To evaluate midterm patient-reported outcomes (PROs) and rates of return to sports of bilateral primary hip arthroscopy in high-level athletic populations with minimum 5-year follow-up and to compare outcomes with a propensity-matched control group of high-level athletic populations undergoing unilateral primary hip arthroscopy. Data were analyzed for high-level athletic populations (high school, college, or professional) who underwent bilateral hip arthroscopy between July 2009 and January 2019. Patients were included if they had at least one of these PROs at minimum 5-year follow-up: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score, International Hip Outcome Tool-12, Hip Outcome Score-Sports Specific Subscale, and Visual Analog Scale for pain. Patients were matched 1:1 to unilateral athletes. Rates of achieving the minimal clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit were compared. Forty-six bilateral athletes were matched to 46 unilateral athletes. The mean follow-up of the bilateral group (second side) is 90.1 ± 28.8 (60.0-130.2) months and 91.4 ± 30.9 (12.3-136.7) for the unilateral group. All groups showed significant PRO improvement. 84.4% of the bilateral first side achieved mHHS minimal clinically important difference, 78.3% of the second side, and 83.3% of the unilateral group (P = .716). 73.3% of the bilateral first side achieved mHHS patient acceptable symptomatic state, 78.3% of the second side, and 85.7% of the unilateral group (P = .364). 57.8% of the bilateral first side achieved mHHS substantial clinical benefit, 60.9% of the bilateral second side, and 76.2% of the unilateral group (P = .160). Bilateral and unilateral athletes returned to sport at a high rate (88.6% and 85.0%). 80.0% of unilateral and 68.8% of bilateral athletes were playing their sport at minimum 5-year follow-up (P = .31). Seven (15.2%) unilateral athletes underwent ipsilateral secondary arthroscopy. Seven bilateral first side patients (15.2%) and 1 bilateral second side patient (2.2%) underwent ipsilateral secondary arthroscopy. Athletes undergoing staged bilateral hip arthroscopy showed favorable return to sports rates, continuation of sports and PROs at minimum 5-year follow-up. These results were comparable with the matched benchmark control group who underwent unilateral hip arthroscopy. Level III, retrospective comparative case series.
To compare the scientific rigor of Beighton Scoring System (BSS) use in generalized joint hypermobility (JH) studies (healthy subject injury risk/rate, physiological or kinesiological function determination) and joint-specific or arthroscopy JH studies; to identify the most commonly used BSS score thresholds; and to describe ways to improve BSS score use for improved surgical and clinical decision-making. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, the PubMed, EBSCO Host, and Web of Science databases were searched using "Beighton score" and "sports injury outcome" terms. Study purpose, publication year, female or male subject number, age and group type, measurement tools, BSS criteria, results, and conclusions data were extracted. Twenty-eight generalized JH studies (43.8%, 28/64) involving 12,138 subjects (6512 females) and 36 joint-specific or arthroscopy JH studies (56.3%, 36/64) involving 7351 subjects (3441 females) were identified. Overall, most studies reported that BSS scores influenced most/all (54.7%, n = 35/64) or some (26.6%, 17/64) study outcomes and most were Evidence Level II (57.8%, n = 37/64) or III (35.9%, n = 23/64). Most generalized JH studies used a BSS score ≥4 (n = 13, 46.4%) or BSS ≥5 (n = 7, 25%) while most joint-specific or arthroscopy JH studies used a BSS score ≥4 (n = 17, 47.2%), a BSS score ≥5 (n = 9, 25%), or the full BSS score scale (n = 7, 19.4%). Joint-specific and arthroscopy JH studies were more recently published (2020.2 ± 3.5 vs 2014.2 ± 6.8, P < .001). Generalized JH studies more frequently reported separate subject sex and age data (53.6%, n = 15/28) while joint-specific or arthroscopy JH studies more often combined this information (92.7%, 33/36) (P = .001). Most generalized JH studies were Evidence Level II (85.7%, 24/28) while most joint-specific or arthroscopy JH studies were Evidence Level III (52.8%, 19/36) (P < .001). Group study quality and bias risk was comparable; however, generalized JH studies had more prospective research designs (96.4%, 27/28 vs 58.3%, 21/36 (P < .001). Generalized JH studies had more prospective research designs, had higher evidence levels, and more frequently reported separate subject age and sex details. Greater use of these characteristics in joint-specific or arthroscopy JH studies may strengthen surgical and clinical decision-making and patient outcome prediction validity. Level IV, narrative review of Level I to IV studies.
Wrist arthroscopy has significantly advanced the diagnosis and treatment of various wrist pathologies, offering minimally invasive alternatives to traditional open surgery. However, the procedure is not without its complications.This study aims to analyze the incidence, nature, and management of complications in a consecutive series of 358 wrist arthroscopy procedures performed by a single surgeon at a dedicated center. This retrospective study included 358 patients who underwent wrist arthroscopy between January 2012 and January 2022. Data were extracted from clinical archives, including intraoperative video recordings and patient files. Complications were identified and analyzed using descriptive statistics. Out of 358 cases, 16 complications were identified, resulting in an incidence rate of 4.46%. The most common complication was iatrogenic chondral damage, observed in 10 patients, primarily occurring in the first year of the study period. Other complications included tendon irritation, nerve injuries, and technical errors during specific procedures such as dorsal capsulodesis and 4-Corner Fusion. No cases of compartment syndrome were reported. Wrist arthroscopy, while generally safe and effective, carries a risk of complications that can be mitigated with experience and adherence to meticulous surgical techniques. The study highlights the spectrum of complications encountered during wrist arthroscopy and emphasizes the importance of awareness and appropriate management of these events in clinical practice. Future prospective studies with larger sample sizes are needed to validate these findings and further refine the safety protocols for wrist arthroscopy.
With the rapid expansion of hip arthroscopy, total hip arthroplasty (THA) following prior arthroscopic intervention is becoming an increasingly common clinical scenario. Yet the literature remains divided on whether the prior arthroscopy meaningfully degrades arthroplasty outcomes. Most patient-reported outcome data trend toward equivalence, while the largest and most recent matched and database studies consistently showed higher rates of dislocation, reoperation, and revision in the prior-arthroscopy cohort. Two patient subgroups warrant particular caution: those converting to THA within 1 year of arthroscopy and those proceeding to THA with minimal radiographic arthritis (Tönnis 0-1). In both groups, THA is more likely to disappoint because the pain generator may not be the joint at all. I argue that THA after failed hip arthroscopy should be a deliberate, evidence-supported decision, not a default endpoint, and that the diagnostic burden before arthroplasty should be raised, not lowered, in patients without clear radiographic disease.
The relationship between early postoperative pain and long-term outcomes after hip arthroscopy is unclear. This study examined whether 2-week postoperative pain scores are associated with 2-year patient-reported outcomes (PROs) after hip arthroscopy and compared outcomes between patients with and without early postoperative pain improvement. Patients undergoing hip arthroscopy for labral tear and/or femoroacetabular impingement syndrome were retrospectively identified from a prospectively enrolled registry. Patients completed baseline, 2-week, and 2-year surveys. Patient-reported outcomes measurement information system (PROMIS) pain interference (PI) assessed pain. Early improvement was defined as a change in PROMIS PI score relative to the minimal clinically important difference threshold of ± 3.1 points from baseline at 2 weeks postoperatively. Patient characteristics and PROs were compared between groups by early improvement status. Of 136 patients, 95 (71%) completed 2-week follow-up, and 70 of 95 (74%) completed 2-year. Improved early PROMIS PI was associated with worse baseline PROMIS Physical Function (p < .001) and PROMIS PI (p < .001), and better 2-week PROs across nearly all outcomes. Worse 2-week PROMIS PI scores correlated with worse 2-year PROMIS PI (p = .02), Fatigue (p = .02), and Anxiety (p = .002). On multivariable analysis, improved 2-week PROMIS PI was independently associated with better 2-year PROMIS PI, Marx Activity Rating Scale, and greater improvement in PROMIS PI. Early improvement in PROMIS PI after hip arthroscopy was independently associated with better 2-year pain and activity outcomes. Patients with improved early postoperative pain had worse baseline pain and function but better early postoperative PROs. 2-week PROMIS PI may serve as a useful prognostic indicator for 2-year PROs after hip arthroscopy.
Shoulder arthroscopy is among the most commonly performed orthopedic procedures. The interscalene brachial plexus (ISB) block is long regarded as the gold standard regional technique for the procedure despite its complications. Ultrasound-guided pericapsular nerve group (PENG) block is now being investigated for shoulder procedures. The present study aimed to compare the clinical outcomes between ultrasound-guided PENG and ISB blocks in the setting of shoulder arthroscopy. The present randomized study was conducted on 50 patients scheduled for elective unilateral shoulder arthroscopy under general anesthesia. They were randomly and equally allocated to one of the study interventions [ISB (n = 25) or PENG (n = 25) blocks] under ultrasound guidance. All outcome assessors were blinded to the allocated interventions. No significant differences were noted between the studied groups regarding postoperative heart rate, mean arterial blood pressure and postoperative pain at different assessment intervals. Also, no significant differences were found between the studied groups regarding the frequency of patients requiring pethidine, total 24-h pethidine dose (106.0 ± 30.0 mg versus 94.0 ± 30.0, p = 0.16) and time to first pethidine request (9.1 ± 1.4 h versus 9.7 ± 1.2, p = 0.11). It was noted that PENG block group had significantly lower frequency of phrenic nerve palsy (0% versus 24.0%, p = 0.022) and paresthesia in the arm (12.0% versus 36.0%, p = 0.047). The present study concludes that the ultrasound-guided PENG block can provide effective management of postoperative pain following shoulder arthroscopy. Importantly, the PENG block offers this benefit with adequate safety profile. The present study protocol was registered at clinicaltrails.gov (Registration number: NCT06235879; Date: February 1, 2024).
To investigate outcomes among patients undergoing total hip arthroplasty after hip arthroscopy (HA-THA) compared with a matched cohort undergoing primary THA without prior arthroscopy (Only-THA). Patients who underwent THA after primary hip arthroscopic labral repair from 2009 to 2022 at a single institution were identified. Cases were propensity-matched 1:4 to primary THA controls by age at THA, sex, body mass index (BMI), surgical approach, and year of surgery. At minimum 2-year follow-up, patient-reported outcomes (PROs)-Forgotten Joint Score (FJS), modified Harris Hip Score (mHHS), and Hip Disability and Osteoarthritis Outcome Score Pain (HOOS-Pain)-were analyzed. Sixty-two hips (age: 47.5 ± 9.3 years, BMI: 29.7 ± 6.2 kg/m2) were matched to 248 Only-THA hips (age: 47.9 ± 10 years, BMI: 29.5 ± 5.8 kg/m2). Although both HA-THA and Only-THA patients showed significant (P < .001) postoperative improvements in PROs, HA-THA patients reported significantly lower postoperative FJS, mHHS, HOOS-Pain, and inferior Visual Analog Scale pain scores (P < .001) compared with Only-THA controls. A cohort-specific minimal clinical important difference for mHHS was calculated as 9.6 points, with 75.7% of HA-THA and 87.5% Only-THA patients achieving this threshold (P = . 077). At mean 6.6 ± 3.3 years follow-up, HA-THA patients with preoperative Tönnis grades 1 reported significantly decreased FJS, mHHS, and HOOS-Pain compared with HA-THA patients with preoperative Tönnis grade 2-3 (P ≤ .05). HA-THA patients with Tönnis grade 1 also exhibited worse PROs (P < .001) compared with Only-THA controls. Although there were no differences in complication rates between HA-THA and Only-THA patients (8% vs. 5%, P = .49), all-cause reoperation was greater amongst HA-THA (10% vs. 2%, P = .01). Patients undergoing THA after prior hip arthroscopy showed modestly inferior subjective outcomes at mid-term follow up compared with an age-matched cohort without prior arthroscopy. Although both groups showed meaningful improvement, a smaller proportion of HA-THA patients achieved the cohort-specific MCID for mHHS compared with Only-THA controls. Level III, retrospective cohort study.
There is a paucity of literature investigating the impact of cannabis usage on functional outcomes after primary hip arthroscopy surgery to treat symptomatic labral tears. To compare patient-reported outcome measures (PROM) for hip arthroscopy patients who did and did not self-report cannabis use, understand how frequency of cannabis use correlates to PROMs, and compare rates of achieving clinically meaningful outcomes for both cohorts. Cohort study; Level of evidence, 3. This was a matched-control cohort study of patients who underwent primary hip arthroscopy for symptomatic labral tears. Included patients were ≥18 years old and completed baseline and 2-year postoperative outcomes surveys. Excluded patients had missing follow-up data, previous ipsilateral hip surgery or revision surgery, and/or hip dysplasia (lateral center-edge angle ≤20°). Patients were retrospectively divided into 2 groups based on whether they were cannabis naive (CN) or cannabis users by reviewing their social history. The 2 groups were then propensity-matched 1:1 by age, sex, body mass index, and Tönnis grade. PROMs were collected prospectively at baseline and 2 years postoperatively. These included the modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Specific Subscale, 33-item International Hip Outcome Tool, Lower Extremity Functional Score, and RAND-36 pain subscale (Pain). In total, 68 patients were included (aged 31.4 ± 9.67 years). Of these, 34 patients had self-reported cannabis use, and 34 did not report use. All PROM scales were similar at baseline (P > .05). Cannabis use was not a predictor of functional outcomes at any time point, including the 2-year follow-up for all PROM scales (P > .05); however, the improvement in Pain scores was significantly better in the CN cohort from baseline to the 2-year follow-up (27.3 ± 28.8 vs 11.6 ± 19.0, P = .012). A linear regression model adjusting for cannabis use frequency found pain scores worsened with increased usage (adjusted mean difference, -2.68; 95% CI, -5.12 to -0.25; P = .031). Further analysis showed no differences in achieving minimal clinically important difference, patient acceptable symptom state, or substantial clinical benefit (P > .05). Self-reported cannabis usage has no impact on raw functional outcomes after hip arthroscopy, but increased usage correlates with worse pain symptoms.
Magnetic resonance arthrography (MRa) is considered superior to magnetic resonance imaging (MRI) in detecting glenoid labral pathology, although both are used in clinical practice with varying accuracy. Diagnostic arthroscopy remains the gold standard. In the pediatric and young adult population, limited data exist comparing MRa/MRI to arthroscopy in detecting superior labrum anterior and posterior (SLAP) lesions in cases of shoulder instability. To evaluate the effectiveness of MRa/MRI in identifying various labral pathologies in a pediatric and young adult population with shoulder instability. Cohort study (Diagnosis); Level of evidence, 2. Patients who underwent shoulder stabilization surgery with MRa/MRI obtained prior to surgery were retrospectively reviewed. Lesions identified on imaging reports were compared to arthroscopic findings used as the gold standard, and sensitivity and specificity were calculated for both MRI and MRa for anterior, posterior, and SLAP lesions. The percentage of time the imaging report was fully correct in identifying the integrity of the glenoid labrum in all 3 regions was calculated. A total of 340 cases met inclusion criteria (297 MRa, 43 MRI). The mean age at surgery was 16.9 ± 1.8 years. There were no statistically significant differences between MRI and MRa in the anterior, posterior, or SLAP lesion groups. The imaging report was correct in fully diagnosing the integrity of the glenoid labrum in all 3 regions 63% of the time. There is no significant difference between MRa and MRI in detecting anterior, posterior, or SLAP lesions in the pediatric/young adult population. Imaging fails to fully diagnose the integrity of the labrum 37% of the time, and caution should be taken when interpreting imaging reports prior to diagnostic arthroscopy.
Background/Objectives: Hip arthroscopy is a minimally invasive procedure with rare complications that can occur due to air entry outside the joint space. Case Presentation: A 19-year-old patient underwent right hip arthroscopy with attempted joint venting. The next morning, she had pain in her right leg, neck, and chest with paresthesias over her hands and feet. A subsequent emergency department physical exam revealed crepitation of the lower extremities, abdomen, chest, and neck caused by air entrance during arthroscopy. The patient also reported blurred near vision. Additionally, the pupils were fixed, did not accommodate, and were dilated at 7 mm. Computed tomography scans revealed subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, and cervicofacial emphysema. Magnetic resonance imaging of the brain revealed a Chiari I malformation. The patient received four hyperbaric oxygen treatments. By the fourth treatment, near visual acuity had improved, but far visual acuity had worsened. Vision had returned to normal eight days after discharge. Conclusions: It is proposed that the patient's reduced near vision, accommodation paralysis, and fixed and dilated pupils were brought about by pneumomediastinum and cervicofacial emphysema, inhibiting the ability of the pupils to constrict, causing bilateral mydriasis and accommodation paralysis for near targets. Additionally, the subsequent transient myopic shift is a known complication of hyperbaric oxygen therapy, which increases the refractive index of the crystalline lens.
To describe the surgical technique and early operative outcomes of using a provisional dynamic external fixator to facilitate arthroscopic-assisted reduction of complex tibial plateau fractures. Between 2014 and 2024, we conducted a retrospective single-center case series of Schatzker IV-VI tibial plateau fractures treated with provisional dynamic external fixation and arthroscopy-assisted circular frame fixation, with a minimum 1-year follow-up. The dynamic fixator permitted knee flexion during definitive surgery, facilitating arthroscopic reduction. Collected variables included perioperative metrics, hospitalization course, 1-year radiographic outcomes, complications, time to union, and knee range of motion. Eleven patients met criteria and were predominantly healthy middle-aged (mean 46.27 years) men (78%). Continuous passive motion began immediately after provisional fixation. Median operative time was 1 hour and 17 minutes for the dynamic frame and 3 hours and 4 minutes for the arthroscopy-assisted definitive procedure, with low estimated blood loss at both stages (median 5 to 25 mL). Definitive fixation occurred a median of 5 days after injury; median hospital stay was 12 days; 83% were discharged home. At 1 year, mean articular depression was 2.25 mm, condylar widening 0.25 mm, and angulation of 4.46°; the median Rasmussen score was 12. Median time to union was 13 weeks and 3 months for full weight-bearing. After 1 year, range of motion was 0° to 115° on average. Complications within 1 year, included infection in 5/11 (45%)-4 pin-site infections treated with oral antibiotics, and 1 deep infection requiring debridement, foot drop 1/11 (9%) and chronic pain 1/11 (9%); no revision surgeries occurred. This case series shows that provisional fixation with a dynamic hinged external fixator for complex tibial plateau fractures permitted knee motion during the interval before definitive surgery and preserved access for arthroscopy-assisted reduction without requiring frame removal. At 1 year, radiographic outcomes were good, knee range of motion was near full, and there was a low rate of serious complications. Level IV, retrospective therapeutic case series.
Hip arthroscopy (HAS) is technically demanding, and surgeon's experience may influence outcomes. However, the magnitude and domain-specific effects of the learning curve remain unclear. A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in PROSPERO (CRD420251185937). PubMed/MEDLINE, Embase and Scopus were searched through 31 December 2025 for studies comparing early versus late experience phases in HAS. Random-effects meta-analyses (Sidik-Jonkman estimator with Hartung-Knapp adjustment) were performed for operative and traction time, patient-reported outcomes, complications, revision arthroscopy and conversion to total hip arthroplasty (THA). Risk of bias was assessed using ROBINS-I and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Eighteen studies (2624 procedures; 1291 early and 1333 late cases) were included. Late cases showed significantly shorter operative time (-31.77 min; 95% confidence interval [CI] -51.40 to -12.14) and traction time (-15.67 min; 95% CI -25.42 to -5.92), with substantial heterogeneity. Functional outcomes favoured late experience, including higher improvement in minimal clinically important difference units (0.58; 95% CI 0.17 to 0.99) and modest gains in modified Harris Hip Score (2.78 points; 95% CI 0.16 to 5.41) and Non-Arthritic Hip Score (8.41 points; 95% CI 1.99 to 14.83). Complication rates and revision arthroscopy did not differ significantly, whereas conversion to THA was lower in late cases (odds ratio [OR] 0.10; 95% CI 0.01 to 0.98). Most studies were at moderate to serious risk of bias, and certainty of evidence was low to very low. Surgeon experience in HAS is associated with improved operative efficiency and modest functional gains, while safety outcomes remain largely unchanged. The lower THA conversion rate in late cases may reflect improved patient selection and decision-making, although confidence is limited by study design and heterogeneity. Level III, systematic review and meta-analysis of predominantly retrospective cohort studies.
OBJECTIVE: To evaluate a 3-month post-hip arthroscopy rehabilitation program within a randomized controlled trial comparing hip arthroscopy to sham surgery for femoroacetabular impingement syndrome (HIP ARThroscopy International [HIPARTI] trial) by describing exercise adherence, type, and pain; 6-month changes in International Hip Outcome Tool-33 (iHOT-33); and physical impairments and functional performance. DESIGN: Exploratory cohort study nested in a pilot randomized controlled trial. METHODS: Participants aged 18 to 50 years with femoroacetabular impingement syndrome completed a 3-month, physical therapist-led, postsurgical rehabilitation program, self-reporting rehabilitation adherence and pain levels on the visual analog scale using weekly training diaries. Baseline to 6-month changes in quality of life (iHOT-33), physical impairment (hip strength, range of motion [ROM]), and functional performance (single-leg hop, side bridge endurance) were reported as mean (standard deviation). RESULTS: Twenty-nine people (37% female, 29.9 ± 7.9 years) participated. Hip extension, abduction, and functional exercises were performed most often. Exercise adherence analysis was limited by underreporting. Training diary data adequate to assess adherence were available for 20 participants (69%). Among those with available data, 16 (80%) met the predefined adherence target of ≥2 sessions per week, and average pain remained acceptable (<2 visual analog scale); iHOT-33 (+18.6 ± 22.5; 95% confidence interval: 10.2, 27.0) and hip flexion ROM (+6°; 95% confidence interval: 2.14, 9.60) improved significantly. Hip extension, adduction, external and internal rotation strength improvements exceeded the minimal detectable change, although they were not significant. CONCLUSION: Adherence was generally high among participants with available data, though limited by underreporting. Hip-related quality of life (iHOT-33) improved despite limited changes in physical impairments, and no improvement in functional performance. J Orthop Sports Phys Ther 2026;56(7):456-464. Epub 23 April 2026. doi:10.2519/jospt.2026.13775.
To compare clinical outcomes following hip arthroscopy for femoroacetabular impingement syndrome using either limited interportal (IP) or T-capsulotomy (TC) technique, with routine capsular closure. This retrospective cohort study included patients ≤50 years old who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between May 2021 and January 2024 with a minimum of 12-month follow-up. Patients were treated with either IP or TC, and all underwent standardized capsular repair. Patient-reported outcomes (PROs) were collected preoperatively and at final follow-up. Cohort-specific minimum clinically important difference thresholds were calculated for each PROs and compared between groups. Improvements in scores were compared with established thresholds for the patient acceptable symptomatic state (PASS). Statistical significance was set at P < .05. A total of 116 patients met the inclusion criteria (54 IP, 62 TC; mean age 34.5 ± 8.8 years; 55% female). Mean follow-up was 15.5 ± 5.4 months. Both groups showed significant improvements in all PROs. Although mean improvements were not statistically different, the interportal group showed consistently higher average postoperative scores. Cohort-specific minimum clinically important difference thresholds were achieved at similar rates in both groups, whereas exploratory analyses using previously published PASS thresholds showed higher PASS achievement in the interportal group for International Hip Outcomes Tool (76% vs 54%) and Patient Reported Outcome Measurement Information System Physical Function (58% vs 46%). No revisions or Clavien-Dindo grade ≥2 complications occurred in either group. Both IP and TC techniques led to significant improvements in PROs following hip arthroscopy with capsular repair, with similar rates of cohort-specific minimum clinically important difference achievement and no differences in revision surgery or major complications. Exploratory analyses showed higher PASS rates for International Hip Outcomes Tool and Patient Reported Outcome Measurement Information System Physical Function in the IP group, suggesting that a more limited capsulotomy may confer functional advantages. Level III, retrospective comparative case series.
Hip arthroscopy is technically demanding, with complications concentrated among inexperienced surgeons and limited structured opportunities for pre-clinical skill acquisition. This pilot study quantified changes in objective simulator performance after a two-day non-immersive virtual reality training programme. 15 male orthopaedic residents (PGY1-PGY3) at a single academic centre, none with prior hip arthroscopy or simulator experience, completed a 12-min baseline assessment on the simulator, two days of training (one hour Fundamentals of Arthroscopic Surgical Training plus one hour hip-specific) using different cases, and an identical post-training assessment. Five simulator-derived metrics were analysed: targets attained, time per target, camera-tissue collisions, femoral head scratches, and probe steadiness. Wilcoxon signed-rank tests with Bonferroni correction (α = 0.01) and effect sizes (r) were applied. All 15 participants completed training. Significant improvement occurred across all five metrics with very large effect sizes (r = 0.88-0.89) surviving Bonferroni correction. Median targets attained increased from 1.0 to 4.0 (of 12; p < 0.001); time per target decreased 50% (n = 11; p = 0.003); collisions decreased 42% (p < 0.001); scratches decreased 50% (p < 0.001); probe steadiness increased from 9 to 37% (p < 0.001). Every participant improved on every paired metric. A two-day non-immersive virtual reality training programme produced consistent improvement in simulator performance across efficiency, precision, and safety-related domains, with every participant improving. These findings support further evaluation of brief simulator-based training as an adjunct to early orthopaedic training, pending assessment of retention and operative transfer.
Pneumatic tourniquets improve surgical visualization during knee arthroscopy, but fixed high pressures may increase postoperative pain. This study investigated whether a minimal effective individualized occlusion pressure (MEIOP), calculated as limb occlusion pressure plus a safety margin, maintains surgical field quality while reducing pain compared to a standardized occlusion pressure (SOP). A preliminary survey of 79 orthopaedic surgeons identified 350 mmHg as the routine SOP. In a subsequent double-blind randomized clinical trial, patients undergoing elective knee arthroscopy were assigned to SOP (350 mmHg) or MEIOP, defined as Doppler-derived limb occlusion pressure plus a safety margin (mean ≈ 230 mmHg). Outcomes included surgical field quality, postoperative using a visual analog scale (VAS) up to 15 days, overall 15-day pain perception, and analgesic consumption. Both groups achieved 100% excellent surgical field ratings. Pain trajectories differed significantly between groups over time (group × time interaction, p = 0.022). The MEIOP group experienced significantly lower pain at discharge (~ 6 h; p = 0.013, d = 1.14) and lower overall 15-day pain perception (p = 0.043, d = 0.89). Analgesic consumption showed a consistent descriptive trend favoring MEIOP throughout follow-up. This proof-of-concept study suggests that individualizing tourniquet pressure using predefined MEIOP protocol preserves satisfactory surgical visualization and is associate with lower postoperative pain compared with a standard high-pressure protocol. This trial was prospectively registered at the Brazilian Clinical Trials Registry (ReBEC; RBR-4xd6cxm).
Labral reconstruction has become an essential technique for treating irreparable acetabular labral pathology. While both segmental and circumferential reconstruction techniques are utilized, it remains unclear whether one provides superior clinical outcomes. To compare patient-reported outcomes, complications, and reoperation rates between segmental and circumferential labral reconstruction. Meta-analysis. A systematic review of the PubMed, Embase, and Scopus databases was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on February 2, 2025. Studies were included if they reported clinical outcomes after arthroscopic hip labral reconstruction using either segmental or circumferential techniques. Data were extracted on patient characteristics, surgical details, patient-reported outcome measures, complications, revision arthroscopy, and conversion to total hip arthroplasty (THA). Meta-analyses were performed using random-effects models, and heterogeneity was assessed using the I2 statistic. A total of 28 studies consisting of 1817 hips were included, with 1086 undergoing segmental and 731 undergoing circumferential reconstruction. Patient characteristics were similar between groups, except for a lower proportion of women in the segmental cohort than circumferential cohort (44.6% vs 73.2%; P < .001). Both techniques resulted in significant improvements in all patient-reported outcomes, including the Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports, International Hip Outcome Tool-12 score, Short Form-12 score, and visual analog scale pain score, with no significant differences between groups (all P > .05). Complication rates and revision rates were comparable (P = .05 and P = .06, respectively). However, circumferential reconstruction was associated with a significantly lower conversion to THA compared with segmental reconstruction (P = .01). Both segmental and circumferential labral reconstruction techniques provide significant and comparable improvements in functional outcomes and pain. Circumferential reconstruction was associated with a lower pooled rate of conversion to THA; however, causality cannot be inferred given the heterogeneity, nonrandomized design, and differences in follow-up duration between studies.
Interscalene brachial plexus block (ISB) is commonly used for shoulder surgery and is associated with predictable complications such as phrenic nerve palsy due to its proximity to adjacent neural structures. While the spread of local anesthetic may involve the recurrent laryngeal nerve, resulting in vocal cord dysfunction, which is uncommon, progression to bilateral vocal cord paralysis, causing acute airway obstruction, is exceedingly rare. A 74-year-old obese female underwent elective outpatient right shoulder arthroscopy under ultrasound-guided interscalene block with bupivacaine. Within hours postoperatively, she developed progressive respiratory distress. Despite high-flow oxygen and bag-valve-mask ventilation, oxygen saturation declined into the 60s with marked resistance to ventilation. Emergent intubation resulted in immediate improvement. Point-of-care ultrasound demonstrated diffuse B-lines without right heart strain, and imaging confirmed pulmonary edema. Workup did not reveal a primary pulmonary or obstructive cardiac etiology; however, troponin elevation consistent with type 2 myocardial infarction was identified. The patient improved rapidly with ventilatory support and diuresis, was extubated within 48 hours, and was discharged without recurrence. This case demonstrates a rare complication of ISB involving sequential spread of local anesthetic, potentially facilitated by arthroscopic fluid extravasation, leading to phrenic nerve involvement and bilateral recurrent laryngeal nerve dysfunction. Resultant airway obstruction caused negative pressure pulmonary edema and secondary demand ischemia. Resistance to ventilation and refractory hypoxemia after ISB should raise concern for upper airway obstruction. Early airway management is critical to improve outcomes.
Capsulolabral adhesions are a common cause of revision hip arthroscopy. Recent evidence suggests a rehabilitation protocol emphasizing early range of motion and circumduction supplemented by oral losartan may be beneficial to prevent adhesion formation. Despite best efforts, adhesions may still form and are often associated with labral pathology. The present technique shows the mechanism by which adhesions elicit labral pathology. Additionally, we share the senior author's preferred method for lysis of adhesions.
Outcome reporting in sports medicine has become increasingly sophisticated, yet sophistication alone does not ensure clinical usefulness. The value, or utility, of an outcome measure lies in its ability to inform patient expectations, shared decision-making, and treatment selection. This limitation is particularly evident in the reporting of return-to-sport (RTS) outcomes. Differences in RTS definitions can yield substantially different reported success rates without reflecting true differences in surgical effectiveness. For example, defining RTS as return to preinjury competitive level produces markedly lower rates than broader definitions based on any attempted participation. The critical issue is not which definition yields higher RTS rates but which provides greater decision-making utility for athletes. Because RTS is highly susceptible to external, nonmedical influences, standardized definitions and careful interpretation are essential for meaningful comparison and clinical relevance.