英文摘要 Abstract
Periprosthetic joint infection (PJI) remains one of the most devastating complications after total joint arthroplasty. The International Consensus Meeting (ICM) has emerged as the leading global initiative to provide evidence-based recommendations on the prevention, diagnosis, and management of PJI. This study compares the recommendations of the 2018 and 2025 ICMs to assess how evolving evidence has shaped clinical guidance. A total of 172 comparable questions were identified across thematic areas, including general, biofilm, hip and knee, shoulder, and spine. Changes in recommendations were observed in 37 questions (21.5%), while 33 (19.2%) were supported by stronger evidence in 2025 and 42 (24.4%) by weaker evidence. Notable evolution included recognition of the increased revision risk following total knee arthroplasty (TKA) after prior ipsilateral arthroscopy, the establishment of a minimum 12-week antibiotic regimen after debridement, antibiotics, and implant retention (DAIR) for acute PJI, and updated guidance on the role of repeat DAIR procedures. Beyond content, the 2025 ICM adopted more directive language with explicit grading of evidence and consensus strength, providing clearer clinical guidance. These findings highlight how the rapid generation of high-quality evidence has transformed consensus recommendations, underscoring the central role of ICM in harmonizing global practice and defining research priorities in the management of PJI.
中文总结
假体周围关节感染（PJI）是全关节置换术后最严重的并发症之一。国际共识会议（ICM）已成为提供基于循证证据的PJI预防、诊断和管理建议的全球领先倡议。本研究比较了2018年和2025年ICM的建议差异，共识别出172个可比较的问题，涵盖一般原则、生物膜、髋膝关节、肩关节和脊柱等主题。在37个问题（21.5%）中观察到建议的变化，33个问题（19.2%）在2025年获得了更强有力的证据支持。2025年ICM采用更加明确的指导性语言和证据分级，为临床实践提供了更清晰的指导。这些发现凸显了高质量证据的快速积累如何推动共识推荐的更新，强调了ICM在全球骨科感染管理中的核心作用。
英文摘要 Abstract
To use a modified Delphi technique to generate an expert consensus statement on the evaluation, diagnosis, treatment, and rehabilitation of posterolateral corner (PLC) injuries of the knee. A 5-individual working group developed a list of 62 statements regarding PLC injuries for use in a 3-round modified Delphi series. Ultimately, 40 statements were retained, and a 100% participation rate was observed in all rounds. Consensus for each statement was quantified. Overall, 82.5% of statements reached consensus. Consensus was reached regarding the following: (1) The dial, posterolateral drawer, and external rotation recurvatum tests, magnetic resonance imaging, varus-stress radiographs, and bilateral hip-to-ankle radiographs have diagnostic utility. (2) The presence of concomitant meniscal pathology or neuromuscular injury influences surgical timing. (3) Useful classification systems to guide treatment of PLC injuries currently do not exist. (4) Acute soft-tissue avulsions involving a single stabilizing structure can be repaired. (5) Isolated repair of grade III PLC tears should not be performed without augmentation or reconstruction, and complete grade III PLC injuries should undergo PLC reconstruction. (6) No universally accepted PLC reconstruction technique exists, although the LaPrade technique (anatomic reconstruction of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament using 2 grafts secured in 2 femoral tunnels, 1 fibular tunnel, and 1 tibial tunnel) may confer superior outcomes. (7) There is no consensus on the utility of routine postoperative varus stress radiographs as an objective measure of surgical success. Statements that achieved unanimous consensus (all experts stating they "strongly agree") concerned routine use of physical and radiographic evaluations to confirm varus laxity due to PLC injuries and bilateral hip-to-ankle radiographs in the setting of chronic PLC injuries. Individualized treatment based on the presence of concomitant injuries and staged rehabilitation programs are essential. The significance of a grade III posterolateral drawer test in detecting external rotational laxity and whether common peroneal nerve neurolysis should be routinely performed remain in question. No single reconstruction technique confers optimal clinical outcomes. Postoperative varus stress radiographs are not reliable for determining residual laxity. Level V, consensus of expert opinion.
中文总结
本文采用改良德尔菲法，就膝关节后外侧角（PLC）损伤的评估、诊断、治疗及康复达成专家共识。由5人工作组制定了62条关于PLC损伤的陈述，经过3轮改良德尔菲调查，最终保留40条陈述，所有轮次参与率达100%。82.5%的陈述达成共识。共识要点包括：1）诊断方面，Dial试验、后外侧抽屉试验、外旋过伸试验、磁共振成像、应力位X线片及双侧髋-踝X线片具有诊断价值；2）治疗上，急性单一稳定结构撕脱可修复，III级PLC损伤应行重建而非单纯修复；3）康复方面，建议基于合并损伤的个体化康复方案。该共识为PLC损伤的临床管理提供了重要参考依据。
英文摘要 Abstract
Routine capsular closure during hip arthroscopy remains a cornerstone of my surgical approach. In my experience, restoring the capsule enhances joint stability, maintains the suction seal, and reduces long-term risk of microinstability, particularly in active or high-risk patients. Although some advocate for selective repair, I believe the downsides of routine closure are minimal and the benefits long-lasting. Until long-term evidence proves otherwise, restoring capsular integrity is essential to joint preservation.
中文总结
本文作者强调在髋关节镜手术中常规进行关节囊闭合的重要性。修复关节囊有助于增强关节稳定性、维持吸力密封效应，并降低长期微不稳定风险，尤其对活跃或高风险患者尤为重要。尽管有观点支持选择性修复，但作者认为常规闭合的缺点有限，而其带来的长期益处显著。在缺乏长期证据证明其他方法更优的情况下，恢复关节囊的完整性对于关节保护至关重要。
英文摘要 Abstract
As the number of hip arthroscopy cases performed annually continues to rise, so does the number of patients requiring revision surgery. Determining the cause of failed hip arthroscopy (HA) can be challenging, with residual femoroacetabular impingement (FAI) being the most common indication for revision. While addressing impingement during primary HA is critical, factors such as articular cartilage defects, labral pathology, and capsular management also influence outcomes. To evaluate trends in revision hip arthroscopy indications at a single institution and assess whether outcomes differ by the primary indication for revision. Case series; Level of evidence, 4. A single-center hip preservation registry was reviewed to identify patients who underwent revision hip arthroscopy for FAI between 2012 and 2019. Patient demographics and primary indications for revision hip arthroscopy were determined, and patient-reported outcomes were collected preoperatively and at a mean follow-up of 5.2 years postoperatively. The most common indication for revision hip arthroscopy in the treatment of femoroacetabular impingement remains residual impingement. Capsular instability has significant consequences for function and may represent a subset of patients who demonstrate more dysfunction before and after revision arthroscopy.
中文总结
随着每年髋关节镜手术数量的增加，需要翻修手术的患者也在增多。确定初次髋关节镜手术失败的原因具有挑战性，其中残余股骨髋臼撞击是最常见的翻修指征。本研究回顾性分析单中心保髋登记数据库中2012至2019年因股骨髋臼撞击症行翻修髋关节镜的患者，平均随访5.2年。研究发现，残余撞击仍是最常见的翻修原因，关节囊不稳对功能影响显著，可能代表一组在翻修前后均表现更多功能障碍的患者亚组。初次手术中充分处理撞击、软骨缺陷、盂唇病变和囊膜管理至关重要。
英文摘要 Abstract
The femoral cam lesion, initially recognized as the "pistol-grip deformity" in femoroacetabular impingement syndrome, has long been a focal point in hip arthroscopy. Although residual cam deformity is widely acknowledged as a major cause of revision surgery, emerging studies have questioned whether cam lesion location impacts surgical outcomes. This line of inquiry essentially revolves around three interconnected aspects: first, given the near-spherical morphology of the femoral head-neck junction, whether isolated superolateral, anterolateral, or anterior cam locations can exist, which is a fundamental question regarding the conceptual framework of cam location taxonomy; second, how the size and location of cam lesions influence the practical execution of femoroplasty, encompassing considerations of surgical technique and operative precision; and third, assuming standardized femoroplasty regardless of lesion size or location, whether the topographic location of the cam itself truly impacts surgical outcomes, exploring the intrinsic effect of cam location on clinical results. Notably, cam lesions seen on anteroposterior radiographs-often appearing as classic pistol-grip deformities-tend to be larger, which may underlie their association with more severe labral-cartilage injury and poorer outcomes, pointing to size rather than location as the key prognostic factor. Our perspective emphasizes the need for intuitive methodologies to better define how cam volume and location interact to affect arthroscopic outcomes, ultimately guiding surgical strategy and individualized prognosis.
中文总结
本文评论探讨了髋关节镜手术中股骨cam病变的位置和大小对手术结果的影响。Cam病变是股骨髋臼撞击综合征中的关键问题，传统上被称为"手枪握把畸形"。尽管残余cam畸形被认为是翻修手术的主要原因，但新研究质疑其位置是否会影响手术效果。文章围绕三个核心问题展开：首先，由于股骨头颈交界处的近球形结构，是否存在独立的上外侧、前外侧或前侧cam病变位置；其次，cam病变的大小和位置如何影响股骨成形术的实际操作；最后，在标准化股骨成形术的前提下，cam病变的位置本身是否真正影响手术结果。文章指出，X线片上显示的cam病变往往更大，这可能与更严重的盂唇-软骨损伤和更差的预后相关，提示大小而非位置是关键预后因素。
英文摘要 Abstract
Osteonecrosis of the femoral head (ONFH) is a progressive and disabling condition characterized by bone microenvironmental dysregulation, including imbalanced bone remodeling, impaired angiogenesis, and dysregulated osteoimmunity. In hip-preserving surgeries for early-stage ONFH, the most common approach is core decompression with grafting. Although widely used synthetic scaffolds, such as ceramics and metals, provide structural support or partially improve blood supply, they cannot counteract the complex pathological microenvironment of ONFH, resulting in poor long-term efficacy. To address these limitations, bioactive scaffolds incorporating functional agents have been developed to modulate pathological abnormalities and improve regenerative outcomes. This review summarizes recent advances in bioactive scaffolds for ONFH, focusing on systems functionalized with small molecules, growth factors, stem cells, exosomes, and metal ions that regulate cellular behaviors and signaling pathways in ONFH microenvironment. Emerging evidence indicates that osteoclasts exhibit heterogeneity, influencing resorptive, angiogenic, osteogenic, and immunoregulatory processes. Building on these insights, we discuss osteoclast heterogeneity and its potential relevance to ONFH, proposing that future scaffold strategies may harness osteoclast-mediated regulation to restore the osteonecrotic niche. By integrating mechanistic insights with material design, bioactive scaffolds provide a framework for targeted microenvironmental modulation and functional bone regeneration in ONFH.
中文总结
股骨头坏死（ONFH）是一种进行性致残性疾病，其特征是骨微环境失调，包括骨重塑失衡、血管生成受损和骨免疫失调。在早期ONFH的保髋手术中，最常用的方法是核心减压联合植骨。尽管广泛使用的合成支架（如陶瓷和金属）提供了结构支持或部分改善了血供，但无法对抗ONFH复杂的病理微环境，导致长期疗效不佳。为解决这些局限性，研究人员开发了包含功能性成分的生物活性支架，以调节病理异常并改善再生结果。本文综述了近年来通过靶向破骨细胞的支架介导微环境调控在ONFH微环境重编程方面的最新进展。新兴证据表明破骨细胞具有异质性，影响骨吸收、血管生成、成骨和免疫调节过程。未来支架策略可能利用破骨细胞介导的调控来恢复骨坏死微环境。
英文摘要 Abstract
To evaluate outcomes, survivorship, and complication rates among patients who underwent concomitant periacetabular osteotomy (PAO) and hip arthroscopy and compare them to patients undergoing isolated PAO. Systematic review and meta-analysis. Medline, EBSCO host, and Google Scholar databases were searched to identify all studies describing concomitant PAO and HA through May 9, 2023 (PROSPERO study protocol registration: CRD42023426191). Patients who underwent concomitant PAO and hip arthroscopy compared to patients who underwent isolated PAO. Randomized controlled trials and cohort studies reporting clinical outcomes after concomitant PAO and hip arthroscopy. Patient-reported outcome measures (PROMs), radiographic outcomes, range of motion scores, complications, re-operations, and survivorship. Based on the available literature, patients undergoing concomitant PAO and hip arthroscopy experience excellent outcomes. However, there is limited evidence to indicate that performing both procedures result in different outcomes compared to PAO alone.
中文总结
本研究通过系统评价和荟萃分析，评估联合髋关节镜与髋臼周围截骨术（PAO）患者的临床结果、生存率及并发症，并与单纯PAO进行比较。检索Medline、EBSCO host和Google Scholar数据库，纳入截至2023年5月所有描述联合手术的研究。主要比较两组在患者报告结局指标（PROMs）、影像学结果、关节活动度评分、并发症、再手术率及生存率方面的差异。研究发现，联合手术患者获得良好结局，但现有证据有限，尚不能证明联合手术与单纯PAO在结局上存在显著差异。临床实践中需权衡联合手术的复杂性和潜在风险。
英文摘要 Abstract
Scheduled follow-up (FU) appointments are a vital element of monitoring patient progress and outcomes. However, failure to attend FU appointments continues to be a regular problem in orthopaedics. To investigate the relationship between FU appointment attendance and functional outcomes after hip arthroscopy. Cohort Study; Level of evidence, 3. A retrospective analysis of prospectively collected data was conducted in patients who underwent primary hip arthroscopy for symptomatic labral tears between 2014 and 2023. FU attendance after suture removal was used to categorize patients into 2 cohorts based on whether they attended all standard FU appointments (AA) or missed at least 1 FU appointment (MAO) at 3-, 6-, or 12-month intervals. Patient-reported outcome measures (PROMs) included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Activities of Daily Living, HOS-Sports Specific Subscale, 33-item International Hip Outcome Tool, and patient satisfaction. Patients who missed at least 1 FU appointment achieved similar improvements in functional outcomes compared with those who attended all. Both cohorts achieved minimal clinically important difference, patient acceptable symptom score, and significant clinical benefit at comparably high rates. These findings suggest that functional outcomes are not associated with FU appointment attendance. Additionally, those who do not attend all of their postoperative FU appointments can still achieve CMOs.
中文总结
本研究探讨髋关节镜术后随访依从性与功能结果之间的关系。回顾性分析2014年至2023年间接受初次髋关节镜手术的症状性盂唇撕裂患者，根据术后3个月、6个月和12个月标准随访是否全部参加（AA组）或至少失约一次（MAO组）分为两组。结果显示，失访至少1次随访的患者与完成所有随访的患者在功能结局改善方面相似，两组均达到最小临床重要差异、患者可接受症状状态和显著临床获益。这些发现提示术后功能结局与随访依从性无显著关联，未参加全部随访的患者仍可获得满意的临床结局。
英文摘要 Abstract
Hip morphology has emerged as an important factor in the development of hip osteoarthritis (OA). Cam morphology is one of the most common hip morphologies, characterized by a bony prominence around the femoral head-neck junction of the hip that alters the normal shape of the femoral head. Cam morphology can contribute to intra-articular joint damage by generating abnormal contact stresses at this junction, initiating femoroacetabular impingement (FAI) syndrome and eventually leading to hip OA. Cam morphology is a causal risk factor for hip OA, but not everybody with this morphology will develop FAI syndrome or OA. The pathogenesis of hip disease is probably driven by the interplay between cam morphology, other coexisting hip morphologies (such as pincer morphology), femoral version, spinopelvic parameters and biomechanical and environmental factors. Early identification of FAI syndrome could enable timely, multidisciplinary intervention and offers the potential to modify the trajectory of disease. Cam morphology can develop during skeletal maturation, particularly in adolescents participating in high-joint-load physical activity, raising important questions about preventative approaches. Management of FAI syndrome includes both surgical and non-surgical approaches. Emerging insights into the pathogenesis and detection of cam morphology are paving the way for more targeted interventions and a deeper understanding of its role in FAI syndrome and hip OA development.
中文总结
髋关节形态已成为影响骨关节炎（OA）发展的重要因素。Cam形态是股骨头颈交界处出现骨性突起，改变了股骨头的正常形状，通过产生异常接触应力导致关节内损伤，进而引发股骨髋臼撞击综合征（FAI），最终导致髋关节OA。尽管Cam形态是髋关节OA的致病风险因素，但并非所有具有该形态的个体都会发展为FAI综合征或OA。髋关节疾病的发病机制可能是由Cam形态与其他共存髋关节形态（如钳夹形态）、股骨扭转度、脊柱-骨盆参数及生物力学和环境因素等多因素相互作用的结果。早期识别FAI综合征可实现及时的多学科干预，有望改变疾病进程。
英文摘要 Abstract
Hip arthroscopy (HA) for femoroacetabular impingement (FAI) is increasingly performed in professional athletes, yet sport-specific return-to-sport (RTS) outcomes remain limited. To assess return-to-sport rates and postoperative outcomes after HA for FAI in a cohort of professional athletes across multiple sports. A retrospective cohort study was conducted using data from a hip preservation registry, including 128 professional athletes (157 hips) treated between 2009 and 2023. Athletes were categorized into 4 sports: baseball, basketball, football, and ice hockey. RTS was defined as athletes recording professional statistics before injury, undergoing surgery, and logging professional statistics postoperatively. Demographic, clinical, and radiographic data were analyzed, and statistical performance measurements were calculated to assess postoperative performance changes. Logistic regression was used to identify predictors of RTS. Hip arthroscopy for FAI was associated with a high overall rate of RTS in this cohort of professional athletes. RTS rates and performance outcomes were not significantly different by sport. Median changes in performance metrics across all sports were modest, suggesting that most athletes returned to a similar level of performance postoperatively. Outliers in the hockey cohort notably influenced mean performance values. Athletes undergoing revision surgery demonstrated a lower RTS rate compared with those undergoing primary procedures.
中文总结
本研究回顾性分析2009年至2023年间128名职业运动员（157髋）行髋关节镜治疗股骨髋臼撞击综合征（FAI）的运动恢复情况及术后结果，涵盖棒球、篮球、橄榄球和冰球四个项目。结果显示，髋关节镜手术在职业运动员中具有较高的总体重返运动率，且不同运动项目间的重返率和功能结局无显著差异，大多数运动员术后恢复到相近的运动水平。接受翻修手术的运动员重返率低于初次手术者，提示首次手术成功对运动恢复至关重要。