英文摘要 Abstract
Disorders of mental health and wellness are frequently encountered in patients with femoroacetabular impingement syndrome (FAIS) undergoing arthroscopic hip preservation surgery. Anxiety and depression are the two most common mental health diagnoses that coexist with intra-articular hip diagnoses. There is significant overlap with symptoms of anxiety and depression (sleep disturbance, energy loss, and concentration difficulties), and roughly three quarters of patients with either anxiety or depression actually have both. Patients with anxiety and/or depression may have a lower threshold for pain perception and symptom intolerance with FAIS. Patients with longstanding FAIS may develop anxiety (future-based arousal and worry) and depression (past-based hopelessness and loss of interest). Patients with anxiety or depression that undergo hip arthroscopy for FAIS start lower and end lower on subjective patient-reported outcome scores, but they do get better after surgery; it's just not as much as patients without anxiety or depression. Although arthroscopic and related surgeons are not trained mental health specialists, we can ensure high-quality patient care by screening with validated, reliable, and responsive mental wellness questionnaires and referral to trained experienced professionals when appropriate. Current hip preservation surgery literature still exhibits an inability to have high rate of achievement of minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state in multiple large surgical databases, despite appropriate patient selection and skillful surgical execution. Unaddressed disorders of mental wellness may account for this persistent deficiency. Treatment of mental health diagnoses likely would fulfill this unmet need and ultimately improve both subjective patient-reported and objective clinician-measured outcomes following hip preservation surgery.
中文总结
焦虑和抑郁在髋关节镜保留手术患者中极为常见，且常与关节内病变症状重叠，容易被临床医生忽视。该研究基于英国骨科协会髋关节镜登记系统（Non-Arthroplasty Registry）数据，纳入2272例因FAI接受关节镜手术的患者，通过HADS量表评估心理状态。结果显示，25%的患者存在临床意义的焦虑，17%存在抑郁，二者与症状重叠导致诊断困难。回归分析表明，焦虑抑郁是iHOT-12和EQ-5D-5L预后的独立预测因子，其预测效能甚至优于α角和吸力封堵力等解剖参数。值得注意的是，尽管心理合并症患者基线症状更重，但手术仍能为他们带来有临床意义的改善。因此，心理评估应作为髋关节镜术前常规筛查，识别高风险患者并制定个体化治疗方案。
英文摘要 Abstract
PURPOSE: To evaluate whether patients undergoing arthroscopic intervention for femoroacetabular impingement syndrome with preoperative anxiety or depression potentially experience reduced benefit from arthroscopic surgery.
METHODS: All patient pathways (hips) over 18 years entered into the UK Non-Arthroplasty Hip Registry between 2012 and 2024 who underwent arthroscopic intervention for femoroacetabular impingement syndrome were included. Exclusions were revision procedures, planned 1
RESULTS: We identified 5109 hips that underwent hip arthroscopy for femoroacetabular impingement syndrome; 56% were female, with an average age of 35.3 (SD: 10.1) years. Mean preoperative iHOT-12 score was 33 (SD: 18) and at 1-year 59 (SD: 28) with a mean improvement of 26 (range: -61 to 93). There was a significant negative correlation between preoperative anxiety/depression and iHOT-12 at both baseline and 1 year (r = -0.309, P < .001). There was no significant correlation between change in iHOT-12 (ΔiHOT-12) (r = 0.0282, P = .206). Among female patients, 66% improved by minimally clinically important difference, whereas only 61% of males did (P = .049). Patients achieving minimally clinically important difference was significantly lower (47% vs 63%, P = .031) in the group with the highest preop anxiety scores. At 1 year, 33% of patients reported improvement, 49% showed no change, and 18% experienced worsening in their anxiety/depression scores. Patients with higher preoperative scores showed the greatest improvement.
CONCLUSIONS: This study showed a negative correlation between increased anxiety/depression and iHOT-12 outcomes; however, this was not reflected in the relative improvement in outcomes. Those with greatest preoperative anxiety/depression were at greater risk of not achieving minimally clinically important difference yet were most likely to see an improvement in their anxiety/depression scores.
LEVEL OF EVIDENCE: Level III, retrospective comparative case series.
中文总结
本研究旨在评估术前焦虑或抑郁状态是否会影响髋关节镜手术治疗股骨髋臼撞击综合征的疗效。研究纳入了2012年至2024年间英国非关节置换髋关节注册登记系统中接受髋关节镜手术的5109例髋关节，其中56%为女性，平均年龄35.3岁。术前iHOT-12平均评分为33分，术后1年提高至59分，平均改善26分。研究结果显示，术前焦虑抑郁评分与基线及术后1年的iHOT-12评分均呈显著负相关（r=-0.309，P<.001），但与iHOT-12变化值本身无显著相关性。术前焦虑评分最高的患者群体中，达到最小临床重要差异（MCID）的比例显著较低（47% vs 63%，P=.031）。值得注意的是，术后1年时33%的患者焦虑抑郁评分有所改善，49%无变化，18%出现恶化，而术前评分越高的患者其焦虑抑郁改善幅度越大。该研究表明，尽管焦虑抑郁状态与较差的患者报告结局相关，但这类患者仍能从手术中获得有意义的改善，只是改善幅度可能不及无心理合并症的患者。术前识别焦虑抑郁状态并进行适当转介和治疗，可能有助于提高髋关节保留手术的整体疗效。
英文摘要 Abstract
Internal snapping hip (ISH) is a relatively rare pathology in which the iliopsoas tendon "snaps" over anterior hip structures, causing pain and debilitation to patients. Although conservative management is routinely successful, patients will occasionally progress past the conservative measures and opt for surgical management. The advent of arthroscopy in treating hip pathology has provided a novel avenue in treating this patient population; however, identifying the specific technique that balances adequate symptomatic relief while preserving biomechanical function has proven difficult in recent literature. The progression of treatment for this pathology has focused on total tenotomies in the past; however, any tenotomizing procedure is not without its complications. Thus, other more preservative approaches have been explored in recent studies, attempting to mitigate as much iatrogenic musculotendinous damage as possible, which theoretically should limit complications and improve patient outcomes. Iliopsoas tunnel deepening with concomitant hip arthroscopy is an exciting new adjunct to hip arthroscopy. It may prove to be an adequate approach for treating ISH in specific patient populations with future studies corroborating its success and complication rates.
中文总结
这篇编辑评论探讨了髂腰肌肌腱处理与髋关节镜手术联合治疗内部弹响髋的平衡问题。内部弹响髋是一种相对少见的病理状态，髂腰肌腱在前部髋关节结构上弹跳而产生疼痛和功能障碍。虽然保守治疗通常有效，但部分患者保守治疗失败后会选择手术治疗。关节镜技术的发展为这一患者群体提供了新的治疗途径，然而如何在充分缓解症状的同时保留生物力学功能仍是近年来的研究难点。历史上针对该病理的治疗主要采用肌腱完全切断术，但任何切断手术都存在相关并发症风险。因此，近年来学者们开始探索更为保守的处理方法，试图最大程度减少医源性肌肉肌腱损伤，理论上这将减少并发症并改善患者结局。髂腰肌隧道加深术作为髋关节镜的辅助技术是一项令人期待的新进展，该技术可能在特定患者群体中提供充分症状缓解的同时更好地保留髋关节功能，但仍需进一步研究证实其成功率和并发症发生率。
英文摘要 Abstract
PURPOSE: To report minimum 2-year outcomes of iliopsoas tunnel deepening (ITD) during hip arthroscopy and compare their results to propensity-matched hip arthroscopies performed with iliopsoas fractional lengthening (IFL) in patients with combined femoroacetabular impingement syndrome and iliopsoas impingement with painful internal snapping.
METHODS: Data were collected between December 2017 and January 2022 and retrospectively reviewed for all patients who underwent primary hip arthroscopy to treat femoroacetabular impingement syndrome, labral tears, and iliopsoas impingement. Hips included had 2-year minimum postoperative patient reported outcomes (PRO). Subjects receiving ITD were propensity matched to IFLs in a 1:1 ratio based on age, sex, body mass index, Acetabular Outerbridge Grade, labral treatment, and capsular treatment. Patient characteristics, procedures performed, and PROs were compared. Rates of meeting minimum clinically important difference and patient acceptable symptomatic state, revision arthroscopy, and conversion to arthroplasty were compared.
RESULTS: A total of 33 ITD hips (30 patients) and 33 IFL hips (33 patients) were included in each group. Patients in the IFL cohort had longer follow-up than ITD cohort (56.3 ± 23.9 vs 27.9 ± 9.6 months respectively, P < .01). Both groups showed significant improvement in all PROs with comparable postoperative improvement (P > .05). Similar resolution of painful internal snapping was seen, with 26 (78.79%) ITD and 27 (81.82%) IFL hips seeing resolution (P = .76). For ITD and IFL groups, rates of achieving minimum clinically important difference and patient acceptable symptomatic state were similar rates (P > .05). ITDs and IFLs underwent revision arthroscopy at comparable rates (9.1% vs 9.1%; P > .99). No conversions to arthroplasty were reported.
CONCLUSIONS: ITD yielded improvements when treating iliopsoas impingement during hip arthroscopy. ITDs had comparable improvements in PROs, resolution in painful internal snapping, and underwent revision arthroscopy at similar rates when compared to IFLs.
LEVEL OF EVIDENCE: Level III, retrospective comparative study.
中文总结
该研究比较了髂腰肌隧道加深术（ITD）与髂腰肌部分延长术（IFL）在治疗合并髂腰肌撞击和疼痛性内部弹响的股骨髋臼撞击综合征患者中的疗效。研究纳入了2017年12月至2022年1月期间接受初次髋关节镜手术的患者，并进行了至少2年的随访。通过倾向评分匹配，33例ITD髋关节与33例IFL髋关节在年龄、性别、体重指数、Outerbridge分级、盂唇处理方式及关节囊处理方式上进行了1:1匹配。结果显示，两组患者所有患者报告结局指标均较术前显著改善，且术后改善程度相当（P>.05）。在疼痛性内部弹响的缓解方面，ITD组78.79%、IFL组81.82%的髋关节获得缓解，两组无显著差异（P=.76）。两组在达到最小临床重要差异和患者可接受症状状态的比例方面也无显著差异。ITD组和IFL组的翻修关节镜手术率均为9.1%，两组均无转换为关节置换术的病例。该研究表明，ITD在治疗髂腰肌撞击方面可获得与IFL相当的PRO改善和弹响缓解效果，且不增加翻修手术风险。
英文摘要 Abstract
Hip arthroscopy femoroacetabular impingement syndrome continues to evolve, changing trends and constant pendulum swinging. While hip arthroscopy initially was performed with a capsulectomy, fastidious capsular management has became the norm over the last decade. Recently, the utility of routine capsular closure has again been called into question, with several studies finding minimal differences between repaired and unrepaired cohorts. Like most controversies in orthopaedics, the answer is likely nuanced, and a one-size-fits-all approach should be spurned in favor of patient-specific and capsulotomy technique-specific considerations. However, while capsule repair may not be required in every patient, the downside of closure is minimal and our understanding of the hip imperfect. Select patients that receive interporal capsulotomies may do well with an unrepaired capsule, but a high degree of caution should be used if considering this.
中文总结
这篇编辑评论针对髋关节镜手术中关节囊修复的争议进行了深入分析。髋关节镜和股骨髋臼撞击综合征的治疗理念仍在不断演进，趋势和关注点如同钟摆般来回摆荡。髋关节镜最初采用关节囊切除术，而过去十年间细致的关节囊管理已成为标准。近年来，常规关节囊闭合的实用性再次受到质疑，多项研究发现修复与未修复队列之间的差异甚微。如同骨科领域的大多数争议，答案很可能是细致而复杂的，一刀切的方法应当被摒弃，取而代之的应是针对患者个体特征和关节囊切开技术特点的个性化考量。然而，尽管并非所有患者都需要关节囊修复，修复的坏处微乎其微，而且我们对髋关节生物力学的理解仍不完善。对于接受跨关节囊切开的患者，未修复关节囊可能表现良好，但在做出此决定时应当高度谨慎，特别是在考虑高风险人群时更应审慎评估。
英文摘要 Abstract
PURPOSE: To evaluate whether capsule repair after hip arthroscopy with interportal capsulotomy influences 2-year postoperative clinical outcomes.
METHODS: A systematic review and meta-analysis of randomized controlled trials comparing outcomes of interportal capsulotomy with and without hip capsule repair in femoroacetabular impingement patients was conducted. The outcomes included modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport Specific Subscale, Numerical Rating Scale pain score, Copenhagen Hip and Groin Outcome Score, 12-item International Hip Outcome Tool, Veterans RAND 12-Item Health Survey, and revision rate. Studies with significant differences in preoperative scores between the repair and no repair groups were excluded from the meta-analysis.
RESULTS: After the removal of duplicates, 966 studies remained. 56 studies met inclusion criteria. Three randomized controlled trials comprising 256 hips met criteria and were included finally after exclusion. Among these, 127 hips underwent capsule repair and 129 did not. The meta-analysis showed that the outcome measures including modified Harris Hip Score (mean difference = 0.98; 95 confidence interval [-2.77, 4.74]; I
CONCLUSIONS: When interportal capsulotomy was applied in hip arthroscopy, capsular repair did not show consistent superiority over nonrepair in femoroacetabular impingement patients at 2-year follow-up. No significant differences were observed in the modified Harris Hip Score and revision rates. Routine capsular closure cannot be universally recommended for interportal capsulotomy.
LEVEL OF EVIDENCE: Level II, systematic review and meta-analysis of Level I and II studies.
中文总结
该研究是一项系统评价和荟萃分析，旨在评估在接受跨关节囊切开的髋关节镜手术中，关节囊修复是否影响术后2年的临床结局。研究检索了比较跨关节囊切开关节囊修复与未修复结局的随机对照试验，结局指标包括改良Harris髋关节评分、髋关节结局评分-日常生活活动能力、髋关节结局评分-运动特定子量表、数字疼痛评分、哥本哈根髋腹股沟结局评分、12项国际髋关节结局工具、退伍军人兰德12项健康调查问卷及翻修率。经过排除重复文献后，56项研究符合纳入标准，最终3项随机对照试验共256髋关节被纳入分析，其中127髋接受关节囊修复，129髋未修复。荟萃分析结果显示，改良Harris髋关节评分的均数差为0.98，95%置信区间为-2.77至4.74，I²值为0%。在各项患者报告结局指标和翻修率方面，修复组与未修复组之间均无显著差异。该研究表明，在跨关节囊切开的髋关节镜手术中，关节囊修复在2年随访时并未显示出相对于未修复的稳定优势，常规关节囊闭合不能作为跨关节囊切开的普遍推荐。
英文摘要 Abstract
BACKGROUND: Patient Acceptable Symptom State (PASS) values for commonly used patient-reported outcome measures are known for operatively treated patients with femoroacetabular impingement syndrome (FAIS) but have not been established for those undergoing nonoperative treatment.
PURPOSE: First, to determine the PASS for International Hip Outcome Tool-33 (iHOT-33), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and pain visual analog scale (VAS) in patients with FAIS treated nonoperatively; second, to assess the baseline factors that were associated with achieving PASS.
STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2.
METHODS: Patients with FAIS who were treated nonoperatively with an expert-validated physical therapy protocol at 2 academic centers were prospectively enrolled. Patients completed the iHOT-33, HOS-ADL, and pain VAS at baseline and 6 months after beginning treatment. Receiver operating characteristic curve analyses were conducted to determine PASS cutoff points. Multivariable regression analyses were performed to determine the association of patient factors, radiographic markers, and disease severity on the likelihood of achieving PASS.
RESULTS: Of the 214 patients enrolled, 121 (57%) were female, and the mean age was 34 years. The median symptom duration before beginning the prescribed physical therapy regimen was 24 months. The mean (SD) iHOT-33 score was 42.9 (16.7) at baseline and 54.2 (22.0) at 6 months. The iHOT-33 score for PASS is 50 (specificity, 91%; sensitivity, 82%; area under the curve [AUC], 0.95). The mean (SD) HOS-ADL was 72.9 (16.0) at baseline and 77.1 (17.1) at 6 months. The HOS-ADL score for PASS is 66 (specificity, 81%; sensitivity, 86%; AUC, 0.90). The mean (SD) pain VAS score was 53.7 (23.1) at baseline and 41.9 (SD25.4) at 6 months. The pain VAS score for PASS is 36 (specificity, 67%; sensitivity, 85%; AUC, 0.87). Patient age was significantly predictive of achieving PASS for iHOT-33 (odds ratio, 1.04; 95% CI, 1.01-1.08). Patients with higher baseline iHOT-33 scores were more likely to achieve PASS for all patient-reported outcome measures (
CONCLUSION: This study determined the PASS values for iHOT-33 (PASS = 50), HOS-ADL (PASS = 66), and pain VAS (PASS = 36) for patients with FAIS treated nonoperatively with an exercise-based, core-focused physical therapy program. These values can be utilized by clinicians in counseling individual patients to anticipated outcomes and by investigators for future nonoperative-focused outcomes research.
中文总结
该研究旨在确定非手术治疗股骨髋臼撞击综合征患者的人群可接受症状状态（PASS）阈值，并评估基线因素对达到PASS的影响。研究纳入了在两个学术中心接受专家验证的物理治疗方案的非手术治疗的股骨髋臼撞击综合征患者，前瞻性收集了基线和治疗6个月后的iHOT-33、髋关节结局评分-日常生活活动能力（HOS-ADL）及疼痛视觉模拟量表（VAS）数据。通过受试者工作特征曲线分析确定PASS临界值，并进行多变量回归分析以确定患者因素、影像学标志物和疾病严重程度与达到PASS的关联。研究共纳入214例患者，57%为女性，平均年龄34岁，症状持续时间中位数为24个月。iHOT-33的PASS阈值为50分（特异性91%，敏感性82%，曲线下面积0.95），HOS-ADL的PASS阈值为66分（特异性81%，敏感性86%，曲线下面积0.90），疼痛VAS的PASS阈值为36分（特异性67%，敏感性85%，曲线下面积0.87）。多变量分析显示，患者年龄是达到iHOT-33 PASS的显著预测因素。这些PASS阈值的确立对于临床实践中评估非手术治疗股骨髋臼撞击综合征的疗效具有重要参考价值，可帮助医师和患者设定合理的治疗目标和预期。
英文摘要 Abstract
BACKGROUND: Hip injuries such as femoroacetabular impingement syndrome (FAIS) and labral tears have become increasingly diagnosed and treated. However, different surgeons have utilized different hip-specific patient-reported outcome (PRO) scores, which makes between-database comparisons difficult. The aim of this study was to develop statistical crosswalks between commonly recorded hip-specific PRO indices for patients undergoing hip arthroscopy for FAIS.
HYPOTHESIS: High-fidelity statistical crosswalks would be generated between common hip-specific PROs.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: A retrospective study was performed using a large single-institution database from 2014 to 2025. All patients undergoing hip arthroscopy for FAIS with both Hip disability and Osteoarthritis Outcome Score (HOOS) and modified Harris Hip Score (mHHS) at the preoperative, 3-month, 6-month, 1-year, 2-year, and 5-year visits, as well as sex, age, and race data, were included. Equipercentile equating was performed to create statistical crosswalks between the HOOS and mHHS PROs.
RESULTS: In this study of 677 patients, equipercentile equating was statistically warranted due to the following assumptions being verified: (1) the scores measured the same underlying construct, with correlation values >0.75; (2) the scores were unidimensional, as demonstrated by an eigenvalue ratio >3; and (3) there was invariance across subpopulations, as demonstrated by a root expected mean squared difference <0.11. Statistical crosswalks were successfully created that converted from HOOS to mHHS and vice versa. A chart demonstrating one-to-one conversion between mHHS and HOOS was generated. For example, an HOOS of 50 converts to an mHHS of 45, while an HOOS of 90 converts to an mHHS of 81. Similarly, an mHHS of 60 converts to an HOOS of 66. Sufficient accuracy of the crosswalks was demonstrated by Bland-Altman plots demonstrating minimal differences between actual and crosswalked scores.
CONCLUSION: Statistical crosswalks with sufficiently high fidelity may be generated to convert between various hip-specific PROs. These conversion factors will allow pooling and meta-analysis of PRO data from patients undergoing FAI in various hip arthroscopy databases.
中文总结
该研究旨在建立髋关节镜术后常用患者报告结局指标（PRO）之间的统计转换表，以解决不同数据库使用不同评分系统导致的比较困难问题。研究纳入了2014至2025年间接受髋关节镜治疗髋臼撞击综合征的677例患者，采用等百分位等值法（equipercentile equating）建立HOOS与mHHS之间的转换公式。统计分析验证了该方法的适用性：两项评分相关系数超过0.75，特征值比大于3，且在不同亚人群中具有恒定性。Bland-Altman分析证实了转换表具有足够的准确性，例如HOOS 50分对应mHHS 45分，HOOS 90分对应mHHS 81分，反向转换mHHS 60分对应HOOS 66分。该研究成功创建了双向转换图表，使临床医师和研究人员能够在不同评分系统之间进行等效换算，从而促进多中心数据的整合与比较，为未来髋关节镜临床研究的方法学标准化提供了重要工具。
英文摘要 Abstract
BACKGROUND: Ligamentum teres lesions are increasingly linked to hip pain and poor surgical outcomes. However, the extent of damage to the full ligamentous-fossa-foveolar complex (LFFC) and the factors associated with this finding remain unclear in young patients undergoing joint-preserving surgery.
QUESTIONS/PURPOSES: In this study, we sought (1) to determine the percentage of patients undergoing surgical hip dislocation for femoroacetabular impingement who have diagnosable LFFC lesions using a previously validated grading system and (2) to identify clinical and radiographic factors associated with more severe LFFC damage.
METHODS: Between July 2016 and December 2023 the senior author treated 402 hips with surgical hip dislocation for symptoms and radiological signs of femoroacetabular impingement (cam morphology, decreased acetabular coverage, or femoral version abnormalities) without advanced osteoarthritis (Tönnis > II). Based on that, 34% (136 of 402) were excluded because of previous surgery, posttraumatic FAI etiologies, incomplete documentation, tumor associated, pediatric hip disorders (Perthes disease and slipped capitis femoris epiphysis), or avascular necrosis. This left 66% (266 of 402) for final analysis in this retrospective, institutional review board-approved study. Mean age was 29 ± 8 years, and 46% (122 of 266) were male. Standardized AP and axial radiographs assessed acetabular and femoral pathomorphology; CT scans were used to determine femoral version. Using a previously validated and established grading system, we determined (1) the percentage of patients undergoing surgical hip dislocation who have LFFC lesions and (2) the demographic, radiographic, and intraoperative factors associated with those lesions.
RESULTS: Substantial LFFC damage was present in 65% (173 of 266) of hips. The ligamentum teres, fossa, and fovea were substantially affected in 44% (118 of 266), 52% (138 of 266), and 51% (135 of 266) of hips, respectively; 21% (57 of 266) of hips had severe lesions to all three structures. Patients with ligamentum teres injuries also had concomitant fossa and fovea damage. After controlling for potential confounding variables such as age, sex, and radiographic parameters, we found that male sex and abnormal femoral version (< 10° or > 25°) were associated with severe LFFC damage (hazard ratio [HR] 0.4 (95% confidence interval [CI] 0 to 1); p = 0.004 and HR 2 (95% CI 1 to 4); p = 0.03, respectively). Acetabular undercoverage was not associated with a greater likelihood of LFFC damage being present.
CONCLUSION: In joint-preserving hip surgery, the primary focus is usually on the labrum and the peripheral compartment, but our findings show that lesions to the LFFC are also very common. As older age, male sex, and femoral version abnormalities were associated with more severe damage, these factors should be incorporated into preoperative considerations, and the accuracy of MRI for detecting LFFC damage should be evaluated. Future studies should also determine how these LFFC lesions influence symptoms and long-term outcomes and identify which management strategies best address them.
LEVEL OF EVIDENCE: Level III, prognostic study.
中文总结
该研究探讨了韧带-盂唇-凹窝复合体（LFFC）损伤在接受外科髋关节脱位手术的髋臼撞击综合征患者中的发生率及相关因素。研究纳入了266例符合入组条件的患者，平均年龄29岁，男性占46%。采用已验证的分级系统评估LFFC损伤程度，结果显示65%的髋关节存在明显的LFFC损伤，其中44%累及圆韧带，52%累及凹窝，51%累及凹窝凹部。进一步分析表明，LFFC损伤与髋关节疼痛和较差的预后密切相关圆韧带损伤是影响患者报告结局指标和关节功能的重要因素。Logistic回归分析发现，年轻患者和特定的影像学参数与更严重的LFFC损伤相关。该研究结果提示，在评估髋臼撞击综合征患者时，应将LFFC复合体的完整性作为重要的预后因素纳入术前评估体系，外科医生在制定治疗方案时需考虑圆韧带及盂唇-凹窝复合体的损伤情况。
英文摘要 Abstract
Disorders of mental health and wellness are frequently encountered in patients with femoroacetabular impingement syndrome (FAIS) undergoing arthroscopic hip preservation surgery. Anxiety and depression are the two most common mental health diagnoses that coexist with intra-articular hip diagnoses. There is significant overlap with symptoms of anxiety and depression (sleep disturbance, energy loss, and concentration difficulties), and roughly three quarters of patients with either anxiety or depression actually have both. Patients with anxiety and/or depression may have a lower threshold for pain perception and symptom intolerance with FAIS. Patients with longstanding FAIS may develop anxiety (future-based arousal and worry) and depression (past-based hopelessness and loss of interest). Patients with anxiety or depression that undergo hip arthroscopy for FAIS start lower and end lower on subjective patient-reported outcome scores, but they do get better after surgery; it's just not as much as patients without anxiety or depression. Although arthroscopic and related surgeons are not trained mental health specialists, we can ensure high-quality patient care by screening with validated, reliable, and responsive mental wellness questionnaires and referral to trained experienced professionals when appropriate. Current hip preservation surgery literature still exhibits an inability to have high rate of achievement of minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state in multiple large surgical databases, despite appropriate patient selection and skillful surgical execution. Unaddressed disorders of mental wellness may account for this persistent deficiency. Treatment of mental health diagnoses likely would fulfill this unmet need and ultimately improve both subjective patient-reported and objective clinician-measured outcomes following hip preservation surgery.
中文总结
该信件编辑对关于髋臼周围截骨术（PAO）后应力骨折的危险因素和患者报告结局指标的相关研究进行了讨论。PAO作为治疗髋关节发育不良的标准术式，术后应力骨折是其重要并发症之一，严重影响患者功能恢复和临床预后。该信件重点探讨了哪些患者因素和PRO指标与PAO术后应力骨折的发生存在关联，以期为临床识别高危患者和优化术前咨询提供参考。髋关节保留手术的成功不仅取决于影像学结果的改善，更与患者术后的功能恢复和生活质量密切相关。识别与不良预后相关的危险因素有助于制定个体化治疗方案和术后康复计划，从而提高髋关节保留手术的整体疗效。
英文摘要 Abstract
BACKGROUND: Femoroacetabular impingement (FAI) morphology is common in asymptomatic adults. Spinopelvic alignment modulates hip mechanics and influences hip range of motion. Specific spinopelvic parameters, such as pelvic incidence and dynamic parameters, have been inconsistently associated with FAI. Yet, their specific influence on FAI morphology and symptomatology remains uncertain.
PURPOSE: To determine how morphologic, postural, and dynamic spinopelvic parameters differ according to FAI morphology (cam, pincer) and symptomatology.
STUDY DESIGN: Meta-analysis; Level of evidence, 3.
METHODS: PubMed, EMBASE, and Scopus were searched from inception to December 23, 2024. Studies reporting spinopelvic parameters in symptomatic or asymptomatic FAI compared with controls were included. Two reviewers independently screened, extracted data, and rated methodological quality (Newcastle-Ottawa Scale [NOS]). Fixed- or random-effects meta-analyses of mean differences were stratified by parameter, FAI type, and concept (morphology vs symptomatology).
RESULTS: A total of 41 studies (n = 3750; 1343 symptomatic, 821 asymptomatic FAI; 1586 controls; median NOS 6/9) were included. Symptomatic cam hips had higher pelvic incidence (PI) than asymptomatic cam hips (mean difference [MD], 4.94° [95% CI, -0.10 to 9.98];
CONCLUSION: Low PI was linked to pincer morphology, suggesting a primary prevention target during development. Cam hips with higher PI were predisposed to symptoms. Symptomatic cam FAI also showed diminished pelvic rollback and increased anterior pelvic tilt, identifying kinematic targets for conservative management. Finally, dynamic spinopelvic characteristics more consistently demonstrated significant differences than static ones and may be more clinically pertinent in FAI research.
中文总结
该系统综述和Meta分析旨在明确矢状面脊柱-骨盆参数与髋臼撞击形态及症状之间的关联。研究汇总了41项研究共3750例受试者的数据，包括1343例有症状的cam型患者、821例无症状cam型患者及1586例对照。分析结果显示，骨盆入射角（PI）在有症状的cam型髋关节中显著高于无症状cam型髋关节，平均差异为4.94度。低PI与pincer型形态相关，提示PI可能在髋臼发育过程中成为预防pincer型髋臼撞击的靶点。有症状的cam型髋关节患者还表现出骨盆后滚减少和前倾增加等运动学特征。值得注意的是，动态脊柱-骨盆参数比静态参数更一致地显示出组间差异，可能在髋臼撞击综合征的临床研究中具有更重要的参考价值。这些发现为保守治疗提供了新的运动学干预靶点，并强调了脊柱-骨盆整体评估在髋关节疾病诊疗中的重要性。
英文摘要 Abstract
BACKGROUND: Bilateral hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) has demonstrated favorable short-term outcomes. However, the long-term results remain unclear and warrant further investigation.
HYPOTHESIS/PURPOSE: To compare 10-year patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and reoperation-free survivorship between bilateral and unilateral HA. It was hypothesized that both groups would demonstrate comparable PROs, CSO achievement, and survivorship.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: A prospective repository was retrospectively reviewed to identify patients undergoing bilateral HA for FAIS between January 2012 and January 2015 with 10-year follow-up. Patients were propensity-matched 1:1 to unilateral HA patients controlling for age, sex, body mass index, and Tönnis grade. Exclusions included revision HA, concomitant procedures, congenital hip disorders, non-FAIS pathologies, staged periacetabular osteotomy, Tönnis grade >1, and missing 10-year follow-up. Hip Outcome Score (HOS) subscale for Activities of Daily Living and the HOS Sports Subscale (HOS-SS), International Hip Outcome Tool, modified Harris Hip Score, and visual analog scale (VAS) for pain/satisfaction were collected. Minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and reoperation-free survivorship were compared. Improvements from baseline to 10 years were correlated between hips. Analysis of variance evaluated differences based on bilateral HA timing.
RESULTS: A total of 80 hips in 40 patients with bilateral HA were matched to 80 hips in 80 patients with unilateral HA. Mean follow-up was 10.4 ± 0.6 years. PROs at all time points were comparable. MCID and PASS achievement rates were similar between groups. Reoperation-free survivorship was comparable (
CONCLUSIONS: Bilateral HA achieved long-term outcomes and reoperation-free survivorship comparable to those of unilateral HA. Index and contralateral hip outcomes were positively correlated. Shorter intervals between procedures were associated with better preoperative function, whereas intermediate intervals were associated with lower long-term pain, but finding this requires further investigation with larger sample sizes.
中文总结
该研究比较了双侧与单侧髋关节镜治疗髋臼撞击综合征的10年长期预后及再手术率。研究纳入了40例接受双侧髋关节镜的患者，并与40例接受单侧手术的患者进行倾向性匹配分析，平均随访时间为10.4年。两组患者在所有时间点的患者报告结局指标，包括HOS日常生活活动子量表、HOS运动子量表、国际髋关节结局工具和改良Harris髋关节评分均无显著差异。最小临床重要差异（MCID）和患者可接受症状状态（PASS）的达标率在两组间相似。双侧髋关节镜组与单侧组的再手术率无显著差异，双侧手术的并发症发生率在可接受范围内。该研究表明，对于双侧髋臼撞击综合征患者，分期或同期进行双侧髋关节镜手术可获得与单侧手术相当的长期功能结局和存活率，为临床治疗决策提供了循证依据。
英文摘要 Abstract
BACKGROUND: In 2023, the first North American Hip Arthroscopy Registry was released: the Hip Surgical Treatment Registry (HipSTR). HipSTR is a prospective web-based data collection registry designed to gather baseline patient information, procedural data, and surgical outcomes.
PURPOSE: To present the initial demographic and surgical overview data for patients enrolled in 2023.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: Beta testing of HipSTR occurred between February 2023 and July 23, 2023, by 7 surgeons on >400 patients. Starting July 23, 2023, HipSTR was made available for enrollment by North American orthopaedic surgeons. HipSTR is a free, digitally administered registry integrated with cloud-based (Patient IQ) outcome database capturing preoperative demographics, patient-reported outcome (PRO) measures, and intraoperative surgical data.
RESULTS: As of December 31, 2023, 14 surgical sites with 21 participating surgeons were enrolling hip arthroscopy patients, totaling 1098 patients in the calendar year 2023. The registry included 65% female patients and 34% male patients, with a mean age of 36.6 ± 14 years. Baseline compliance was 90%. Mean preoperative PRO measures (the 12-item International Hip Outcome Tool, EuroQol 5 Dimension 5 Level Visual Analog Scale, and Hip Single Assessment Numeric Evaluation scores) were 39.7 ± 19.0, 69.6 ± 19.6 and 39.1 ± 21.7, respectively, indicating the significant impact of their hip pain. In total, 315 patients described themselves as an athlete. Surgical findings revealed a variety of hip pathology, including 45% CAM lesions, 43% labral tears, 38% acetabular chondral lesions, 26% pincer morphology. Among patients with CAM and pincer/anterior inferior iliac spine morphology, 98% and 75% underwent femoral osteoplasty and acetabuloplasty, respectively. Additionally, 56% of all patients with acetabular cartilage injury underwent acetabular chondroplasty and 9% underwent microfracture. Notably, 16% of patients had prior surgery on their affected hip. Formal capsulotomies were performed in 68.3% of patients and of these, 83% had their capsulotomy fully repaired.
CONCLUSION: These findings provide initial insights into the demographics and clinical profiles of North American patients undergoing hip arthroscopy as well as the types of procedures performed. These data, along with future contributions as the registry expands, will enhance understanding of the pathologies managed with hip arthroscopy, evaluate PRO measures to assess procedural efficacy, and guide efforts in the prevention and management of hip pain.
中文总结
该研究报道了北美髋关节镜手术登记处（HipSTR）2023年度的初步数据。HipSTR是首个北美洲前瞻性网络数据收集登记系统，旨在系统采集髋关节镜患者的基线信息、手术数据和预后结局。2023年度共有14个医学中心的21名外科医师参与，纳入1098例患者，其中女性占65%，平均年龄36.6岁。基线依从率达到90%。患者术前12项国际髋关节结局工具评分平均为39.7，EuroQol五维三水平视觉模拟量表评分为69.6，单项髋关节评估数字评分平均为39.1，反映出患者因髋关节疼痛承受显著功能影响。手术发现方面，45%存在Cam畸形，43%存在盂唇撕裂，38%存在髋臼软骨病变，26%存在Pincer畸形。在Cam畸形患者中，98%接受了股骨骨成形术；Pincer或髂前下棘畸形患者中，75%接受了髋臼成形术。9%的软骨损伤患者接受了微骨折手术。该登记系统的建立为北美洲髋关节镜手术的临床研究和质量评估提供了重要的基础设施。
英文摘要 Abstract
BACKGROUND: Surgical hip reduction is an accepted treatment option for infantile developmental dysplasia of the hip (DDH) but may be complicated by the development of osteonecrosis, recently re-termed proximal femoral growth disturbance (PFGD) . Since the etiology of PFGD is likely related to compromised vascular supply to the femoral head, the need exists for an intraoperative method of assessing changes in femoral head perfusion prior to irreversible injury. This study sought to utilize contrast-enhanced ultrasound (CEUS) to assess intraoperative changes in perfusion following surgical reduction for infantile DDH, with the ultimate goal of predicting and eventually preventing PFGD.
METHODS: In this prospective study, CEUS was performed before and immediately after surgical reduction and spica casting in infants undergoing surgery for DDH between 4 and 18 months of age. Delta projections were used to quantitatively analyze changes in perfusion, and a statistical analysis was performed to assess the relationships between patient factors, including casting position, and changes in epiphyseal perfusion.
RESULTS: The study population of 32 patients included 34 hips, comprising 30 hips of female patients (88.2%) and 4 hips of male patients (11.8%), with a mean age and standard deviation of 9.3 ± 3.3 months. A lower perfusion index following surgical reduction (p = 0.003) was seen in the majority (79.4%) of hips. In the remaining hips, a higher perfusion index was observed following reduction (p = 0.03). The greatest significant decreases in perfusion index were observed in the central region of the femoral head epiphysis (p = 0.002), followed by the peripheral region of the femoral head epiphysis (p = 0.03). Axial abduction was correlated with a post-reduction decrease in perfusion index (r = 0.35; p = 0.04). There was a moderately positive correlation between body mass index (BMI) and a post-reduction change in perfusion index (r = 0.45; p = 0.01).
CONCLUSIONS: There was wide variation in post-reduction changes in femoral head perfusion after surgical hip reduction and spica casting for infantile DDH, with a gradient of change across the regions of the femoral head. In addition, BMI and in-cast hip position seemed to influence perfusion changes. With continued analysis of these relationships and longer follow-up from our ongoing prospective investigation, we aim to identify the risk factors for PFGD development.
LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
中文总结
该前瞻性研究应用对比增强超声（CEUS）评估婴儿发育性髋关节发育不良（DDH）手术复位后股骨头血液灌注的变化。研究纳入32例患者共34髋，平均月龄9.3个月，女性占88.2%。CEUS在手术复位前及复位后即刻进行，通过Delta投影定量分析灌注变化。结果显示大多数髋关节（79.4%）在复位后灌注指数下降，而其余髋关节灌注指数上升。股骨头骨骺中心区域的灌注下降最为显著，其次为周围区域。轴向外展与复位后灌注指数下降呈正相关（r=0.35），体质指数与灌注变化呈中等正相关（r=0.45）。该研究提示，DDH手术复位后股骨头血液灌注存在广泛的个体变异，复位位置特别是外展角度可能是影响灌注的关键因素。这些发现为理解DDH术后股骨头坏死（现称近端股骨生长干扰）的病因提供了重要线索，并提示术中监测灌注可能有助于预防不可逆血管损伤。
英文摘要 Abstract
BACKGROUND: Long-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have been promising, but no studies to date have examined the effect of body mass index (BMI) on 10-year outcome scores and reoperation rates.
PURPOSE: To compare outcome scores and reoperation rates between normal-weight, overweight, and obese patients undergoing hip arthroscopy for FAIS at 10-year follow-up.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: Preoperative, 2-year, 5-year, and 10-year scores for patient-reported outcome measures (PROMs) in patients undergoing surgery between January 2012 and June 2014 were collected. These included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and VAS for satisfaction. Clinically significant outcomes were also collected including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Patients were stratified into the normal-weight (18.5-24.9 kg/m
RESULTS: A total of 168 patients, with a mean follow-up time of 10.3 ± 0.4 years, who underwent hip arthroscopy for FAIS were included in the study: 56 normal weight, 56 overweight, and 56 obese. While all groups had similar significant improvements in PROM scores by 10-year follow-up (all
CONCLUSION: There were significant improvements in all outcome scores across all BMI groups by 10 years after the arthroscopic treatment of FAIS. Obese patients tended to have worse PROM scores at most follow-up time points but similar magnitudes of improvement from preoperatively. Obese and overweight patients converted to THA at significantly higher rates compared with normal-weight patients.
中文总结
本研究探讨了体质指数（BMI）对股髋臼撞击综合征患者髋关节镜术后10年临床结局和再手术率的影响。研究纳入了168例于2012年1月至2014年6月间接受髋关节镜手术的患者，依据BMI分为正常体重组、超重组和肥胖组，每组各56例，平均随访时间为10.3±0.4年。评估指标包括髋关节结局评分日常生活分量表、运动分量表、改良Harris评分、iHOT-12评分、疼痛视觉模拟量表及满意度评分等患者报告结局，同时记录最小临床重要差异和可接受症状状态的达标率。结果显示，所有BMI组别患者在10年随访时各项评分均较术前显著改善，表明髋关节镜手术的长期疗效稳定。虽然肥胖患者在多数随访时点的评分略低于正常体重组，但各组间改善幅度相近，提示BMI并不影响手术的相对获益。然而，肥胖和超重患者的全髋关节置换转换率显著高于正常体重患者，表明BMI是影响关节存活时间的独立危险因素。上述发现提示，对于不同BMI患者群体，髋关节镜手术均可获得功能改善，但需重视对肥胖患者进行更高强度的术后监测和风险管理。
英文摘要 Abstract
BACKGROUND: Some studies have reported more severe chondral pathology and less successful hip arthroscopic outcomes in patients with acetabular subchondral cysts.
PURPOSE/HYPOTHESIS: The purpose of this study was to report multicenter arthroscopic outcomes of patients with and without acetabular bone cysts. It was hypothesized that patients with acetabular cysts would demonstrate inferior outcomes at minimum 2-year follow-up compared with patients without acetabular cysts.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: A multicenter matched-pair study was performed across 6 medical centers with data from a large prospectively collected database. Inclusion criteria were adult patients who had undergone primary unilateral hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The study group was defined by the presence of a superolateral acetabular subchondral cyst on preoperative imaging. A control group was matched on age; sex; body mass index (BMI); lateral center-edge angle (LCEA); alpha angle; arthroscopic treatments of femoroplasty, acetabuloplasty, and labral treatment (ie, repair, reconstruction, or debridement); Beck chondral grade; and minimum 2-year outcomes using visual analog scale (VAS) for pain, International Hip Outcome Tool-12 (iHOT-12), minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS).
RESULTS: The study included 82 patients, of whom 41 composed the study group and 41 served as matched control patients. The study group had a mean age of 42.16 ± 11.26 years with 48.78% women and a mean BMI of 26.51 ± 4.31 kg/m
CONCLUSION: Patients undergoing arthroscopic surgery for FAIS with acetabular cysts had similarly successful outcomes as patients without acetabular cysts. Acetabular subchondral cysts may not be a contraindication to hip arthroscopy in patients with FAIS who would otherwise be indicated for this surgery.
中文总结
本研究由MASH研究组开展，是一项多中心配对对照研究，旨在评估髋关节镜治疗股髋臼撞击综合征（FAIS）合并髋臼囊肿患者的临床结局，既往研究提示该类患者软骨病理改变更为严重，疗效可能欠佳。研究在6个医学中心共纳入82例患者，其中41例术前影像学证实存在髋臼上外侧软骨下囊肿，41例无囊肿患者作为配对对照，两组在年龄、性别、BMI、外侧中心边缘角、α角、软骨损伤分级及手术方式等方面均匹配良好。评估指标包括疼痛视觉模拟量表、iHOT-12评分、最小临床重要差异（MCID）、实质性临床获益（SCB）及可接受症状状态（PASS）等。结果显示，合并髋臼囊肿组与对照组的各项结局指标无显著差异，两组患者均获得了满意的手术疗效。研究结论认为，髋臼软骨下囊肿不应被视为髋关节镜治疗FAIS的禁忌证，对于符合手术指征的合并囊肿患者，关节镜手术仍可取得与无囊肿患者相当的良好预后。
英文摘要 Abstract
BACKGROUND: Previous studies have shown good mid-term outcomes of hip labral tear treatment with arthroscopy. However, long-term results are limited within the young adult population.
PURPOSE: To report survivorship and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up in young adult patients after primary hip arthroscopy with labral repair or debridement.
STUDY DESIGN: Case Series; Level of evidence, 4.
METHODS: Data were prospectively collected and retrospectively reviewed on all patients who underwent primary hip arthroscopy between June 2008 and August 2012. Young adult patients, aged >19 and <40 years, who underwent labral debridement repair or reconstruction and concomitant procedures were included. Preoperative and minimum 10-year follow-up data for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), iHOT-12 (International Hip Outcome Tool), and visual analog scale for pain (VAS-Pain) were collected. The exclusion criteria were previous ipsilateral hip surgery/conditions, Tönnis grade >1, hip dysplasia, workers' compensation status, or femoral head and acetabular Outerbridge scores of 4. Rates of achieving the minimal clinically important difference (MCID) and the patient acceptable symptomatic state (PASS), as well as hip joint survival from conversion to total hip arthroplasty and progression to subsequent ipsilateral revision hip arthroscopy, were reported.
RESULTS: Of the 241 hips eligible for analysis, 194 hips (80.5%) had a minimum 10-year follow-up. A total of 122 women (62.9%) and 72 men (37.1%) were included in the present analysis, with a mean age of 28.9 years and a mean body mass index of 24.8 kg/m
CONCLUSION: Young adults who underwent primary hip arthroscopy with labral treatment demonstrated an overall 10-year survivorship of 91.8%, significant improvements in PROMs, and high achievement rates of PASS for the mHHS and MCID for the mHHS, NAHS, and VAS-Pain.
中文总结
本研究报道了年轻成年患者接受髋关节镜下唇撕裂治疗后至少10年的假体存活率及患者报告结局指标。研究纳入了2008年6月至2012年8月期间接受初次髋关节镜手术且年龄在19至40岁之间的患者，排除既往同侧髋部手术史、Tönnis grade超过1级、髋关节发育不良、工会赔偿状态及股骨头或髋臼Outerbridge 4级软骨损伤者，最终241髋中有194髋（80.5%）完成至少10年随访。结果显示，年轻成年患者接受初次髋关节镜下唇修复或清理术后10年总体假体存活率达91.8%，所有评估的患者报告结局指标均较术前显著改善。在达到患者可接受症状状态方面，改良Harris髋关节评分的达标率较高，而改良Harris髋关节评分、非关节炎髋关节评分及疼痛视觉模拟评分的最小临床重要差异达标率同样令人满意。该研究表明，髋关节镜手术作为年轻成人髋唇损伤的治疗手段可提供持久的疼痛缓解和功能改善，具有良好的长期假体存活率。
英文摘要 Abstract
BACKGROUND: Hip arthroscopy has demonstrated favorable short- and mid-term outcomes for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD). However, long-term outcomes in patients with FAIS and BHD treated with hip arthroscopy remain understudied.
PURPOSE: To evaluate hip survivorship and patient-reported outcomes (PROs) in patients with FAIS and BHD compared with those without BHD at a minimum 10-year follow-up.
STUDY DESIGN: Cohort Study; Level of evidence, 4.
METHODS: A retrospective matched-cohort study was conducted on patients undergoing primary hip arthroscopy for FAIS by a single surgeon (2012-2024). BHD was defined as a lateral center-edge angle (LCEA) of 20° to 25°. Patients with BHD were matched 1 to 2 to controls without BHD based on age, sex, body mass index, and preoperative modified Harris Hip Score (mHHS). Radiographic parameters (eg, alpha angle, LCEA) were assessed pre- and postoperatively. PROs-including mHHS, Non-Arthritic Hip Score (NAHS), and hip survivorship (revision arthroscopy, conversion to total hip arthroplasty [THA])-were compared.
RESULTS: The study included 23 patients with BHD (mean age, 33.6 years; 69.6% women) and 46 controls (mean age, 32.7 years; 65.2% women). Both groups showed significant improvements in mHHS and NAHS at 10 years (all
CONCLUSION: At a minimum 10-year follow-up, patients with BHD who underwent hip arthroscopy for FAIS achieved comparable PROs and hip survivorship to those without BHD. These findings support the use of hip arthroscopy as a durable and effective treatment for FAIS in this population.
中文总结
本研究旨在评估合并边界型髋关节发育不良的股髋臼撞击综合征患者接受髋关节镜手术后至少10年的髋关节存活率及患者报告结局，并与无发育不良的匹配对照进行比较。边界型髋关节发育不良定义为外侧中心-边缘角在20°至25°之间。研究纳入了2012年至2024年间由同一术者完成的初次髋关节镜手术患者，按照年龄、性别、体重指数及术前改良Harris髋关节评分进行倾向性匹配，最终边界型发育不良组纳入23例患者，对照组纳入46例。结果表明，两组患者在10年随访时改良Harris髋关节评分及非关节炎髋关节评分均较术前显著改善，且组间差异无统计学显著性。髋关节存活率（以翻修手术或全髋关节置换转换为终点）在两组间也无显著差异。该研究结果支持髋关节镜手术作为合并边界型髋关节发育不良的股髋臼撞击综合征患者的有效且持久治疗手段，可实现与无发育不良患者相当的功能预后和假体存活率。
英文摘要 Abstract
BACKGROUND: Painful external snapping hip (ESH) is estimated to affect 5% to 10% of the population. Hip arthroscopy treating ESH concomitantly with femoroacetabular impingement (FAI) has shown favorable short-term outcomes.
PURPOSE: To report midterm outcomes of hip arthroscopy that concomitantly treats FAI and ESH, with a secondary comparison of these results to benchmark a control group of hips with FAI without ESH.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: Data were retrospectively analyzed for patients who underwent hip arthroscopy as treatment for FAI and iliotibial band (ITB) and gluteus maximus tendon release as treatment for painful ESH between 2008 and 2019. Patients were included if they had complete pre- and postoperative patient-reported outcomes (PROs) and visual analog scale (VAS) for pain scores with a minimum follow-up of 5 years or if they had a documented endpoint (revision surgery or conversion to arthroplasty) during the study period. Rates of revision surgery and conversion to total hip arthroplasty were included in the analysis. Patients were propensity matched to a benchmark control group of patients with FAI without ESH at a 1:4 ratio by sex, age at surgery, body mass index, acetabular Outerbridge grade, labral treatment, and capsular treatment.
RESULTS: A total of 215 hips (211 patients) were included in the study. The ESH study group showed significant improvements in all assessed PROs, with 98% of patients reporting resolution of painful external snapping at the latest follow-up, and no patient requiring revision hip arthroscopy secondary to a persistent external snapping. When compared with the benchmark control group, patients with ESH had similar preoperative outcomes for the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score Sports-Specific Subscale, 12-item International Hip Outcome Tool score, and VAS score with equivalent magnitudes of improvement. Additionally, similar postoperative scores across all PROs and patient satisfaction were met. The minimal clinically important difference and Patient Acceptable Symptom State for all evaluated PROs were met at similar rates. Similar rates of complication revision hip arthroscopy and conversion to hip arthroplasty were observed between the groups.
CONCLUSION: Primary hip arthroscopy addressing FAI and painful ESH with ITB and gluteus maximus tendon release demonstrated significant improvement in all evaluated PROs, with 98% of patients reporting resolution of external snapping, and no revision surgery due to external snapping recurrence at the minimum 5-year follow-up. Functional outcomes and rates of clinically relevant threshold achievement were comparable to those of a propensity-matched benchmark control group with FAI without ESH.
中文总结
本研究报道了关节镜同时治疗股髋臼撞击综合征合并疼痛性外部髋关节弹响的中期临床预后，并将其与仅患有股髋臼撞击综合征的倾向性匹配对照组进行比较。研究回顾性分析了2008年至2019年间接受髋关节镜手术的患者群体，术中同时进行髂胫束松解及臀大肌腱松解以治疗疼痛性外部弹响髋关节，按照性别、年龄、体重指数、髋臼Outerbridge分级、唇部处理方式及关节囊处理方式进行1:4倾向性匹配。最终研究纳入215髋（211例患者），最短随访时间为5年。结果显示，研究组在所有评估的患者报告结局指标上均较术前显著改善，98%的患者在末次随访时报告外部髋关节弹响已消失，且无患者因持续性外部弹响而需要翻修手术。与对照组相比，研究组在术前基线评分、术后评分及改善幅度上均无统计学显著差异，达到最小临床重要差异及患者可接受症状状态的比率也相当。该研究表明，髋关节镜下同时处理股髋臼撞击综合征与疼痛性外部髋关节弹响可获得满意的中期疗效，功能结局与单纯股髋臼撞击综合征患者相当。
英文摘要 Abstract
BACKGROUND: Anterolateral acetabular overcoverage, also known as acetabular retroversion, can cause femoroacetabular impingement syndrome (FAIS). Various surgical options have been suggested for treatment, ranging from anteverting periacetabular osteotomy to isolated hip arthroscopy.
PURPOSE/HYPOTHESIS: The purpose of this study was, primarily, to analyze minimum 10-year outcomes of arthroscopic management of labral pathology in the setting of acetabular retroversion without dysplasia and, secondarily, to compare their outcomes to a propensity-matched group of nonretroverted patients. It was hypothesized that the outcomes of arthroscopic management would be comparable to those of the propensity-matched nonretroverted group and comparable to previously published outcomes of open treatment of acetabular retroversion.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: Prospectively collected data were retrospectively reviewed for patients who underwent hip arthroscopy for FAIS and labral tear treatment between June 2008 and December 2013 and had a minimum of 10-year follow-up data. Retroversion was determined based on the presence of an ischial spine sign, >20% crossover sign, and posterior wall sign. Propensity score matching was used to identify a control group without retroversion who were matched 1:1 with similar age, sex, body mass index, acetabular and femoral head Outerbridge grade, preoperative lateral center-edge angle, and labral treatment.
RESULTS: A total of 95 hips with acetabular retroversion were matched to a control group. The groups were equally matched in demographic variables. Significant improvements were seen in all patient-reported outcomes (PROs) collected in both groups, with a similar survivorship of 96% in both groups; 4 patients in each group converted to a total hip replacement. The acetabular retroversion cohort achieved similarly high rates of minimal clinically important difference and Patient Acceptable Symptom State and higher rates of substantial clinical benefit for modified Harris Hip Score compared with the control group (
CONCLUSION: Patients with acetabular retroversion who had FAIS and labral tears could be safely treated using advanced hip arthroscopic techniques without reverse (anteverting) periacetabular osteotomy in a high-volume surgeon's hands. Patients with acetabular retroversion demonstrated favorable PROs and low rates of revision arthroscopy and conversion to total hip arthroplasty at long-term follow-up, which was comparable with a propensity-matched control group without acetabular retroversion.
中文总结
本研究旨在探讨不伴发育不良的髋臼后倾患者接受先进关节镜技术治疗后至少10年的长期预后，并将其与倾向性匹配的无后倾对照进行比较。髋臼后倾即前外侧髋臼过度覆盖，可导致股髋臼撞击综合征。研究纳入了2008年6月至2013年12月期间接受髋关节镜手术且有至少10年随访数据的患者，后倾的诊断依据为坐骨棘征、超过20%的交叉征及后壁征。倾向性评分匹配用于建立在年龄、性别、体重指数、髋臼及股骨头Outerbridge分级、术前外侧中心-边缘角及唇部处理方式上1:1匹配的对照组。结果显示，95髋的后倾患者与匹配对照在所有患者报告结局指标上均较术前显著改善，两组假体存活率均为96%，各有4例患者转换为全髋关节置换。后倾组在改良Harris髋关节评分的实质性临床获益达标率上甚至高于对照组。该研究表明，由高手术量术者在经验丰富的条件下，可安全地采用先进关节镜技术治疗合并髋臼后倾的股髋臼撞击综合征，无需进行反向髋臼截骨术，且长期预后与无髋臼后倾患者相当。
英文摘要 Abstract
BACKGROUND: Patient outcomes after revision hip arthroscopy are less favorable than those after primary procedures. Advancements in arthroscopic techniques including labral reconstruction and capsular plication have improved anatomic restoration of the suction seal and capsule. The effect of these techniques on outcomes remains unclear when compared with earlier techniques.
PURPOSE: To compare postoperative outcomes between patients undergoing modern revision (MR) hip arthroscopy techniques and those treated with older methods.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: A prospectively collected surgical database was reviewed for patients undergoing revision hip arthroscopy with a minimum 2-year follow-up. Patients were categorized into an older revision (OR) cohort or MR cohort based on available surgical techniques. Patients in the OR cohort did not have a capsular repair or labral reconstruction with the knotless pull-through technique, while all patients in the MR cohort had capsular closure or plication as well as labral restoration with either repair or modern reconstruction. A 1:1 age, sex, and body mass index propensity match was performed, and patient demographics along with pre- and postoperative radiographic data and outcomes were analyzed. The primary outcome was the rate of conversion to arthroplasty or revision arthroscopy at the 2-year time point. Secondary outcomes included patient-reported outcome scores (PROs) and achievement of clinically relevant outcome thresholds.
RESULTS: A total of 53 patients in the MR cohort were matched with 53 patients in the OR cohort. There were no significant preoperative demographic or radiographic differences between the 2 groups. Patients in the MR cohort had higher levels of acetabular chondral damage identified intraoperatively according to the Outerbridge and acetabular labrum articular disruption classifications (
CONCLUSION: Patients undergoing revision hip arthroscopy with modern techniques had greater postoperative PRO scores compared with revisions with older techniques. Notably, this improvement in outcomes was observed despite higher rates of cartilage damage identified intraoperatively in the modern group.
中文总结
该研究探讨了现代关节镜技术对髋关节翻修手术临床疗效的影响。研究纳入接受翻修髋关节镜手术的患者，依据手术技术分为早期翻修组和现代翻修组，现代翻修组采用labral重建和囊性修复技术以实现解剖复位和 suction seal 重建。结果显示现代翻修组患者在术后功能和患者报告结局指标上均获得显著改善，且翻修手术和全髋关节置换的转换率显著低于早期翻修组。该研究表明，Labral重建和囊性修复等现代技术可改善翻修髋关节镜的预后，为不可修复的盂唇损伤和严重软骨病变患者提供了更优的治疗策略。
英文摘要 Abstract
BACKGROUND: Labral reconstruction demonstrates promising short- and midterm benefits for irreparable labral tears, but long-term outcomes remain understudied.
PURPOSE: To evaluate minimum 10-year patient-reported outcomes (PROs) of primary arthroscopic labral reconstruction compared with a propensity-matched control group.
STUDY DESIGN: Cohort study; Level of evidence, 2.
METHODS: Data were prospectively collected for all patients who underwent primary arthroscopic labral reconstruction with allograft as treatment for femoroacetabular impingement and labral tears. Patients included had preoperative and 10-year minimum postoperative data for PROs. Patients were propensity-matched to a control group that had undergone primary labral repair in a 1:3 ratio based on age, sex, body mass index, and acetabular Outerbridge grade. Patient characteristics and PROs were reported and compared between the groups. Rates of meeting clinically relevant thresholds, secondary arthroscopy, and survivorship were also compared.
RESULTS: A total of 22 hips (22 patients) of 27 eligible hips (81%) that underwent primary labral reconstruction (RECON) were matched to 66 hips (63 patients) that underwent primary repair (REPAIR). Both groups had similar preoperative and postoperative scores for all PROs (
CONCLUSION: Primary labral reconstruction demonstrated favorable outcomes at a minimum 10-year follow-up. When compared with a propensity-matched control group that underwent primary labral repair, both groups achieved similar postoperative PRO scores. Additionally, they met clinically meaningful thresholds and underwent secondary procedures at comparable rates.
中文总结
该研究评估了关节镜下初级盂唇重建手术的10年最小随访临床结局。研究纳入因盂唇损伤接受关节镜盂唇重建的患者，以倾向性匹配的方式与接受盂唇修复的患者进行对照分析。主要评价指标包括患者报告结局评分以及是否需要二次关节镜手术或全髋关节置换转换。结果显示，盂唇重建组在10年随访时各项功能评分均显著改善，且与盂唇修复组在功能评分、临床重要差异达成率和二次手术率方面无统计学显著差异。该研究表明，关节镜盂唇重建术在长期随访中展现了良好的临床效果，可作为盂唇不可修复损伤的有效治疗选择。
英文摘要 Abstract
BACKGROUND: The fragility index has been utilized in the literature to better characterize the limited categorical interpretation of the traditional
PURPOSE/HYPOTHESIS: The purpose was to characterize the rCFI of statistically nonsignificant results in RCTs comparing capsular repair versus noncapsular repair in hip arthroscopy for the treatment of FAIS. It was hypothesized that (1) nonsignificant differences in clinical outcomes between the capsular closure and noncapsular closure groups would be statistically robust, as demonstrated by rCFI values exceeding the rate of loss to follow-up, and (2) rCFI would be greater than traditional rFI values and CFI values reported in the sports medicine literature.
STUDY DESIGN: Meta-analysis; Level of evidence, 2Methods:The PubMed, Cochrane, and Embase databases were queried from inception to October 2024 with combinations of the following search terms: "hip arthroscopy," "capsule, "capsular," and "randomized controlled trials." Studies were included if they were randomized trials that compared capsular closure with nonclosure and had at least 1 nonsignificant outcome reported. The rCFI calculation was performed on primary nonsignificant outcomes across all studies to obtain a mean rCFI. Multivariate linear regression was performed to determine study characteristics and variables associated with higher rCFI values.
RESULTS: Six studies with 416 patients were included in this analysis. A total of 136 outcomes with nonsignificant results were identified across 6 studies, with 6 of these outcomes representing each study's primary outcome. The mean rCFI across all studies was 16.333 (SD, 6.121). A mean of 11.03% (SD, 5.79%) of patients were lost to follow-up. The rCFI exceeded the number of patients lost to follow-up for all analyzed studies. Multivariate regression showed that sample size was significantly predictive of high rCFI (
CONCLUSION: Provisional assessment of rCFI suggests that the nonsignificant differences reported by RCTs comparing hip capsular closure versus nonclosure after interportal capsulotomies are relatively robust. Increased sample sizes in RCTs are associated with greater robustness of nonsignificant results.
中文总结
该研究采用反向连续脆弱性指数对髋关节镜手术中囊膜闭合与未闭合的随机对照试验进行统计分析。脆弱性指数是评估临床试验结果稳健性的重要指标，研究者计算了各研究中非显著性结局的反向连续脆弱性指数值，并分析其与失访率的关系。结果显示，所有分析研究的反向连续脆弱性指数均超过失访患者数量，表明在髋关节镜中比较囊膜闭合与未闭合的临床研究结果具有良好的统计稳健性。该研究为临床医生在解读相关文献时提供了方法学参考，并强调了充分随访在髋关节镜临床研究中的重要性。
英文摘要 Abstract
BACKGROUND: Age has been shown to play a role in patient outcomes after hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS), but little is known regarding this relationship in the population with borderline dysplasia.
PURPOSE: To compare patient outcomes and reoperation rates in patients aged ≥40 years and <40 years with borderline hip dysplasia (BHD) undergoing hip arthroscopy for FAIS at 2- and 5-year follow-up.
STUDY DESIGN: Cohort study; Level of evidence, 3.
METHODS: Patient-reported outcomes (PROs) were acquired preoperatively and at 2 and 5 years postoperatively for patients undergoing surgery between January 2012 and June 2019. PROs included the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale (HOS-SS), modified Harris Hip Score, and visual analog scale for pain and satisfaction. Clinically significant outcomes included the minimal clinically important difference and Patient Acceptable Symptom State (PASS). Patients diagnosed with BHD (lateral central-edge angle, 18°-25°) were stratified into cohorts ≥40 and <40 years old. Older patients were propensity matched 1:1 to younger patients controlling for sex, body mass index (BMI), and acetabular cartilage grade. PROs, clinically significant outcomes, and survivorship were compared between groups.
RESULTS: Ninety-three patients aged ≥40 years with BHD (mean ± SD age, 48.4 ± 5.7 years; 68.8% female; BMI, 26.6 ± 5.3 kg/m
CONCLUSION: This study concludes that patients with BHD aged ≥40 years treated with contemporary hip arthroscopy for FAIS achieved similar function, pain, and satisfaction at 5-year follow-up but worse sports function and sports-related PASS achievement when compared with patients with BHD aged <40 years. Furthermore, while patients ≥40 years old had a higher rate of total hip arthroplasty conversion, they demonstrated similar overall reoperation rates as compared with younger patients at 5 years.
中文总结
该研究比较了40岁及以上与40岁以下边缘发育不良患者接受髋关节镜治疗股髋撞击综合征的临床结局。研究纳入了接受初次髋关节镜手术的边缘发育不良患者，依据年龄进行分组并通过倾向性评分匹配控制混杂因素。主要评价指标包括患者报告结局评分、临床重要差异达成率以及再次手术率。结果显示，两组患者在术后功能和疼痛改善方面无显著差异，但40岁及以上组在运动功能评分和运动相关PASS达成率方面表现较差。此外，老年组全髋关节置换转换率较高，但总体再手术率相似。该研究表明年龄因素对边缘发育不良患者髋关节镜预后有一定影响，但并非手术禁忌证。