Background:Acetabular labral tears are frequently treated with arthroscopic repair using suture anchors. Iatrogenic chondral injury may occur during predrilling for suture anchors owing to factors such as portal location and drill guide type. Purpose/Hypothesis:The purpose of this study was to evaluate the effect of portal location and use of straight versus curved drill guides on drill perforation rates of the acetabular subchondral bone and outer cortex. It was hypothesized that curved guides and distal portals would minimize these perforation rates. Study Design:Controlled laboratory study. Methods:Nine cadaveric acetabula were marked at specific clockface positions (3:00 to 11:00) and drilled through anterior, anterolateral, and distal anterolateral accessory (DALA) portals using straight and curved guides. Ninety drill holes were analyzed for subchondral and cortical perforations. Statistical analysis included Fisher exact test and regression modeling. Results:A total of 90 acetabular suture anchor drill holes were created using each combination of portal (anterior, anterolateral, DALA), drill guide (curved, straight), and clockface position on the acetabulum. Among 90 drillings, 7 (7.8%) perforated the subchondral bone, and 10 (11.1%) perforated the outer cortex. Out of 45 drillings performed with a straight drill guide, 6 (13.3%) perforated the subchondral surface, as opposed to 1 (2.2%) with a curved drill guide. Of 30 drillings conducted via the anterolateral portal, 5 (16.7%) perforated the subchondral surface, as compared with 1 (3.3%) drilled from the DALA or anterior portal. Multiple linear regression based on portal, drill guide, and clockface position did not predict subchondral perforation (R 2 = 0.08; P = .35) or outer cortical perforation (R 2 = 0.04; P = .35). Conclusion:The use of anterior and DALA portals minimized subchondral perforation rates but was not statistically significant. Curved guides showed a trend toward reduced perforations when compared with straight guides. Articular surface penetration was most common at the 3:00 and 11:00 positions. Clinical Relevance:This study supports the use of curved guides and distal portals to enhance safety during arthroscopic acetabular labral repair, providing actionable insights for optimizing surgical techniques.

PURPOSE:To identify risk factors for pitcher injury during the 2023 inaugural pitch clock season and evaluate the relationship between pitcher injuries and changes in pitch pace between the 2022 and 2023 seasons. METHODS:Pitchers were included for analysis if they had ≥70 pitches recorded in the Major League Baseball Statcast dataset, in the 2022 and 2023 seasons. Injury analysis was performed for those on the injured list in 2023. Pitch pace was defined as the time (in seconds) between pitches. Increased pitch pace represented less time between pitches. Univariate analyses examined injury rates by starting versus relief pitchers; age; and pitch count, type, and pace, while multivariate logistic regression assessed age, position, and pace change. Subgroup analyses evaluated pitch pace changes by position and throwing arm injury. RESULTS:This analysis included 537 pitchers, with a median age of 29 years, and 319 injuries affecting 239 different pitchers. Pitch pace increased from 20.5 to 17.1 seconds between 2022 and 2023, and relievers increased their pace by 1.6 seconds more than starting pitchers. The elbow (18.8%) and shoulder (18.5%) were the most injured areas, and most injuries occurred in the throwing arm (64.3%). Each second decrease in time between pitches (i.e., faster pace) increased odds of injury by 19% (adjusted Odds ratio, 1.19; 95% confidence interval, 1.05, 1.34; P = .006). Each additional year of age increased the odds of injury by 11% (adjusted Odds ratio, 1.11; 95% confidence interval, 1.05; 1.17; P < .001). Starting pitchers had 120% higher odds of injury than relief pitchers (adjusted Odds ratio, 2.20; 95% confidence interval, 1.52; 3.21; P < .001). CONCLUSIONS:After pitch clock implementation, a greater increase in pitch pace, older age, and the role of starting pitcher emerged as significant risk factors for injury during the 2023 season. LEVEL OF EVIDENCE:Level III, retrospective comparative study.

Tendinopathy of the gluteus and minimus tendons is an increasingly recognized source of lateral hip pain. In recalcitrant cases, following exhaustion of nonoperative modalities, operative treatment is being considered more aggressively and optimistically with both open and endoscopic techniques, promising significant pain relief and gait improvement. Recent cadaveric biomechanical analysis demonstrated increased anatomic footprint coverage and higher load to failure of double-row compared to single-row suture anchor techniques. Because of the combined advantages of both double-row anchors and rip-stop repair demonstrated in rotator cuff repair, this article proposes and highlights an open, double-row, rip-stop suture anchor technique to address abductor tendon tears.

Purpose To use advanced topic modeling, specifically the Bidirectional Encoder Representations from Transformers Topic (BERTopic) Model, to analyze research topics in Arthroscopy: The Journal of Arthroscopic and Related Surgery (Arthroscopy). Methods Text data from the titles and abstracts of 7,304 original articles and reviews published in Arthroscopy between 1985 and 2023 were included to train the BERTopic artificial intelligence (AI) model for topic generation. BERTopic, an advanced natural language processing tool implemented in Python via Jupyter Notebook, uses contextual embeddings and clustering algorithms to efficiently group large datasets into topics based on semantic similarity. The AI-generated topics were then analyzed by frequency (i.e., the number of studies classified under each topic from 1985 to 2023) and popularity (i.e., “hot” and “cold” topic patterns based on linear regression models of topic frequency from 2020 to 2023). Results The BERTopic model categorized 6,901 articles into 35 topics. The most common topics from 1985 to 2023 were anterior cruciate ligament reconstruction, hip arthroscopy and femoroacetabular impingement (FAI), and shoulder instability. From 2020 to 2023, hip arthroscopy and femoroacetabular impingement, superior capsular reconstruction, and anterior cruciate ligament reconstruction were identified as “hot” or popular topics, whereas suture anchor biomechanics, platelet-rich plasma, and arthroscopic irrigation were identified as “cold” topics, indicating a decline in popularity. Conclusions Using BERTopic, the study showed an efficient way to analyze large amounts of data to establish patterns within orthopaedic sports medicine literature. This study shows the capacity of the BERTopic model to synthesize thousands of articles within Arthroscopy: The Journal of Arthroscopic and Related Surgery into 35 key topics. The ability to process large amounts of data with accuracy and efficiency provides a powerful tool for establishing and defining the current landscape and potential future directions of orthopaedic literature. Clinical Relevance Using AI to investigate topics a journal has published will allow us to recognize patterns, identifying common topics, emerging topics, and shifts in focus over time. It will also allow us to identify research gaps that may need to be addressed.

Introduction: Hip arthroscopies (HA) have increased exponentially worldwide since 2006, but studies outside the United States suggest HA may be declining since 2014. However, to our knowledge, there have been no studies assessing this declining trend in the United States. Additionally, there is a paucity of large, multicentered database studies assessing risk factors for perioperative HA complications. Therefore, the aims of this study were to (1) determine surgical volume trends and (2) perioperative risk factors for surgical complications of HA from 2015-2020 in the United States using the National Surgical Quality Improvement Program (NSQIP) database. Methods: The NSQIP database was used to identify adult patients (>18 years old) who underwent HA between 20015 and 2020. Univariate and multivariate logistic regression was used to identify independent risk factors for acute postoperative complications among various patient demographics and comorbid factors. Using multivariate regression models, a subgroup analysis of obese (BMI > 30) patients was performed to determine the adjusted odds for surgical complications based on BMI. Results: We identified 1,025 patients who underwent HA, with a median (IQR) age of 38 (28-49) years. Most patients were female (55.3%), while a minority were obese (31.8%). HA cases experienced a nearly two-fold decrease from 25.5 per 10,000 sports medicine cases in 2015 to 14.3 per 10,000 in 2020. Surgical complications were uncommon, occurring in only 14 patients (1.4%), the most common of which were return to the operating room (0.7%) and deep vein thrombosis (0.4%). Multivariate analysis showed that inpatient procedures (AOR: 5.71 (95% CI: 1.38-23.73), p=0.016) and bleeding disorders (AOR: 13.36 (95% CI: 1.65-108.05), p=0.015) were independent predictors of surgical complications in the 30 days after hip arthroscopy. For obese patients, BMI was also an independent predictor for surgical complications, where for each kg/m2 point increase in BMI the odds of surgical complications increase by 13%. (OR: 1.13 (95% CI: 1.02 to 1.25), p=0.021). Conclusions: This study highlights a notable decline in the number of hip arthroscopies (HA) performed in the United States from 2015 to 2020, consistent with trends observed in other countries. The overall rate of surgical complications following HA was low (1.4%), further indicating the safety of HA. Based on our risk factor analysis, there may be a need for careful patient selection and preoperative assessment, particularly in obese patients and those with bleeding disorders undergoing inpatient HA, to optimize outcomes and minimize the risk of postoperative complications in HA.

Introduction: The pulvinar, located adjacent to the medial wall of the acetabulum, consists of fat and fibrous tissue and may prevent medialization of the femoral head during a reduction attempt. Patients experiencing hip pain who undergo hip arthroscopy may exhibit varied appearances of pulvinar pathology. The precise significance of these variations remains unknown. The purpose of this study was to evaluate the inter-observer reliabilities of two grading systems for the pulvinar to allow for future study. Methods: 300 intraoperative arthroscopic photographs of the pulvinar were reviewed by 9 hip preservation surgeons. Images were reviewed for quality and assessed into two classification systems, denoted as System A (descriptive) and System B (Likert). System A consisted of six descriptive options: normal, mild synovitis, inflamed/hemorrhage, hyperplasia, fibrotic, and other (namely PVNS, synovial chondromatosis, etc.). Alternatively, System B included four-point Likert scale: normal, mild synovitis, moderate synovitis, and severe synovitis. A power analysis was conducted prior to initiating the study, revealing that a minimum sample size of 251 would result in a 95% confidence interval with a margin of 0.1 when the kappa statistic reached at least 0.60. Statistical examination was performed to provide a Fleiss Kappa score with a 95% confidence interval. Agreement was classified as poor for <0, slight for 0-0.2, fair for 0.21-0.4, moderate for 0.41-0.6, substantial for 0.61-0.8, and almost perfect for >0.8. Results: A total of 300 intraoperative arthroscopic photographs of the pulvinar were reviewed and rated. System A demonstrated an inter-observer reliability of ĸ=0.31 (0.27-0.36). System B demonstrated an inter-observer reliability of ĸ=0.64 (0.62-0.66). Some concern was made by examining surgeons about 46 images possibly being suboptimal. When these were removed, inter-observer reliability of System A improved to ĸ=0.40 (0.36-0.44) whereas System B was unaffected. Conclusion: Interobserver reliability for the pulvinar when viewed arthroscopically was substantial for a Likert based rating system and fair to moderate for a descriptive based classification. Understanding and development of these classification systems may allow further investigation to create treatment algorithms for pulvinar pathology. Keywords: Pulvinar, Hip Pain, Hip Arthroscopy

ObjectivesImage-guided ultrasound or fluoroscopic glenohumeral injections have high accuracy rates, but require training, equipment, cost, and radiation exposure (fluoroscopy). In contrast, landmark-guided glenohumeral injections do not require additional subspecialist referral or equipment. An optimal technique would be safe, accurate, and have few barriers to implementation. The purpose of this study was to define the accuracy of glenohumeral needle placement via an anterior landmark-guided approach as assessed by direct arthroscopic visualization.MethodsA consecutive series of adult patients undergoing shoulder arthroscopy in the beach chair position were included in this study. Demographic and procedural data were collected. Time required to perform the injection, precise location of the needle-tip, and factors that affected accuracy of injection were also assessed.ResultsA standardized anterior landmark-guided glenohumeral joint injection was performed in the operating room prior to surgery and location of the needle tip was documented by arthroscopic visualization with a low complication profile and few barriers to implementation. A total of 81 patients were enrolled. Successful intra-articular glenohumeral needle placement by Sports Medicine and Shoulder/elbow fellowship trained orthopaedic surgeons was confirmed in 93.8% (76/81) of patients. Average time to complete the procedure was 24.8 seconds. There were no patient-related variables associated with non-intra-articular injection in the cohort.ConclusionsThis study demonstrated a technique of anterior landmark-guided glenohumeral injection has an accuracy of 93.8% and requires less than 30 seconds to perform. This method is safe, yields similar accuracy to image-guided procedures with improved cost-and time-efficiency, and less radiation exposure. No patient-related factors were associated with inaccurate needle placement. Anterior landmark-guided glenohumeral injections may be utilized with confidence by providers in the clinical setting.Level of EvidenceLevel 5.

Background: Anterior shoulder instability is associated with Hill-Sachs lesions (HSLs) in 40% to 90% of cases. When addressing anterior shoulder instability, unaddressed engaging or “off-track” HSL have a recurrence rate of 75%. Remplissage is a known technique to address recurrent instability in the setting of an engaging HSL. In this video, we demonstrate that a double-anchor-pulley technique may be used to address recurrent instability in the setting of engaging HSL. Indications: Patients with recurrent anterior shoulder instability with off-track HSL in patients with glenoid bone loss <20% are candidates for arthroscopic Remplissage. Technique Description: Patients are placed in the lateral decubitus position. Examination under anesthesia is performed to assess for degree of instability and engagement of HSL. Posterior, anterosuperior, and anteroinferior portals are established. Routine diagnostic arthroscopy is performed with identification of the HSL. While viewing from an anterosuperior portal and working through the posterior portal, the HSL bed is prepared with curettage and a bur. A 5.5-mm accessory Cannula is used through an accessory posterior portal. Two knotless all-suture self-tensioning anchors are placed in the anterior and inferior aspect of the defect, passed through the cannula, and tagged for later identification. Bankart stabilization is performed. The knotless anchors are linked to each other to perform a knotless repair with a broad area of compression. Results: Results are excellent with only a 5.6% failure rate, significant patient improvement, low complication rate, and 95.5% return to play. Discussion: We demonstrate the technical aspects of an all-arthroscopic Remplissage technique using all-suture knotless anchors to provide a simple and reproducible method of performing a Remplissage. 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.

ABSTRACT Introduction Surgical volume at Military Treatment Facilities (MTFs) has been gradually decreasing for roughly the past 2 decades. The Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program linked surgical volume and readiness using a tool known as the KSA metric. However, the extent to which military medical missions contribute to the readiness of critical wartime specialties has not been evaluated using this metric. Methods In this study, a retrospective analysis was conducted using the surgical case logs from the US Naval Ship (USNS) Comfort missions in 2018 and 2019. The comprehensive case log data were categorized by year, surgeon, procedure, and location. The analysis focused on providing detailed descriptive statistics, including percentages pertaining to the types of procedures performed during these missions. The 2018 mission was 11 weeks in duration, and supported activities in Ecuador, Peru, Colombia, and Honduras. The USNS Comfort mission in 2019 lasted 6 months (June-November 2019), and visited 12 countries in Central America, South America, and the Caribbean. Results The 2019 mission case log, spanning 6 months, was evaluated using the KSA score in order to assess readiness and compare against 6 months of MTF KSA values within the same calendar year. In 2019, the orthopedic surgeon aboard the USNS Comfort had a total KSA score of 44,006, but the 6-month USNS Comfort mission only contributed 5,364 points (12% of the annual score). The general surgery practice aboard the USNS Comfort produced lower KSA scores compared to each surgeon’s respective MTF practice (Table III). Analyzing the cases logged by general surgeons also highlights minimal surgical diversity during these missions, with more than 90% of cases being hernia repairs or laparoscopic cholecystectomies (Table I). In addition, 35% of total procedures performed in 2018 and 2019 were performed laparoscopically. Conclusions The analysis of operative data from the 2019 USNS Comfort mission, in comparison with the surgeons’ work at their respective MTFs, reveals limited benefit in the ability of hospital-ship missions to bolster surgical readiness as measured by the KSA score. However, this is not a reflection on the value of Global Health Engagement (GHE) itself but a review of the way in which it is leveraged to support surgical readiness. Military surgeons participate in GHE as part of a larger strategy to strengthen relationships with partner nations, improve military medical force interoperability, and bolster partner nation medical capacity and capabilities. The KSA score offers an excellent tool to compare readiness metrics across significantly different GHE missions, and facilitates the opportunity for future prospective studies to improve case volume, diversity, and ultimately readiness.

CASE:A 14-year-old adolescent girl and 18-year-old man underwent right anterior cruciate ligament (ACL) reconstruction using quadriceps tendon (QT) autografts via partial-thickness harvest. While both patients initially recovered well, later they experienced a painful snapping in their knee localized to the lateral QT, just proximal to the patella. Surgical completion of the previous partial-thickness defect with imbrication provided resolution of symptoms at 4 and 9 months postoperatively, respectively. CONCLUSION:We present a snapping QT as a rare complication of partial-thickness QT harvest for ACL reconstruction. Surgical completion of the partial-thickness defect with imbrication resolved the snapping sensation in these two cases.

High tibial osteotomy is a dynamic operation, used as an effective procedure in both joint preservation and knee stability. Applications and indications are expanding, with good results in the treatment of malalignment associated with arthrosis, knee instability, meniscus deficiency or transplants, and/or cartilage restoration. Appropriate patient selection and preoperative planning are critical to achieving good outcomes after surgery. Coronal and sagittal plane corrections made through the proximal tibia can effectively alter joint mechanics creating a more favorable environment for cartilage, meniscus, and ligamentous structures about the knee. Advancing techniques and technologies have allowed for more precise planning and execution of osteotomies.

PurposeExtensor mechanism injuries, which comprise patella fractures, patella tendon tears and quadriceps tendon tears, are severely debilitating injuries and a common cause of traumatic knee pathology that requires surgical intervention. Risk factors for short-term surgical complications and venous thromboembolism (VTE) in this population have not been well characterised. The aim of this study was to identify perioperative risk factors associated with these short-term complications.MethodsThe National Surgical Quality Improvement Program database was used to identify patients who underwent an isolated, primary extensor mechanism repair from 2015 to 2020. Patients were stratified by injury type. Demographic data were collected and compared. A multivariate logistic regression was used to control for demographic and comorbid factors while assessing risk factors for developing short-term complications.ResultsA total of 8355 patients were identified for inclusion in this study. Overall, 3% of patients sustained short-term surgical complications and 1% were diagnosed with VTE within 30 days of surgery. Patella fracture fixation had a nearly twofold higher risk for surgical complications compared to quadriceps tendon repair (p = 0.004). Patella tendon repair had a twofold higher risk for VTE (p = 0.045), specifically deep vein thrombosis (p = 0.020), compared to patella fracture fixation. Increasing age, smoking and American Society of Anesthesiologists Classifications 3 and 4 were also found to be risk factors for surgical complications (p = 0.012, p = 0.004, p = 0.011 and p = 0.032, respectively).ConclusionThis study used a nationally representative, widely validated, peer-reviewed database to provide valuable insights into risk factors for short-term postoperative complications associated with extensor mechanism repair procedures, revealing notable differences in risk profiles among distinct surgical procedures. The results of this study will inform surgeons and patients in enhancing risk assessment, guiding procedure-specific decision-making, optimising preoperative care, improving postoperative monitoring and contributing to future research of extensor mechanism injuries.Level of EvidenceLevel III.

Patella alta is a common pathoanatomic contributor to various knee pathologies, including patella instability, fat pad impingement, and patellar tendinopathy. The 2 most common surgical techniques used to treat patella alta include a distalizing tibial tubercle osteotomy and patella tendon imbrication. Although these 2 surgical techniques are effective, they are associated with significant surgical morbidity and a limiting postoperative course with prolonged rehabilitation. In this Technical Note, we propose a simple means of distalizing the patella and improving patella maltracking via the addition of a medial patellotibial ligament reconstruction. The described technique is easy to perform, has little postoperative morbidity, and is familiar to most knee surgeons who perform anterior cruciate ligament reconstruction.

Research regarding revision anterior cruciate ligament reconstruction (RACLR) with quadriceps tendon (QT) autografts is lacking. The purpose of this study was to perform a systematic review and meta-analysis of RACLR with QT and compare its patient outcomes to RACLR with hamstring tendon (HT) and bone–patellar tendon–bone (BTB) autografts. Adhering to PRISMA guidelines, a search for studies using QT in RACLR was performed within PubMed, Scopus, and CINAHL from database date of inception through December 26, 2022. Primary outcomes sought included: failure rate, Lysholm scores, International Knee Documentation Committee (IKDC) scores, IKDC grades, arthrometric knee side-to-side differences (STSD), pivot shift grade, donor site morbidity, return to sport, visual analog scale (VAS) pain scores. Nine studies were included consisting of 606 RACLR: 349 QT, 169 HT, and 88 BTB. Overall failure rates were 7.6

The purpose of this paper was to evaluate the response to intra-articular hip injections with and without concurrent gadolinium administration. Our secondary outcome was to compare post-operative outcomes between patients with an initial false-negative gadolinium-containing injection and a matched control group. Patients receiving a series of two hip diagnostic intra-articular injections (DIAI), the first with gadolinium for concurrent MRA and the second without gadolinium, were retrospectively identified. Pain response to DIAI, injectate volume, local anesthetic volume, inclusion of corticosteroids, and method of injection were compared between injections. False-negative injection was defined as < 50

The purpose of this study was to evaluate the effectiveness of our novel chronic patellar tendon repair with allograft augmentation in an active-duty military population. From 2014 to 2018, five patients with chronic patellar tendon ruptures were treated with a primary repair of the patellar tendon augmented with Achilles tendon allograft. All patients were followed for 12 months, and their range of motion, Lysholm scores, and straight leg raise ability were assessed. Additionally, their return to active military duty was followed. All patients were managed with tendon reapproximation and Achilles allograft augmentation. Lysholm scores improved in all patients from an average of 35 to 87 postoperatively. No patients demonstrated postoperative extensor lag, and patients regained an average flexion of 130 degrees. All patients returned to active military duty. We presented a safe and effective technique to manage chronic patellar tendon ruptures that produced good outcomes. (Journal of Surgical Orthopaedic Advances 32(3):242-245, 2023).

Background:Hip microinstability is an increasingly recognized cause of pain and disability in young adults. It is unknown whether differences in passive hip range of motion (ROM) exist between patients with versus without hip microinstability. Hypothesis:Underlying ligamentous and capsular laxity will result in differences in clinically detectable passive ROM between patients with femoroacetabular impingement (FAI), patients with microinstability, and asymptomatic controls. Study Design:Cross-sectional study; Level of evidence, 3. Methods:A retrospective review of all patients undergoing hip arthroscopy between 2012 and 2018 was conducted. Patients with a diagnosis of isolated microinstability based on intraoperative findings were identified and classified as having isolated FAI, instability, or FAI + instability. Patients without a history of hip injury were included as controls. Range of motion was recorded in the supine position for flexion, internal rotation, and external rotation. Univariate and multivariate analysis was performed on each measurement in isolation as well as combinations of motion to include total rotation arc, flexion + rotation arc, and flexion + 2× rotation arc Models were then created and tested to predict instability status. Results:In total, 263 hips were included: 69 with isolated instability, 50 with FAI, 50 with FAI + instability, and 94 control hips. A higher proportion of patients in the instability and FAI + instability groups were female compared with the FAI and control groups (P < .001). On univariate analysis, differences were found in all groups in all planes of motion (P < .001). Multivariable analysis demonstrated differences in all groups in flexion and flexion + rotation arc. In symptomatic patients, the best performing predictive model for hip microinstability was flexion + rotation arc ≥200° (Akaike information criterion, 132.3; P < .001) with a sensitivity of 68.9%, specificity of 80.0%, positive predictive value of 89.1%, and negative predictive value of 51.9%. Conclusion:Patients with hip microinstability had significantly greater ROM than symptomatic and asymptomatic cohorts without hip microinstability. Symptomatic patients with hip flexion + rotation arc ≥200° were highly likely to have positive intraoperative findings for hip microinstability, whereas instability status was difficult to predict in patients with a flexion + rotation arc of <200°.

BACKGROUND:Magnetic resonance imaging (MRI) scans and radiographs are often utilized in assessing for preoperative osteoarthritis in patients undergoing hip preservation surgery.PURPOSE:To determine if MRI scans improve inter- or intrarater reliabilities over radiographs for findings of hip arthritis.STUDY DESIGN:Cohort study (Diagnosis); Level of evidence, 3.METHODS:Anteroposterior and cross-table lateral radiographs as well as a representative coronal and sagittal T2-weighted MRI scan were reviewed for 50 patients by 7 experienced subspecialty hip preservation surgeons, with a minimum experience of 10 years. Radiographs and MRI scans were assessed for joint space narrowing, subchondral cysts, osteophytes, subchondral sclerosis, Likert osteoarthritis grade (none, mild, moderate, or severe), and Tönnis grade. MRI scans were also evaluated for bony edema, heterogeneous articular cartilage, and chondral defects. Inter- and intrarater reliabilities were calculated utilizing the Fleiss method with a 95% CI.RESULTS:The scans of 50 patients (28 female and 22 male) with a mean age of 42.8 years (SD, 14.2 years; range, 19-70 years) were reviewed. Radiographs revealed fair agreement for joint space narrowing (κ = 0.25 [95% CI, 0.21-0.30]), osteophytes (κ = 0.26 [95% CI, 0.14-0.40]), Likert osteoarthritis grading (κ = 0.33 [95% CI, 0.28-0.37]) and Tönnis grade (κ = 0.30 [95% CI, 0.26-0.34). Radiographs revealed moderate agreement for subchondral cysts (κ = 0.53 [95% CI, 0.35-0.69]). MRI scans demonstrated poor to fair agreement for joint space narrowing (κ = 0.15 [95% CI, 0.09-0.21]), subchondral sclerosis (κ = 0.27 [0.19-0.34]), heterogeneous articular cartilage (κ = 0.07 [95% CI, 0.00-0.14]), Likert osteoarthritis grade (κ = 0.19 [95% CI, 0.15-0.24]), and Tönnis grade (κ = 0.20 [95% CI, 0.15-0.24]). MRI scans demonstrated substantial agreement for subchondral cysts (κ = 0.73 [95% CI, 0.63-0.83]). Intrarater reliabilities were statistically improved compared with interrater reliabilities, but no differences were found between radiographs and MRI scans for joint space narrowing, subchondral cysts, osteophytes, osteoarthritis grade, or Tönnis grade.CONCLUSION:Radiographs and MRI scans had substantial limitations and inconsistency between raters in evaluating common markers of hip osteoarthritis. MRI scans demonstrated strong reliability in evaluating for subchondral cysts but did not improve the interobserver variability of grading hip arthritis.

Background: The presence of pre-existing osteoarthritis (OA) has been associated with poor results after hip arthroscopic surgery. There is limited evidence validating the currently available grading systems of hip OA in patients undergoing hip preservation. Purpose/Hypothesis: Our purpose was to evaluate the interobserver and intraobserver reliabilities of 2 grading systems in a group of patients undergoing hip preservation: the Tönnis grading system and a simple 4-choice Likert scale. The hypothesis was that interobserver and intraobserver reliabilities using the Tönnis grading system would be poor among surgeons experienced in hip preservation and that a 4-choice Likert scale would be more reliable. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 100 hip radiographs were reviewed by 8 experienced hip preservation surgeons. Overall, 2 rounds of reviews were performed, at least 3 weeks apart, assessing for the presence, degree, and/or location of joint space narrowing, joint space asymmetry, subchondral cysts, osteophytes, and sclerosis. The radiographs were assigned a Tönnis grade as well as a Likert grade of OA, reported as none, mild, moderate, or severe. Statistical analysis was conducted to provide Fleiss kappa values with 95% CIs. Agreement was classified as poor for <0.00, slight for 0.00-0.20, fair for 0.21-0.40, moderate for 0.41-0.60, substantial for 0.61-0.80, and almost perfect for >0.80. Results: A total of 50 patients (28 female and 22 male) with a mean age of 42.8 ± 14.2 years (range, 19-70 years) were reviewed. The Tönnis grade demonstrated an interobserver kappa value of 0.30 (95% CI, 0.26-0.34). The Likert grade demonstrated an interobserver kappa value of 0.33 (95% CI, 0.28-0.37). All other measures demonstrated interobserver kappa values classified as slight or fair except for subchondral cysts which was moderate. Intraobserver reliabilities were statistically significantly higher than interobserver reliabilities. Intraobserver reliabilities for both the Tönnis grade (κ = 0.55 [95% CI, 0.51-0.60]) and Likert grade (κ = 0.59 [95% CI, 0.55-0.63]) demonstrated similar kappa values, consistent with moderate agreement. Subchondral cysts demonstrated the strongest interobserver (κ = 0.53) and intraobserver (κ = 0.85) reliabilities. Conclusion: Interobserver and intraobserver reliabilities were fair and moderate, respectively, for grading OA. Given the limited interobserver reliability, caution should be used when interpreting and translating studies that utilize the Tönnis grade or other rating to dictate treatment algorithms.

Purpose:To compare subjective outcomes and complications of anterior cruciate ligament reconstruction (ACLR) using either bone-patellar tendon-bone (BPTB) or quadriceps tendon (QT) autograft.Methods:A retrospective analysis of prospectively collected data identified consecutive cohorts of patients undergoing ACLR with either BPTB or QT autograft. Patients with less than 12-month follow-up and those undergoing concomitant osteotomies, cartilage restoration, and/or other ligament reconstruction procedures were excluded. Pre- and postsurgical patient-reported outcomes including International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, Tegner, and Marx were compared between groups. Complications requiring reoperation were recorded.Results:One hundred nineteen patients met inclusion criteria, including 39 QT autografts and 80 BPTB autografts. Demographic information was comparable between groups. Mean follow-up was comparable between groups (QT 22.4 ± 10.6 months vs BPTB 28.5 ± 18.5 months, P = .06). At minimum 12-month follow-up (range 12.0-100.8 months), patients in both groups demonstrated statistically significant improvements in International Knee Documentation Committee (QT 60.0%, P < .0001; BPTB 57.7%, P < .0001), all Knee Injury and Osteoarthritis Outcome Score domains, PROMIS Mobility T-Score (QT 27.2%, P = .0001; BPTB 23.2%, P < .0001), PROMIS Global Physical Health (QT 14.4%, P = .002; BPTB 13.4%, P = .001), PROMIS Physical Function (QT 29.6%, P < .0001; BPTB 37.1%, P < .0001), PROMIS Pain Interference (QT -16.5%, P < .0001; BPTB -20.8%, P < .0001), Single Assessment Numeric Evaluation, (QT 76.9%, P < .0001; BPTB 73.3%, P < .0001), Tegner (QT 92.9%, P = .0002; BPTB 101.4%, P < .0001), and Marx (QT -26.6%, P = .02; BPTB -32.0%, P = .0002) with no statistically significant differences between the 2 groups. Overall postoperative reoperation rate did not differ between groups (QT 12.8% vs BPTB 23.8%, P = .2). Revision ACL reconstruction rate did not differ between groups (QT 5.1% vs BPTB 7.5%, P = .6).Conclusions:Patients undergoing autograft ACLR with either BPTB or QT demonstrated significant subjective improvements in patient-reported outcomes from preoperative values and no statistically significant differences in outcomes between the groups. Complication and revision ACLR rates were similar between the 2 groups.Level of Evidence:III, retrospective cohort study.