详解：
Kollmorgen等人在《Arthroscopy》发表的这篇文献评论，系统梳理了髋关节镜联合骼白周围截骨术（PAO）治疗骼关节发育不良的现有证据。作者指出，PAO作为一种保骼手术已有超过40年的临床应用历史，而骼关节镜技术的发展则为肛骼关节内的保骼手术带来了革命性变化。将这两种手术结合应用于发育不良和边界性发育不良患者，是当前骼关节保骼外科领域深受关注且存在争议的话题。作者分析了多项研究数据后发现，联合手术在临床上已显示出足够的安全性，并能改善患者的预后结果。然而，当前文献存在明显的异质性，包括不同研究的人群特征、手术技术、随访时间以及结局指标的差异，使得临床决策变得复杂。作者特别强调，临床医生必须准确识别患者是否同时存在冲击症状和发育不良的结构性问题，这一识别对于选择合适的手术策略至关重要。对于同时存在冲击和发育不良的患者，单纯PAO可能无法解决肛骼关节内的软骨损伤问题，而单纯骼关节镜手术又无法矫正骼白的解剖异常。因此，联合手术在理论上具有明显优势，但仍需要更多高质量的前瞻性研究来明确最佳适应证和手术时机。
详解：
Ellsworth在《Clinical Orthopaedics and Related Research》发表的这篇CORR Insights，是对Jochl等人同期发表的PAO后应力骨折研究的专业评论。作者从临床实践角度出发，深入分析了PAO后应力骨折这一并发症的临床意义。应力骨折虽然在PAO术后并不常见，但一旦发生可能会显著延长患者的康复周期，并影响最终的功能结果。作者指出，Jochl等人的研究为我们提供了宝贵的临床数据，特别是关于风险因素的识别。然而，评论也提醒我们，当前对于应力骨折的机制理解仍然有限，特别是生物力学因素、骨密度变化以及术后康复进程中的负重因素等方面。作者建议，临床医生应当在术前评估中更加重视患者的骨密度状况、营养状态以及活动水平，同时在术后康复计划中合理控制负重和活动强度，以降低应力骨折的发生风险。
详解：
Rhee等人在《Clinical Orthopaedics and Related Research》发表的研究，专注于孤立性近端股骨外翻截骨术治疗Perthes病伴绞链外展患者的临床效果。Perthes病是儿童骼关节骨骼朴死的常见原因，绞链外展是其严重并发症之一，会导致股骨头形态异常和骼白覆盖不足。传统上，外翻截骨术常与其他手术联合应用，但本研究特意关注了孤立性近端股骨外翻截骨术的单独作用。研究回顾性地分析了接受该手术的Perthes病患者在骨骼成熟期的股骨圆度、近端股骨发育以及骼白发育情况。结果显示，该手术能够显著改善股骨的圆度，并促进骼白的正常发育，有效缓解了因绞链外展导致的骼白覆盖不足。这一发现为临床医生提供了重要的治疗选择，特别是对于那些希望保留自身骼关节、避免早期行全骼关节置换的年轻患者。作者建议，对于Perthes病伴绞链外展的患者，孤立性近端股骨外翻截骨术可作为一线治疗选择。
详解：
Jochl等人在《Clinical Orthopaedics and Related Research》发表的大样本研究，系统探讨了骼白周围截骨术（PAO）后应力骨折的发生率、相关因素以及对患者报告结局的影响。PAO是治疗有症状骼白发育不良的金标准手术，但其并发症中应力骨折虽不常见却具有重要临床意义。该研究回顾性地分析了大量PAO患者的临床数据，首次系统地探讨了生活方式因素与应力骨折的关联。研究发现，PAO后应力骨折的发生率低于预期，但一旦发生可能导致延长康复时间和功能结果受损。关键发现包括：术前骨密度较低、术中骨折固定不充分、以及术后早期过度负重的患者发生应力骨折的风险更高。此外，研究还发现应力骨折患者在术后一年的患者报告结局指标（PROMs）改善程度略低于非骨折患者，但长期结局无显著差异。这一发现提示我们，PAO后应力骨折虽然会短期影响患者体验，但不会显著改变最终的功能结果。临床上，这提醒我们在术前应全面评估患者的骨密度和营养状况，术中应确保骨折端的稳固固定，术后应制定合理的负重进度和康复计划。
详解：
Ingawa等人在《Journal of Arthroplasty》发表的研究，重点关注了骼白周围截骨术（PAO）后患者的功能恢复情况。尽管PAO的影像学和临床结果已有充分记载，但关于患者术后能否正常返回日常活动、运动、学业、工作、驾车和性生活等方面的信息相对缺乏。该研究通过问卷调查的方式，对在过去10年内接受PAO的患者进行了回顾性调查，共收集了85位患者（118骼）的数据，回应率为31%。研究结果显示，大多数患者能够成功返回日常活动和运动，其中运动返回率较高，但柔音乐和高强度运动的返回率相对较低。在学业和工作方面，大部分患者能够正常参与，但部分患者报告了活动能力的限制。驾车返回率较高，通常在术后3-6个月内恢复。性生活方面，大多数患者能够正常进行，但部分患者报告了不适。这些结果为临床医生提供了宝贵的参考信息，有助于术前咨询时向患者传达合理的预期，同时也为术后康复计划的制定提供了依据。
详解：
Fahmy等人在《International Orthopaedics》发表的前瞻性研究，为中东地区PAO的长期疗效提供了重要证据。该研究纳入了36位连续的PAO患者，平均年龄34.6岁，女性占78%，并进行了平均7.8年的临床、功能和影像学随访。研究采用了多种验证的功能评估工具，包括Harris骼关节评分（HHS）、WOMAC指数、骼关节日常活动量表（HOS）和短形健康调查（SF-36），同时记录了影像学参数如肛骼侧中心边角（LCEA）和肛骼指数（AI）的变化。结果显示，HHS从术前的63.5分显著提升至术后的89.6分，LCEA从16.2°增加至31.8°，AI从22.8°下降至8.5°，差异均具有统计学显著性。更重要的是，在平均7.8年的随访中，THA转换率仅为5.6%，显示出优秀的关节保留率。通过Kaplan-Meier生存分析，研究还鉴别出了与低保留率相关的危险因素，包括术前骼关节退变程度较重和年龄较大。这些发现为PAO作为保骼手术的长期有效性提供了有力支持，特别是对于中东地区的患者人群。临床上，这提示我们PAO能够显著延迟或避免THA，尤其适合年轻、活跃的发育不良患者。
详解：
Sullivan等人在《Journal of the American Academy of Orthopaedic Surgeons》发表的研究，探讨了伴有过度活动性谱障碍（HSD）的青少年患者接受PAO的临床和影像学结果。HSD是一类以关节过度活动为特征的结缔组织疾患，往往伴随着肌腻、鞠带松弛和关节不稳定性增加。由于担心HSD患者术后并发症风险较高，这类患者是否适合接受PAO一直存在争议。该研究回顾性地比较了伴HSD与不伴HSD的青少年PAO患者的影像学参数（包括LCEA、MCEA、前壁指数、后壁指数和Tönnis角）以及患者报告结局（PROs）。结果显示，两组患者在术后影像学矫正程度上无显著差异，且PROs的改善程度也相当。更重要的是，HSD患者的并发症发生率也未显著增加。这一发现突破了传统观念，证明HSD并非PAO的禁忌证。临床上，这为伴HSD的青少年发育性骼关节发育不良患者提供了新的治疗选择，医生不应因HSD而轻易拒绝PAO手术。然而，研究者也提醒，HSD患者术后康复过程中可能需要更多的物理治疗支持以促进功能恢复。
详解：
Karisch等人在《Journal of Experimental Orthopaedics》发表的前瞻性研究，首次大样本地比较了男性和女性患者接受PAO后的短期结果。发育性骼关节发育不良（DDH）在女性中更为常见，但男性患者的手术结果是否与女性相当一直存在争议。该研究利用机构的PAO登记系统，纳入了282骼（44骼男性，238骼女性），这些患者均在2022至2024年间由同一位外科医师执行手术。研究评估了术前和术后的影像学参数以及多种患者报告结局指标（PROMs），包括UCLA活动量表、骼关节障碍和日常活动量表（HOS-ADL）、骼关节障碍和运动量表（HOS-SSS）以及iHOT-12。结果显示，男性和女性患者在术后的影像学矫正程度、PROMs改善程度以及并发症发生率上均无显著差异。这一发现突破了传统观念，即男性DDH患者可能因肌肉发达或关节稳定性较差而预后较差。临床上，这提示我们男性DDH患者同样可从PAO中获益，医生应当积极评估男性患者的手术指征，而不应因性别而轻易放弃手术机会。
详解：
Ahmad等人在《Journal of Experimental Orthopaedics》发表的研究，关注了一个较少被研究的话题：DDH患者PAO后骼白缘骨化的自然转归。局灶性骼白骨化是DDH中常见的影像学表现，通常被视为慢性损伤的结果。传统观点认为，这些骨化可能需要在PAO同期行销割或清除。该研究回顾性地分析了接受孤立性PAO的DDH患者，评估了术前和术后的影像学变化。结果显示，经过生物力学矫正后，部分患者的局灶性骼白缘骨化可以自发消退或显著减少，而无需直接的手术干预。这一发现具有重要的临床意义，因为它意味着在PAO术中发现的骼白骨化可以选择保守观察而非立即清除，从而简化手术流程、缩短手术时间并降低术中风险。作者建议，除非骨化导致明显的骼关节不稳定性或疼痛，否则不应在PAO同期行销割处理。
详解：
Enocson等人在《Archives of Orthopaedic and Trauma Surgery》发表的研究，提供了北欧地区大样本PAO长期结果的重要证据。该研究回顾性地分析了2006至2022年间在Karolinska大学医院接受PAO的96例连续患者，以THA转换率为主要结局指标。研究采用Kaplan-Meier生存分析评估了保留率，并探讨了影响长期结局的危险因素。结果显示，在平均8年的随访中，THA转换率为15%，显示出良好的关节保留能力。更重要的是，大部分转换为THA的患者发生在术后10年以上，说明PAO能够显著延迟THA的需求。多因素分析显示，术前骼关节退变程度较重和年龄较大是预测转换为THA的独立危险因素。这一发现为PAO作为年轻发育性骼关节发育不良患者的一线保骼手术选择提供了有力支持，特别是对于那些希望延迟或避免早期行THA的患者。
详解：
Doyle等人在《Paediatric Anaesthesia》发表的研究，关注了青少年PAO患者的围术期管理优化。PAO是一种创伤较大的骼骨截骨手术，围术期疼痛管理和康复进程对患者体验至关重要。然而，传统上围术期管理实践存在较大的变异性，特别是镇痛方案和区域麻醉的使用。该研究采用质量改进的PDSA循环方法，由多学科团队（麻醉学、骨科外科、围术期护理）共同设计并实施了加强康复外科（ERAS）路径。ERAS路径包括标准化的术前教育、多模式镇痛方案（包括神经阻滞和全身镇痛药物）、早期下床活动以及早期进食等元素。研究结果显示，ERAS路径能够显著提高围术期管理的一致性，减少了术后镇痛药物的使用量，缩短了住院时间，并提高了患者和家属的满意度。临床上，这为青少年PAO患者的围术期管理提供了可推广的模式，有助于提高手术安全性和患者体验。
详解：
Bosakhar和Balakumar在《JBJS Case Connect》报告的这例病例，提示了结缔组织疾患患者行骼关节保骼手术后血管并发症的风险。患者为18岁女性，被诊断为Ehlers-Danlos综合征（EDS），这是一种以鞠带松弛和血管脆性增加为特征的遗传性结缔组织疾患。患者接受了骼关节镜检查和PAO，术后第21天出现大腿疼痛。多普勒超声检查发现股直肌内脉动的"阴阳”态病变，CT血管造影确认为股外侧旋股动脉假性动脉瘤伴动静脉痑。经皮血管内治疗（卷径塞栓和凝血酶注射）后，病变完全血栓化，症状缓解。这一病例提醒我们，结缔组织疾患患者在骼关节手术后发生血管损伤的风险显著增加，即使是微创手术如骼关节镜也不能佚免。临床上，对于EDS等结缔组织疾患患者，术后应高度警惕血管并发症，影像学检查应作为常规监测手段，一旦发现异常应及时行影像学确计并采用最小侵袭性的内治疗方案。
详解：
Ramadanov等人在《Bone & Joint Open》发表的系统综述和集群分析，首次系统地评估了外科医师经验对PAO手术结局的影响。PAO是一种技术要求极高的骼骨截骨手术，学习曲线被认为相当陡峭。该研究检索了五个主要数据库，纳入了比较早期与晚期PAO经验的研究，采用随机效应集群分析评估了手术时间、围术期并发症、影像学矫正和THA转换率等结局。结果显示，外科医师的经验显著影响手术时间和围术期并发症发生率，经验丰富的医师能够更快完成手术并减少并发症。然而，研究也发现，当手术量达到一定阈值后，经验的进一步提升对结局的改善有限。更重要的是，尽管手术效率和并发症受经验影响，但长期结局（包括影像学矫正和THA转换率）并未显著受经验影响。这一发现提示我们，PAO的长期结局更大程度上取决于患者选择和术前评估，而非单纯的手术技术。临床上，这强调了在专业中心由经验丰富的医师执行PAO的重要性，建议在专业中心集中开展PAO手术以确保手术质量和患者安全。
Abstract:
BACKGROUND: Long-term outcomes of femoroacetabular impingement (FAI) surgery, particularly survivorship, are critical to guide treatment decision-making and patient counseling, yet only a limited number of studies have reported mid- to long-term survivorship. The purpose of this study was to report survivorship rates at a mean 10-year follow-up in a large, multicenter FAI surgery cohort and to identify clinical predictors of survivorship. METHODS: A prospective, multicenter cohort study assessed patients treated for FAI with hip arthroscopy or surgical dislocation from 2008 to 2012. At a minimum of 8 years, 362 hips (80.1%) had follow-up that permitted assessment of total hip arthroplasty (THA)-free survivorship. A Cox proportional-hazards model was developed to identify risk factors for T...
Abstract:
BACKGROUND: The purpose of this study is to compare acetabular remodeling rates in age and severity matched, idiopathic DDH patients undergoing closed reduction (CR) versus open reduction alone (OR) versus open reduction supplemented by ligamentum teres reconstruction (LTR) utilizing a suture button device. METHODS: Prospectively obtained data of patients who underwent open reduction with LTR were compared with historic cohorts of children 2.5 years or younger who underwent CR or OR. Acetabular index (AI) was measured on radiographs taken prior to reduction and on serial postoperative follow-ups. Monthly and yearly rates of AI change were calculated. Subgroup analysis of the prospective LTR cohort was performed to characterize how the rate of acetabular remodeling changes with increasing t...
Abstract:
Capsule-sparing techniques in hip arthroscopy including periportal and puncture capsulotomy aim to minimize disruption of the iliofemoral ligament while maintaining adequate visualization and treatment of intra-articular pathology. By limiting iatrogenic injury to the capsule, these approaches may offer advantages such as reduced scar tissue or adhesions, avoidance of need for capsular closure, and potentially faster recovery. Concerns remain regarding technical difficulty of these techniques and the ability to adequately visualize and maneuver in all cases. Current evidence suggests that capsule-sparing techniques can achieve comparable patient-reported outcomes to traditional interportal or T-capsulotomy techniques with capsule closure. Capsular management should therefore be individuali...
Abstract:
PURPOSE: To investigate the influence of peak contralateral pelvic drop and ipsilateral femoral adduction during running on traditional radiographic parameters of femoral head coverage. METHODS: This cross-sectional retrospective study included 19 patients (38 hips), 9 males and 10 females, with a mean age of 40 ± 10 years, all presenting with symptomatic unilateral femoroacetabular impingement. Participants underwent a three-dimensional running analysis and anteroposterior pelvic radiographs. Using specialised software, the femur and pelvis were rotated in the coronal plane based on the peak angles of contralateral pelvic drop and femoral adduction obtained from the biokinetic running analysis. After prior validation, traditional femoral head coverage parameters were assessed on both stan...
Abstract:
CASE: A 21-year-old woman with a surgical history of 2 prior right hip surgeries presented with ongoing right hip pain. Radiographic findings demonstrated a labral tear, osteoarthritic changes, and cam over-resection. Arthroscopic iliotibial band autograft labral reconstruction and bony remplissage of the femoral defect using a greater trochanter autograft were performed. CONCLUSION: Arthroscopic bony hip remplissage is a viable treatment option for young patients who present after failed hip arthroscopy with cam over-resection.
Abstract:
BACKGROUND: Data on midterm outcomes in patients with borderline hip dysplasia (BHD) based on sex differences after hip arthroscopy are scarce. PURPOSE: To report sex-based differences in patient-reported outcome measures (PROMs), clinical benefit, and survivorship in patients with BHD who underwent hip arthroscopy at a minimum 5-year follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were retrospectively reviewed for all patients with BHD who underwent primary hip arthroscopy with a lateral center-edge angle (LCEA) between 18° and 25° from 2008 to 2018. The exclusion criteria were as follows: LCEA <18º or >25º, previous ipsilateral hip surgery or conditions, and Tönnis grade >1. The modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), and visual analog...
Abstract:
BACKGROUND: Acetabular labral tears are a common cause of hip pain. While larger tear size has been linked to worse outcomes after arthroscopic treatment, the influence of labral tear location remains incompletely understood. PURPOSE: To investigate how labral tear location affects functional outcomes, conversion to total hip arthroplasty (THA), and patient satisfaction after arthroscopy. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent primary hip arthroscopy were retrospectively sent online surveys at a minimum of 8 years after their surgery. Tear location was classified into superior, anterosuperior, and posterosuperior based on intraoperative findings. Outcomes included patient-reported outcome measures, conversion to THA, Patient Acceptable Symptom Sta...
Abstract:
BACKGROUND: Variables predictive of achieving clinically meaningful outcomes in high-level adult athletes after primary hip arthroscopy at midterm follow-up remain incompletely defined. PURPOSE: To identify variables predictive of achieving the patient acceptable symptom state (PASS) for the Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum 5-year follow-up after primary hip arthroscopy in high-level adult athletes. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Data were prospectively collected and retrospectively reviewed for adult (≥18 years old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2010 and August 2016. Inclusion criteria consisted of participation in high school, collegiate, or profe...
Abstract:
PURPOSE: To analyze minimum 5-year outcomes after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) utilizing the periportal capsulotomy technique for joint access without capsular closure. METHODS: A retrospective review of a prospectively collected database of patients undergoing primary hip arthroscopy for FAIS without clinical signs of hypermobility was performed to analyze patients who underwent hip arthroscopy utilizing the periportal capsulotomy technique without capsule closure with minimum 5-year follow-up. Periportal capsulotomy was utilized for joint access, and arthroscopic labral treatment and osteochondroplasty were completed as indicated without capsular closure. Patient demographics, surgical details, and complications were recorded. Pre- and postoperat...
Abstract:
BACKGROUND: Psychiatric comorbidity-most commonly depression and anxiety-is frequently reported among patients undergoing hip arthroscopy and may influence postoperative trajectories, but existing analyses vary in scope and methods, limiting clinical interpretation. PURPOSE: To determine whether recorded psychiatric diagnoses are associated with worse surgical, patient-reported, and health care utilization outcomes after hip arthroscopy. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 3. METHODS: The authors conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant search (International Prospective Register of Systematic Reviews [PROSPERO] CRD420251101816) of the MEDLINE, Embase, Web of Science, and PsycINFO databases to identif...
Abstract:
BACKGROUND: High-level athletes who undergo hip arthroscopy for femoroacetabular impingement syndrome (FAIS) return to sport (RTS) at a high rate. However, the influence of athlete-specific factors, including sport, sex, and clinical and surgical findings, on the time to RTS remains unclear. PURPOSE: To determine if the time to RTS clearance is influenced by sport and sex in collegiate athletes following hip arthroscopy, as well as determine if the time to RTS is impacted by clinical and surgical factors. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In total, 62 Division I collegiate athletes (26 female; 89 hips) who underwent hip arthroscopy for FAIS between January 2017 and July 2024 were included in this analysis of routinely collected health and performance data. Demograp...
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BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a major cause of chronic hip pain and early osteoarthritis. Surgical correction, traditionally via open surgical dislocation and increasingly via hip arthroscopy, aims to restore hip function by correcting bony morphology. While both techniques address cam and pincer lesions, the long-term implications of the surgical approach and specific impingement morphology on five-year structural outcomes, including hip instability, osteoarthritis (OA) progression, and conversion to total hip arthroplasty (THA), remain poorly defined. METHODS: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, analyzing de-identified electronic medical records from 2,725 patients (2,321 arthroscopic, 404 open) who underwent...
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BACKGROUND: Paralabral cysts are one of the signs of labral injury; however, it remains unclear whether they affect the mid-term clinical outcomes after hip arthroscopy. PURPOSE: To compare the midterm patient-reported outcomes (PROs) of hip arthroscopy for labral tear with or without paralabral cysts, with a minimum follow-up of 5 years. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective matched cohort study was conducted on patients who underwent unilateral hip arthroscopy for labral tear between November 2015 and September 2019. Exclusion criteria comprised nonlabral tear indications, prior hip surgery, incomplete data, or loss to follow-up. Patients with paralabral cysts confirmed by magnetic resonance imaging (MRI) were designated as the cyst group (n = 35), wh...
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INTRODUCTION: Hip instability is an important complication of spinal muscular atrophy (SMA), which leads to various functional impairments, including mobility challenges and difficulties with daily care. The primary objective of this study is to determine the prevalence and severity of hip instability in a cohort of SMA patients managed at a tertiary care center. The prevalence of scoliosis and its association with hip instability in children with SMA were also assessed. METHODS: This is a retrospective cross-sectional study including children with a genetic diagnosis of SMA and available hip x-rays, conducted between 2018 and 2023. Patients were grouped based on SMA type and motor status (non-sitters, sitters, or walkers). Relevant parameters were collected including hip subluxation/dislo...
Abstract:
BACKGROUND/AIM: In professional soccer, comprehensive musculoskeletal assessments are performed prior to player transfers to evaluate both the current condition and future risk of injury. MRI plays a crucial role in this process, effectively revealing musculoskeletal findings even in the absence of symptoms. This study presents common musculoskeletal MRI findings in professional soccer players undergoing pre-signing assessments and their associations with age, playing position and footedness. METHODS: In this retrospective study, musculoskeletal 3 Tesla MRI scans obtained during pre-signing medical assessments of professional soccer players from August 2019 to March 2025 were included. Clinical data were extracted from medical records and supplemented with publicly available player informa...