated disorders, or Tönnis 2+ osteoarthritis. Beighton ≥4 was considered a marker of GJH. Patients recorded whether their primary and secondary complaint was pain, mobility, or instability. Chi-squared or Fisher’s Exact test were utilized to compare groups. Results: The study included 665 patients with mean age of 24.9±7.8 years and 55.8% being female. The GJH (Beighton ≥4) was 56.9% in females and 28.6% in males (p<0.001). In females, 43.9%, 22.4%, and 7.0% had Beighton of 5+, 7+, and 9 respectively, compared to 16.3%, 5.4%, and 1.7% in males (p<0.001). Overall, pain was the primary complaint in 71.6 % of patients, compared to 24.2% complaining primarily of issues of mobility and 4.2% complaining primarily of issues with stability. Among females, the presence of GJH did not influence primary complaints with pain being the predominant symptom in 73.2% of females with Beighton 4+, compared to 70.3% of females with Beighton score under 4 (p=0.402). Overall, 18.0% had stability as primary or secondary complaint. This was unchanged for females (17.8%) and males (18.4%) (p=0.844). GJH had no effect either for Beighton ≥4 (19.3%) and Beighton <4 (17.0%) (p=0.445). Conclusions: Over half of female patients undergoing FAI surgery have underlying GJH as measured by the Beighton score. Even in the setting of females with GJH, primary complaint remains pain, followed by mobility then instability. Further research is needed to better understand the role of generalized joint hypermobility in the pathophysiology of FAI and the outcomes of surgical treatment.

This research aimed to compare return-to-sport (RTS) muscle strength testing in athletes 6 months following a quadriceps tendon (QT) autograft anterior cruciate ligament (ACL) reconstruction performed with or without a nerve block. Retrospective analysis of RTS strength testing in competitive or recreational athletes who had a QT ACL reconstruction at a Midwest academic referral center. There were 182 participants ranging from 12 to 29 years of age with a mean age of 16.9 years old. Patients were stratified into two groups based on whether they received an intraoperative nerve (adductor canal) block. Relevant tests performed during RTS testing included isokinetic quadriceps and hamstring strength (ISOK) in addition to limb symmetry and self-reported psychological readiness. Most patients underwent multiple RTS tests; for this study, we used the data from their initial test typically performed in the 6-month postoperative timeframe. Forty-three patients had an intraoperative nerve block, while 139 did not have a block. There were no observed statistically significant differences in quadriceps or hamstring strength when comparing the median scores of the nerve block and no-block groups across the major quantitative categories of isokinetic muscle strength, limb symmetry, tuck jump errors, or psychological readiness to return to sport. There was evidence of a relationship between increased graft thickness and decreased isokinetic quadriceps strength at both 60 and 300 deg/s in addition to lower self-reported confidence in readiness to RTS. No significant differences in functional strength testing or psychological readiness at 6 months were seen in ACL reconstruction involving QT grafts based on block status. There was evidence of a relationship between increased QT autograft thickness and decreased functional outcomes at 6 months. This research strengthens the case for leveraging an adductor canal block in QT ACL reconstruction involving young athletes as an effective tool for pain management without compromising muscle strength or RTS readiness. The level of evidence is III.

Hip dysplasia is currently diagnosed with two-dimensional radiographic measurements that may not adequately describe the aetiology of pain and dysfunction associated with dysplastic deformity and future osteoarthritis progression. This study aimed to assess how accurately two-dimensional radiographic measurements represent the three-dimensional mechanical joint environment. Spearman ρ correlation was used to determine associations between radiographic measurements of hip dysplasia made on pre-operative and 6-month post-operative standing AP pelvis radiographs, and hip contact stress calculated based on pre- and post-operative pelvis CT scans for a series of 100 patients (125 dysplastic hips) treated with periacetabular osteotomy using discrete element analysis. Only moderate correlations were observed between radiographic measurements and contact mechanics. Pre-operative lateral centre edge angle of Wiberg had the highest, though moderate, correlation with mean cumulative contact stress-time exposure (ρ = -0.5112, P < .0001). Tönnis angle (ρ = 0.4898, P < .0001) and extrusion index (ρ = 0.4579, P < .0001) also had moderate correlations with pre-operative mean cumulative contact stress-time exposure. Only weak correlations were found post-operatively and when comparing change in radiographic measurements to computational contact mechanics metrics before and after surgery. These findings indicate the mechanical environment of the hip joint is more complex than simple radiographic measurements that quantify coverage of the femoral head by the acetabulum. Evaluation of three-dimensional contact mechanics in dysplastic hips should be used in combination with two-dimensional radiographic evaluation for guiding clinical care for patients with hip dysplasia.

Background: The optimal treatment of patients with symptomatic borderline acetabular dysplasia remains a major controversy in hip preservation. The literature on borderline dysplasia focuses on treatment of overlapping subgroups of this population, yet the entire population of patients with symptomatic borderline dysplasia remains to be better defined. The purpose of the current study was to define the clinical presentation of borderline acetabular dysplasia across the full spectrum of treatments with hip arthroscopy and/or periacetabular osteotomy. Methods: A prospective multicenter cohort study of the surgical treatment of borderline acetabular dysplasia was performed. All patients undergoing primary surgical treatment of hip pain in setting of borderline dysplasia [lateral center edge angle (LCEA) 18-25°] were included from 25 surgeons at 16 institutions. Exclusion criteria included revision surgery and diagnosis of Ehlers-Danlos syndrome. Clinical characteristics and imaging parameters were assessed in the entire population, regardless of treatment type. Results: The study cohort included 506 hips (74.7% female) with a mean age of 24.4+7.5 years (including 29.2% 18 years of age or younger). The LCEA was 18-20° in 27.3% and 20-25° in 72.7% with a relatively uniform distribution across the 18-25° range. The mean acetabular inclination was 9.1+4.4, with 35.1% in 10-15 range and 7.9% greater than 15. The mean baseline mHHS was 61.7+14.3, while iHOT-12 was 33.7+17.1. Pain was the primary patient-reported symptom in 70.8% of cases, compared to 18.2% for mobility and 5.3% for stability. Pain chronicity was less than 1 year in 36.9%, 1 to 3 years in 34.8%, and greater than 3 years in 28.3%. Pain was located in the anterior groin in 80.4% of patients, compared to 69.6% for lateral hip, 38.5% for posterior hip, and 22.9% for anterior thigh, with 79.6% of patients reporting at least one non-groin pain location. The Beighton score was 4+, 5+, and 8+ in 48.6%, 39.1%, and 11.3% of patients. Conclusions: Patients undergoing surgical treatment in setting of borderline acetabular dysplasia demonstrate significant variability including clinical presentation and radiographic morphology. Future research on outcomes of surgical intervention in setting of borderline dysplasia should investigate the role of these characteristics in the outcome of treatment.

Background: We previously published multi-centered studies about FAI to understand pathophysiology and outcomes. Now, we will compare the contemporary and historical cohorts to understand the similarities and differences. Baseline demographic, imaging, and surgical data will be presented. Methods: This is a multi-institutional cohort that underwent arthroscopy for FAI. Enrollment was between 2020 and 2022. Patients aged 14-45 years were included. Exclusion criteria were previous ipsilateral hip procedures, associated conditions, or high-grade osteoarthritis (Tonnis 2+). Data included demographic, imaging, patient-reported outcomes measurement information system (PROMIS), legacy patient-reported outcome measures (PROM), and surgical. Results: After enrollment, 679 hips were compared to 760 hips from the previous cohort. Mean age was lower at 24.9±7.9 years compared to 29.1± 11.7 years (p<0.001). Female predominance was similar at 56.0% and 54.3%, respectively (p=0.533). BMI was higher at 25.6±5.2 kg/m2 and 24.9±4.5 kg/m2 (p=0.047). Isolated CAMs were higher (72.9% versus 43.0%) and combined FAI was lower (27.1% versus 51.7%) (p<0.001). More patients had symptoms <1 year (41.1% versus 33.6%, p<0.001). Pain was more common laterally (64.2% versus 28.5%), posteriorly (36.5% versus 13.1%), and anteriorly on the thigh (25.2% versus 2.9%) (p<0.001). PROMIS for physical function, pain, mobility, depression, and anxiety were 42.1±7.0, 60.0±5.8, 42.9±7.2, 48.3±9.6, and 51.7±10.2, respectively. For legacy PROMs, the new cohort had better mHHS and HOOS ADL and QoL and worse HOOS symptoms and SF-12 mental component (p<0.05). HOOS pain and sports were similar (p>0.05). There was less osteoarthritis (grade 1: 16.2% versus 53.3%), higher alpha angles (68.8° versus 62.5°), and lower lateral center-edge angles (28.6° versus 29.9°) (p<0.05). There were more labral repairs (93.1% versus 54.1%), less acetabular chondroplasties (45.4% versus 57.5%), and less microfractures (3.8% versus 8.7%) (p-values<0.001). Conclusion: There were key differences between the contemporary and historical groups that may represent temporal changes between generations. Understanding these differences will help provide better care for FAI patients. This study will serve as the baseline for future follow-up studies.

Introduction: Youth sports participation and early specialization has drastically increased, but there is limited investigation into the impact on physical and mental health. Power sports participation during hip development (8 to 14 years old) can increase the risk of hip morphology resulting in femoroacetabular impingement (FAI) and hip dysplasia. The goal of this study was to assess the impact of youth sport specialization from 8-14 years old on musculoskeletal injury and mental health in college age young adults. Methods: 18- to 22-year-old college students were enrolled at five universities to complete a survey documenting sports participation and specialization between 8 and 14 years old. Additionally, the survey characterized current sport participation and level, musculoskeletal injury and treatment, and current physical and mental health. Participants were grouped according to whether or not they specialized in a single youth sport. Differences between groups were evaluated using chi-square or Wilcoxon Rank Sum tests, for categorical or continuous variables, respectively. Results: Of 1,018 young adults who completed the survey, 749 (73.6%) were female. Baseball/softball, basketball, soccer, track/cross country, and volleyball were the most common primary sports. 388 (37%) of respondents quit other sports entirely between the ages of 8- to 14-years-old to specialize in their primary sport. Youth athletes that reported specialization more commonly had hip/groin pain (62.7% vs 53.3% p=0.0035) and were more likely to quit their primary sport entirely due to injury (68.0% vs 55.4%, p<0.0001). Of patients that reported hip or groin pain, early specialization was associated with surgical treatment (21.3% vs 12.4%, p=0.0328). Hip arthroscopy was the most common surgical treatment reported in 39 participants. Early specialization was also associated with lower iHOT scores (p=0.0005) but was not associated with orthopaedic surgeries other than hip and did not result in lower mental or physical health scores. Discussion: Youth sport specialization from 8 to 14 years old was very common in over 1000 college-age young adults. Specialization was associated with hip pain and surgical treatment of hip conditions. Youth athletes should be discouraged from early specialization to avoid future hip pain and dysfunction. Further investigation is needed to determine the impact of specialization in power sports during high-risk times of hip development on hip morphology.

Background: The optimal treatment of patients with symptomatic borderline acetabular dysplasia is a major controversy in hip preservation, as patients may have primary symptoms of impingement or instability. Intraarticular pathologies driven by these processes may differ and have not been thoroughly investigated. The purpose of this study was to investigate differences in intra-articular disease patterns between borderline hips treated with isolated hip arthroscopy (HS) compared to combined HS with periacetabular osteotomy (HS/PAO). Methods: Patients were prospectively enrolled in a multicenter cohort database. Inclusion criteria were borderline acetabular dysplasia (defined by lateral center edge angle 18-25 degrees), aged 14-40 years who failed standard conservative care. All surgeons had established teams with expertise in HS and PAO with established interobserver reliability for arthroscopic disease assessment. Treatment groups include isolated HS or HS/PAO (performed in combination on same day). Exclusion criteria were isolated PAO without arthroscopy (n=138), revision arthroscopy, and Tonnis osteoarthritis grade 2 or greater. Intraoperative labral and cartilage pathology were compared between the HS group and the HS/PAO group. Results: There were 483 hips (67.8% female) with a mean age of 24.5+7.8 years; 318 (65.8%) underwent HS and 165 (34.2%) underwent HS/PAO. Hips undergoing HS were more likely to have an abnormal labrum than those undergoing HS/PAO (6.3% vs 12.1%, p=0.027), including labral detachment (55.3% vs. 38.8%, p<0.001) and degeneration (28.3% vs. 17.6%, p=0.009). Hips undergoing HS had half the rate of labral hypertrophy than combined HS/PAO (21.1% vs. 44.8%, p<0.001). Acetabular cartilage damage was more likely to be present in isolated HS compared to HS/PAO (77.7%, vs. 64.8%, p=0.003), and higher-grade cleavage (27.7% vs. 11.5%, p<0.001) and chondral defects (7.9% vs. 0.6%, p<0.001) were more likely. Ligamentum teres pathology was similar between groups (14.6% HS vs. 10.5% HS/PAO, p=0.226). Capsular laxity was noted in fewer HS than HS/PAO hips (15.0% vs 33.1%, p<0.001). Conclusion: In this prospective multicenter cohort study of patients undergoing surgical treatment of borderline acetabular dysplasia, hips with impingement-predominant symptoms indicated for isolated HS were more likely to have more advanced labral and cartilage damage compared to hips with instability predominant-symptoms who were indicated for HS/PAO.

Introduction: Femoroacetabular impingement commonly causes labral and cartilage damage. Understanding what clinical and CT-morphological factors are associated with increased labral and acetabular cartilage damage may give insight into the FAI pathophysiology. The present study aims to identify factors associated with labral and cartilage damage. Method: This is a prospective, multicenter cohort of patients undergoing primary arthroscopy for treatment of symptomatic FAI. Enrollment was between 2020 and 2022. The current study investigated predictive factors of advanced labral damage (detachment or full-thickness tear length >4cm) and advanced acetabular cartilage damage (delamination or full-thickness defect ≥200mm2). Finally, we performed external validation for the previously reported RAPID score that predicts high-grade cartilage injury. Results: There were 647 patients in the cohort. For labral injuries, there were 384/647 (59.4%) detachments and 154/647 (23.8%) full-thickness defects, with labral tears ≥4cm was present in 100/558 (17.9%) hips. Older age (OR:1.04, p=0.002), males (OR:1.83,p=0.005), and larger alpha angles at 2:00 (OR:1.02,p=0.04) were associated with full-thickness labral injuries. Older age (OR:1.06,p<0.001) and larger alpha angles at 2:00 (OR:1.03,p=0.01) were associated with tears ≥4cm. 258/679 (38.0%) patients had delamination or full-thickness cartilage defects. Older age (OR:1.09,p<0.001), males (OR:1.91 p=0.003), decreased IRF (OR:0.95,p<0.001), higher femoral version (OR:1.02,p=0.04), and larger alpha angles at 1:30 (OR:1.06,p<0.001) were associated with delamination or defect cartilage injuries. Advanced acetabular cartilage damage ≥200mm2 was present in 109/679 (16.8%) hips and was associated with larger alpha angles at 2:00 (OR:1.07,p<0.001), decreased IRF (OR:0.95,p<0.001), and males (OR:2.52,p=0.002), and age (OR:1.05,p=0.002). For RAPID score external validation, we used our data for their model (sex, Tonnis OA Grade, radiographic alpha angle) and found an AUC of 0.685. With an adjusted model using CT alpha angles, AUC improved to 0.703. Our final model improved the AUC to 0.809 and included age, sex, IRF, femoral version, and CT alpha angles. Conclusion: FAI commonly has associated labral and cartilage injuries. The current study found multiple predictive factors for advanced labral and cartilage injuries as well as for larger lesions. A model including age, sex, IRF, femoral version, and CT alpha angles appears to best predict acetabular cartilage damage. Further research should investigate how these affect outcomes.

BACKGROUND:Psychological distress is increasing in adolescents and young adults, but comprehensive screening programs are not commonly incorporated into orthopaedic clinical practice. We implemented a screening program for depression symptoms and psychological distress in adolescents and young adults with hip pain. The aims of this study were to report the prevalence and risk factors and determine the relationship with patient-reported pain and dysfunction. METHODS:Patients 10 to 24 years of age presenting for hip pain at an initial clinic visit completed the Patient Health Questionnaire-9 (PHQ-9), the 17-item Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) tool, and the International Hip Outcome Tool-12 (iHOT). Two outcome levels for depression symptoms using the PHQ-9 were compared (mild or less versus moderate or greater), and 3 outcome levels for psychological distress using the OSPRO-YF were compared (none or mild versus moderate versus severe). Age, sex, body mass index, previous surgery, and the hip diagnosis were entered into logistic regression models to predict outcomes for the levels of depression symptoms and psychological distress. iHOT scores were compared between groups using the Wilcoxon rank-sum test and the Kruskal-Wallis test followed by pairwise Wilcoxon rank-sum tests. RESULTS:Among 500 patients who completed screening, 10.6% had moderate or greater depression symptoms and 26.9% had severe psychological distress. Multivariable logistic regression revealed that young adults (age, 20 to 24 years) had higher odds of moderate or greater depression symptoms compared with adolescents (age, 10 to 19 years) (odds ratio, 2.09; p = 0.016). Female patients (risk ratio [RR], 1.86; p = 0.026), patients who had undergone a prior surgery (RR, 2.29; p = 0.025), and overweight patients (RR, 2.10; p = 0.008) had a higher risk of severe psychological distress. Both moderate or greater depression symptoms and increasing levels of psychological distress were significantly associated with lower iHOT scores (all p < 0.001). CONCLUSIONS:Psychological distress was common in adolescents and young adults with hip pain and was associated with greater patient-reported hip pain and dysfunction. Young adults had a greater risk of depression symptoms. Severe psychological distress was more common in female patients, overweight patients, and those who had undergone failed prior hip surgery. LEVEL OF EVIDENCE:Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Hip dysplasia is present in approximately 1-4% of the adult population and is associated with pain and eventually osteoarthritis. Despite the high prevalence of hip dysplasia, there is little known about the heritability and the factors associated with developing pain and disability. The aim of this study was to document the prevalence of hip dysplasia in parents of young adults treated with periacetabular osteotomy (PAO) for hip dysplasia and determine risk factors for pain, osteoarthritis, and total hip arthroplasty in these parents. Methods: Parents of young adults from age 13-27 years old with hip dysplasia indicated for PAO at our institution were enrolled. Both biologic parents were required to participate for eligibility. Study participants completed the international Hip Outcome Tool (iHOT), family and personal history of hip pain, disability, treatment, and history of youth sports participation. Standing AP pelvis and bilateral Dunn lateral radiographs were completed for each enrolled parent. Radiographic dysplasia was defined as lateral center of edge angle (LCEA) <25 or Tönnis angle >11. Composite hip failure was defined as iHOT <63 Tönnis grade >2, or total hip arthroplasty. Categorical variables were summarized as frequencies (percentages) and continuous variables as means(standard deviations) with chi-square and independent t-tests used for group comparisons, respectively. Results: There were 25 sets of parents that completed surveys and radiographs. Mothers versus fathers did not significantly differ in average iHOT scores (82.2±17.3 vs 88.1±18.1, p=0.248), prevalence of dysplasia (36% vs 48%, p=0.390) or composite failure (72% vs 88%, p=0.157). In the maternal cohort, there was a significantly higher frequency of composite hip joint failure with dysplastic (100%) vs non-dysplastic hips (56%, p=0.027). In the paternal cohort, however, rates did not significantly differ (92% vs 85%, p=1.000) Conclusions: Radiographic hip dysplasia was very common in parents of young adults treated for hip dysplasia with PAO. Despite a lower prevalence of hip dysplasia compared with fathers, a significant relationship between radiographic hip dysplasia and composite hip joint failure was only detectable in mothers. These results suggest that female hip joints are more sensitive to reduced lateral coverage seen in hip dysplasia.

Objectives: The role of psychological factors in the clinical presentation and outcomes of treated is increasingly recognized in orthopaedic surgery. Particularly, in prearthritic hip disorders, young adult hip patients often have significant psychological undertones. Patient resiliency, as quantified by the brief resiliency scale (BRS), is a static patient characteristic and has been increasingly recognized for its potential role in pain and symptomatology. The purpose of the current study was to investigate the correlation between BRS and traditional hip patient-reported outcome measures (PROMs). Methods: A prospective multicenter cohort study of 696 patients undergoing femoroacetabular impingement (FAI) primary hip arthroscopy surgery was performed and utilized for the current study. Inclusion criteria are patients aged 14 to 45 years old with idiopathic FAI not caused by childhood disease. Exclusion criteria are previous ipsilateral hip procedures or disease processes such as neuromuscular disease or high-grade osteoarthritis. PROMs included the Patient-Reported Outcomes Measurement Information System (PROMIS) domains of pain interference, physical function, mobility, anxiety, and depression, as well as hip disability and osteoarthritis and outcome score (HOOS), modified Harris hip score (mHHS), international hip outcome tool (iHOT-12), and short form-12 (SF-12). Resiliency was divided into low resiliency (score < 3), normal resiliency (score 3 to 4.3), and high resiliency (score > 4.3) as described by Smith et al 1 to use as categorical variables to compare to the other patient-reported scores. The Pearson correlation coefficient (r) was calculated and the Kruskall Willis test was used to measure association between BRS and the other PROMs for continuous and categorical values, respectively. R values ≥0.7, ≥0.4, and ≥0.1 signify a strong, moderate, and weak correlation, respectively. For categorical analysis, P values < 0.05 were considered significant. Results: The cohort of 696 patients had mean age was 24.9 ± 7.9 years and a female predominance at 56%. Average BRS scores were 3.7 ± 0.7. Overall, 13.7% of patients had low resiliency, while 65.8% had normal resiliency and 20.5% had high resiliency. Linear correlation, using Pearson coefficients, found associations between BRS and all other scores. There were only weak associations between BRS scores and PROs (all r < 0.25) except a moderate correlation with PROMIS depression (r = -0.476, p < 0.001) and PROMIS anxiety (r = -0.481, p < 0.001). Patients in higher resiliency groups reported less severe symptoms in HOOS – quality of life (p < 0.001), HOOS – sports and recreation (p = 0.004), HOOS – activities of daily living (p = 0.004), HOOS – pain (p = 0.026), iHOT-12 (p = 0.01), mHHS (p = 0.004), SF-12 mental (p < 0.001), PROMIS physical function (p = 0.003), PROMIS pain (p < 0.001), PROMIS mobility (p < 0.001), PROMIS depression (p < 0.001), and PROMIS anxiety (p < 0.001). Patients with higher activity levels (UCLA ≥9) demonstrated higher resiliency (p = 0.04). Conclusions: In FAI patients, patient resiliency appears to influence baseline PROs. Overall, 14% of patients had low resiliency while 21% had high resiliency. Further studies are needed to investigate this relationship and whether concurrent psychological treatment will help improve patient outcomes after hip arthroscopy for FAI. Figure 1