Aims. This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Methods. Data on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded. The EuroQol five-dimension (EQ-5D) and International Hip Outcome Tool 12 (iHOT-12) questionnaires were collected preoperatively and at six and 12 months post-operatively. Due to concerns over differential questionnaire non-response between the two groups, a combination of random sampling, propensity score matching, and pooled multivariable linear regression models were employed to compare iHOT-12 improvement. Results. A total of 2,025 labral debridements (55%) and 1,659 labral repairs (45%) were identified. Both groups saw significant (p < 0.001) EQ-5D and iHOT-12 gain compared to preoperative scores at 12 months (iHOT-12 improvement: labral repair = +28.7 (95% confidence interval (CI) 26.4 to 30.9), labral debridement = +24.7 (95% CI 22.5 to 27.0)), however there was no significant difference between procedures after multivariable modelling. Overall, 66% of cases achieved the minimum clinically important difference (MCID) and 48% achieved substantial clinical benefit at 12 months. Conclusion. Both labral procedures were successful in significantly improving early functional outcome following hip arthroscopy, regardless of age or sex. Labral repair was associated with superior outcomes in univariable analysis, however there was no significant superiority demonstrated in the multivariable model. Level of evidence: III. Cite this article: Bone Jt Open 2022;3(4):291–301

Since its creation, labral repair has become the preferred method among surgeons for the arthroscopic treatment of acetabular labral tears resulting in pain and dysfunction for patients. Labral reconstruction is performed mainly in revision hip arthroscopy but can be used in the primary setting when the labrum cannot be repaired or is calcified. The purpose of this study was to compare the survival between primary labral repair and labral reconstruction with survival defined as no further surgery (revision or total hip replacement). Patients who underwent labral repair or reconstruction between January 2005 and December 2018 in the primary setting were included in the study. Patients were included if they had primary hip arthroscopy with the senior author for femoroacetabular impingement (FAI), involving either labral reconstruction or labral repair, and were within the ages of 18 and 65 at the time of surgery. Exclusion criteria included confounding injuries (Leggs Calves Perthes, avascular necrosis, femoral head fracture, etc.), history of unilateral or bilateral hip surgeries, or Tönnis grades of 2 or 3 at the time of surgery. Labral repairs were performed when adequate tissue was available for repair and labral reconstruction was performed when tissue was absent, ossified or torn beyond repair. A total of 501 labral repairs and 114 labral reconstructions performed in the primary setting were included in the study. Labral reconstruction patients were older (37±10) compared to labral repair (34±11).(p=0.021). Second surgeries were required in 19/114 (17%) of labral reconstruction and 40/501(8%) [odds ratio: 2.3; 95% CI 1.3 to 4.2] (p=0.008). Revision hip arthroscopy were required in 6/114(5%) labral reconstructions and 33/501(6.5%) labral repair (p=0.496). Total hip replacement was required in 13/114 labral reconstructions and 7/501 labral repairs [odds ratio:9.1 95%CI 3.5 to 23] (p=< 0.01). The mean survival for the labral repair group was 10.2 years (95%CI:10 to 10.5) and 11.9 years (98%CI:10.9 to 12.8) in the labral reconstruction group. Conversion to total hip was required more often following primary labral reconstruction. Revision hip arthroscopy rates were similar between groups as was the mean survival, with both over 10 years. Similar survival was seen in labral repair and reconstruction when strict patient selection criteria are followed

Introduction. The purpose of this study was to demonstrate postoperative improvement and high satisfaction rates after a surgical approach that includes arthroscopic labral repair only, in patients with borderline dysplasia, without instability. Methods. Between September 2009 and December 2011, patients less than 50 years old who underwent hip arthroscopy for symptomatic intra-articular hip disorders, with a lateral center-edge (CE) angle between 20 and 25, were included in this study. Patients with Tönnis grade 2 or greater, hip joint space narrowing, severe hip dysplasia (CE〈20), hip joint instability and Legg-Calve-Perthes disease were excluded. Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Arthritis index (WOMAC), and visual analog scale (VAS) for pain were obtained in all patients preoperatively and at 1, 2, and 3 years postoperatively. Results. A total of 36 patients met the criteria to be included in the study. Of these, 32 (88.8%) patients were available for follow-up. There was a significant improvement in mHHS from 67.19±7.66 to 82.69±6.95 (P<0.001), and WOMAC score from 58.90±5.77 to 77.90±6.38 (P<0.001). There was a significant improvement in VAS scores from 5.8 to 2.9 (P<0.001). There was a significant improvement in range of motion, flexion from 108.44±7.77 to 115.31±6.08 (P<0.001) and external rotation from 29.06±5.74 to 33.13±4.88 (P<0.001). Conclusions. The current study demonstrates favorable results in borderline dysplasia hip without instability at minimum 3-year follow-up for an arthroscopic approach that includes labral repair. Labrum is the main key-stone structure, which should be preserved in borderline dysplasia hip for functional and pain improvement. Also the prognosis of treatment is probably forecasted more by the nature of stability and the intra-articular pathology rather than simply the presence or absence of radiographic finding of borderline dysplasia

Purpose. The purpose of this study was to demonstrate postoperative improvement and high satisfaction rates after a surgical approach that includes arthroscopic labral repair only, in patients with borderline dysplasia, without instability. Methods. Between September 2009 and December 2011, patients less than 50 years old who underwent hip arthroscopy for symptomatic intra-articular hip disorders, with a lateral center-edge (CE) angle between 20 and 25, were included in this study. Patients with Tönnis grade 2 or greater, hip joint space narrowing, severe hip dysplasia, hip joint instability and Legg-Calve-Perthes disease were excluded. Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), Western Ontario and McMaster Universities Arthritis index (WOMAC), and visual analog scale (VAS) for pain were obtained in all patients preoperatively and at 1, 2, and 3 years postoperatively. Results. A total of 36 patients met the criteria to be included in the study. Of these, 32 (88.8%) patients were available for follow-up. There was a significant improvement in mHHS from 67.19 ± 7.66 to 82.69 ± 6.95 (P<0.05), WOMAC score from 58.90 ± 5.77 to 77.90 ± 6.38 (P<0.05), and VAS scores from 5.8 ± 0.88 to 2.9 ± 0.62 (P<0.05). There was a also improvement in range of motion, flexion from 108.44 ± 7.77 to 115.31 ± 6.08 (P<0.05) and external rotation from 29.06 ± 5.74 to 33.13 ± 4.88 (P<0.05). Conclusions. The current study demonstrates favorable results in borderline dysplasia hip without instability at minimum 3-year follow-up for an arthroscopic approach that includes labral repair. Labrum is the main key-stone structure, which should be preserved in borderline dysplasia hip for functional and pain improvement

Objectives. The aim of this study was to use registry data to report and compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum. Methods. Data on adult patients who underwent arthroscopic labral debridement or repair between January 2012 and March 2019 was extracted from the UK Non-Arthroplasty Hip Registry dataset. Patients who underwent microfracture, osteophyte excision or a concurrent extra-articular procedure were excluded. Outcomes comprised EuroQol-5 Dimensions (EQ-5D) index and the International Hip Outcome Tool 12 (iHOT-12), preoperatively and at 6 and 12 months. Results. A total of 3,553 arthroscopies comprising 1,986 labral debridement (56%) and 1,567 labral repairs (44%) were identified. Both groups saw significant (p <0.0001) EQ-5D and iHOT-12 gain compared to pre-operative baseline scores at 6 months (iHOT-12: repair = +27.4 (95%CI 25.2 to 29.5), debridement = +24.8 (95%CI 22.7 to 26.9)) which was maintained at 12 months (repair = +28.3 (95%CI 26.0 to 30.6), debridement = +24.3 (95%CI 22.0 to 26.5)) with improvement being significantly greater in the repair group by 12 months (p = 0.016) including after modelling for patient and surgical factors. Overall, 64% of cases achieved the minimum clinically important difference (MCID) and 47% achieved substantial clinical benefit (SCB: repair = 51%, debridement = 43%, p = 0.005) at 12 months. Significant functional improvement was seen for both genders and in younger and older (>40 years) cohorts. Conclusion. Both labral repair and debridement techniques were successful in significantly improving 12-month outcomes following hip arthroscopy regardless of age or gender. Labral repair was associated with superior outcomes in comparison to debridement. Whilst patient selection is crucial, our findings support the repair of an injured labrum where possible. A multi-centre randomised controlled trial would be the most appropriate next step to overcome bias inherent in the existing literature

Aims. Research on hip biomechanics has analyzed femoroacetabular contact pressures and forces in distinct hip conditions, with different procedures, and used diverse loading and testing conditions. The aim of this scoping review was to identify and summarize the available evidence in the literature for hip contact pressures and force in cadaver and in vivo studies, and how joint loading, labral status, and femoral and acetabular morphology can affect these biomechanical parameters. Methods. We used the PRISMA extension for scoping reviews for this literature search in three databases. After screening, 16 studies were included for the final analysis. Results. The studies assessed different hip conditions like labrum status, the biomechanical effect of the cam, femoral version, acetabular coverage, and the effect of rim trimming. The testing and loading conditions were also quite diverse, and this disparity limits direct comparisons between the different researches. With normal anatomy the mean contact pressures ranged from 1.54 to 4.4 MPa, and the average peak contact pressures ranged from 2 to 9.3 MPa. Labral tear or resection showed an increase in contact pressures that diminished after repair or reconstruction of the labrum. Complete cam resection also decreased the contact pressure, and acetabular rim resection of 6 mm increased the contact pressure at the acetabular base. Conclusion. To date there is no standardized methodology to access hip contact biomechanics in hip arthroscopy, or with the preservation of the periarticular soft-tissues. A tendency towards improved biomechanics (lower contact pressures) was seen with labral repair and reconstruction techniques as well as with cam correction. Cite this article: Bone Joint Res 2023;12(12):712–721

The study sought to determine the results of labral restoration among patients over age 60 compared to a cohort of younger adults. 21 consecutive patients over age 60 undergoing labral repair with minimum one-year follow-up were compared to a contemporaneous group of 21 patients age 18–55 matched for gender, degree of chondral damage, and associated FAI or dysplasia. Follow-up averaged 18.9 months (12 to 24 months). The study group averaged 63.2 years (61 to 71); with 20 FAI and one dysplasia. 19 had acetabular articular damage (2 grade IV, 11 grade III, 5 grade II, 1 grade I) and 6 had femoral changes (1 grade IV, 5 grade 3). The control group averaged 35.8 years (20 to 54). Average improvement among the study group was 28.1 points modified Harris Hip Score (mHHS) and 37.5 points iHOT; and among the control group, 21.2 points mHHS and 37.1 points iHOT. There was no statistically significant difference between the two groups in the amount of improvement, with statistically and clinically significant improvement noted in both. Two study group patients underwent total hip arthroplasty (THA) at average 10 months with one control group THA at 11 months. All three converted to THA had combined grade IV acetabular and grade III femoral damage. There were no repeat arthroscopies and no complications in either group. We conclude that patients over age 60 can benefit from arthroscopic labral repair with improved outcomes, modest rates of conversion to THA, and small risk of complication. Results are comparable to younger adults. Combined bipolar grade IV or grade III articular damage is a harbinger of conversion to THA, regardless of age

Background. Acetabular labral tears can cause pain and microinstability and are the most common indication for hip arthroscopy. Hip labral repair demonstrates better clinical outcome scores at a mean of 3.5 years post surgery than labral excision and tends to be performed in a younger age group. While different labral stitch configurations are possible, the most frequently used are a mattress stitch passed though the hip labrum at its widest part, or a simple loop surrounding the labrum. To determine the strength of variousrepair techniques and the impact suture passer sizesonhip labrum failure after cyclic loading. Methods. 35 unattached fresh-frozen bovine hip labrums were assigned to 5 repair techniques (7 specimens each): Group 1: horizontal mattress using a penetrating grasper; Group 2: vertical mattress using a penetrating grasper; Group 3: vertical mattress using asuture lasso; Group 4: Oblique repair using a penetrating grasper; Group 5: vertical mattress using a penetrating grasper and monopolar radio frequency device. Using a materials testing machine and after a 10N preload, each contruct was subjected to 20 cycles at 5N–80N. Cyclic elongation, peak-to-peak displacement, ultimate failure load, stiffness, and failure mode were recorded. Results. Group 1 (249N) had lower ultimate load than groups 2 (277N), 3 (289N), 4 (281N), and 5 (278N) (p<0.05) and higher peak to peak displacement, cyclic elongation (14mm) than group 3 (12mm) (p<0.05). Group 2 (15mm) had higher peak to peak displacement than group 3 (p<0.05). Group 3 had lower cyclic elongation and peak to peak displacements than group 4 (p<0.05). Conclusion. A horizontal mattress hip labrum repair demonstrates lower ultimate failure load than a vertical mattress or an oblique suture repair. A smaller diameter suture passing device demonstrated less cyclic displacement but no difference in ultimate failure load than a large diameter device. Radiofrequency treatment did not have any effect on the strength of the suture repair configuration. Level of evidence. Level 5

Arthroscopic stabilisation of the shoulder is a technically-demanding and developing technique, and the reported results have yet to match those for open surgery. We present a consecutive initial series of 55 patients with post-traumatic recurrent anteroinferior instability managed since September 1999 using a titanium knotless suture anchor. Patients were reviewed from 12–33 months postoperatively and assessed using the Rowe, Walch-Duplay and Constant scores. Following mobilisation of the capsulolabral complex, labral reconstruction was achieved using a two-portal technique and an average of three anchors placed on the glenoid articular rim. In 13 cases, additional electrothermal shrinkage was required to reduce capsular redundancy in the anterior and inferior recesses following labral repair, although 11 of these were in the first 18 months. Incorporation of a south-to-north capsular shift has reduced the need for supplementary shrinkage. Complications have included one instance of anchor migration requiring open retrieval and two documented episodes of recurrent instability, although these occurred in patients having surgery within the first six months after the introduction of this technique. Based on our initial experience, we believe that arthroscopic labral repair is a viable alternative to open Bankart repair and have now expanded the indications to include patients with primary dislocation, those participating in gymnastic and contact/collision sports, and revision cases with failed open repairs

The purpose of this study was to validate a dry model for the assessment of performance of arthroscopic rotator cuff repair (RCR) and labral repair (LR). We hypothesised that the combination of a checklist and a previously validated global rating scale (GRS) would be a valid and reliable means of assessing RCR and LR when performed by residents in a dry model. An arthroscopic RCR and LR was performed on a dry model by residents, fellows, and sports medicine staff. Any prior RCR and LR exposure was noted. Participants were given a detailed surgical manuscript and technique video before the study began. Evaluation of residents was performed by staff surgeons with task-specific checklists created using a modified Delphi procedure, and the Arthroscopic Surgical Skill Evaluation Tool (ASSET). The hand movements and arthroscopic view of the procedures were recorded. Both videos were scored by a fellow blinded to the year of training of each participant. A total of 35 residents, six fellows and five staff surgeons performed both arthroscopic RCR and LR on a dry model model (48 total). The internal reliability (Cronbach's Alpha) of the test using the total ASSET score was high (>0.8)). One-way analysis of variance for the total ASSET score and the total checklist score demonstrated a difference between participants based upon year of training (p<0.05). Post hoc analysis also demonstrated a significant difference in global ratings and checklist scores between junior residents (PGY1–3) and senior residents (PGY4&5), senior residents and fellows, and fellows and staff. A good correlation was seen between the total ASSET score and prior exposure to RCR and LR. The inter-rater reliability (ICC) between the examiner ratings and the blinded assessor ratings for the total ASSET score was good (0.8). The results of this study provide evidence that the performance of a RCR and LR in a dry model is a valid and reliable method of assessing a resident's ability to perform these procedures, prior to performance in the operating room

Aim: Retrospective evaluation of the clinical results of arthroscopic capsulolabral stabilisation using suture anchors with a mattress technique. Materials and Methods: Sixty five consecutive procedures in sixty-two patients (50 male, 12 female) with mean age of 38 years (14–66) underwent capsulolabral stabilisation by the senior author between 2005 and 2008. There was a history of dislocation in 38 shoulders (58.4%), 16(42.6%) had recurrent and 6 bilateral instability, 27 patients (41.5% shoulders) presented with pain. Thirteen patients had gradual onset and 14 after an injury. The mean follow up was 29 months (14–54). Results: Arthroscopic findings included three patients (5%) with glenoid bone loss more than 15%, Hill Sachs lesions greater than 20% in eighteen patients (27.6%) and six cases where the torn labrum was partially absent. Three shoulders had a panlabral tear (4.4%). A mean of 2.3 (1–4) anchors were used. The mean Rowe score was 92.3 (30–100) with 90% excellent or good and the mean Oxford Score was 41(16–48) with 89% excellent or good. All heavy manual workers returned to work in a mean of 15.4 weeks. Four professional athletes are back to preinjury level in a mean of twenty weeks. There were two (3%) failures with redislocation. Conclusion: Reinforcement of labral repair with capsule plication is an effective means to treat shoulder instability with a 97% success rate and no exclusion criteria

Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular work such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary PAO cohort with no intra-articular work performed at the time of PAO. From June 2012 to March 2022, 368 rectus sparing PAOs were performed and followed for a minimum of one year (mean 5.9 years). The average age was 24 (range 14–46) and 89% were female. Patients were evaluated at last follow-up for patient-reported outcomes (PROMs). Clinical records were reviewed for complications or subsequent surgery. Radiographs were reviewed for the following acetabular parameters: LCEA, ACEA, AI, and the alpha-angle (AA). Patients were cross-referenced from the two largest hospital systems in our area to determine if subsequent HA was performed. Descriptive statistics were used to analyze risk factors for HA. 16 hips (15 patients) (4.4%) underwent subsequent HA with labral repair and femoral osteochondroplasty most common. For those with a minimum of two years of follow-up, 5.3% underwent subsequent HA. No hips underwent THA; one revision PAO was performed. 14 hips experienced a complication and 99 underwent hardware removal. All PROMs improved significantly post-operatively. Radiographically 80% of hips were in goal for acetabular correction parameters with no significant differences between those who underwent subsequent HA and those who did not. Rectus sparing PAO is associated with a low rate of subsequent HA for intra-articular pathology at 5-year follow-up. Acetabular correction alone may be sufficient as the primary intervention for the majority of patients with symptomatic acetabular dysplasia

Concepts in glenoid tracking and treatment strategies of glenoid bone loss are well established. Initial observations in our practice in Singapore showed few patients with major bone loss requiring glenoid reconstructions. This led us to investigate the incidence of and the extent of bone loss in our patients with shoulder instability. Our study revealed bony Bankart lesions were seen in 46% of our patients but glenoid bone loss measured only 6–10% of the glenoid surface. In the same study we found that arthroscopic labral repair with capsular plication and Mason-Ellen suturing (Hybrid technique) was sufficient to stabilise patients with bipolar bone defects and minor glenoid bone loss. This led us to develop the concept of minor bone loss and a new algorithm. Our algorithm and strategies to deal with major bone loss will also be discussed, and techniques & outcomes of Arthroscopic Bony Bankart repair, Arthroscopic Glenoid Reconstruction and Arthroscopic Remplissage procedures will be shown

Introduction. Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular work such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose of this review was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary PAO cohort with no intra-articular work performed at the time of PAO. Methods. From June 2012 to September 2019, 272 Rectus Sparing PAOs were performed and followed for a minimum of one year (mean 4.6 years). The average age was 24 (range 14–44) and 87% were female. The average BMI was 25 and average length of hospital stay was 2.9 days. Patients were evaluated at last follow-up with PROMIS PF-CAT, pain and mental health scores. Clinical records were reviewed for complications or subsequent surgery. Pre and post-operative radiographs were reviewed for change in the following acetabular parameters: LCEA, ACEA, AI, and the alpha-angle was obtained from preoperative radiographs. Patients were cross-referenced from the two largest hospital systems in our area to determine if subsequent HA was performed. Descriptive statistics and logistic regression were used to analyze risk factors for HA. Results. 13 hips (12 patients) (4.8%) underwent subsequent HA with labral repair and femoral-osteochondroplasty most common. No hips underwent THA and one revision PAO was performed. 13 hips experienced a complication and 90 hips underwent hardware removal. All PROM improved significantly post-operatively. Radiographically 80% of hips were in goal for acetabular correction parameters and amongst the LCEA, ACEA, AI and alpha angle (AA), only the AA was significant risk factor for subsequent arthroscopy. Conclusion. Rectus sparing PAO is associated with a low rate of subsequent HA for intra-articular pathology at 5-year follow-up. Acetabular correction alone may be sufficient for the majority of patients with symptomatic acetabular dysplasia

Glutamate regulates the expression of apoptosis-related genes and triggers the apoptosis of fibroblasts in rotator cuff tendons. Subacromial bursitis is always accompanied by symptomatic rotator cuff tear (RCT). However, no study has been reported on the presence of glutamate in subacromial bursa and on its involvement of shoulder pain in patients who had RCT. The purposes of this study were to determine whether the glutamate expression in subacromial bursa is associated with the presence of RCT and with the severity of shoulder pain accompanying RCT. Subacromial bursal tissues were harvested from patients who underwent arthroscopic rotator cuff tendon repair or glenoid labral repair with intact rotator cuff tendon. Glutamate tissue concentrations were measured, using a glutamate assay kit. Expressions of glutamate and its receptors in subacromial bursae were histologically determined. The sizes of RCT were determined by arthroscopic findings, using the DeOrio and Cofield classification. The severity of shoulder pain was determined, using visual analog scale (VAS). Any associations between glutamate concentrations and the size of RCT were evaluated, using logistic regression analysis. The correlation between glutamate concentrations and the severity of pain was determined, using the Pearson correlation coefficient. Differences with a probability <0.05 were considered statistically significant. Glutamate concentrations showed significant differences between the torn tendon group and the intact tendon group (P = 0.009). Concentrations of glutamate significantly increased according to increases in tear size (P < 0.001). In histological studies, the expressions of glutamate and of its ionotropic and metabotropic receptors have been confirmed in subacromial bursa. Glutamate concentrations were significantly correlated with pain on VAS (Rho=0.56 and P =0.01). The expression of glutamate in subacromial bursa is significantly associated with the presence of RCT and significantly correlated with its accompanying shoulder pain. Acknowledgements: This research was supported by the Basic Science Research Program, through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A3A01018955 and 2017R1D1A1B03035232)

Excessive postoperative opioid prescribing is a significant contributor to the opioid crisis. Prescribing in orthopaedic surgery is often further complicated by high use of opioid-based preoperative analgesia. ‘Opioid PrEscRiptions and usage After Surgery’ (OPERAS) is an international multicentre prospective student- and trainee-led collaborative study which aims to quantify the amount of opioids prescribed at discharge after common orthopaedic surgeries against what is consumed by patients at 7-days, and assess the impact of opioids on patient-reported outcomes. Data is being collected over 6 14-day periods on consecutive adult patients undergoing shoulder arthroplasty, rotator cuff repair, shoulder labral repair, anterior cruciate ligament repair, hip arthroplasty, and knee arthroplasty, with follow-up via telephone call at 7-days after discharge. The primary outcome is the proportion of oral morphine equivalents (OME) of prescribed opioids versus consumed opioids at 7-days post-discharge. This ongoing study is actively recruiting in over 20 countries. Globally, 65 centres are collecting orthopaedic, including 10 New Zealand centres and 17 Australian centres. To date, 284 orthopaedic patients have been prospectively enrolled with complete data (mean age 59.6 ± 16.7 years; 51.6% female). Overall, 77% and 89% of patients were prescribed opioids on discharge in New Zealand and Australia respectively. On average, 60% of prescribed opioids were consumed at 7-days post-discharge globally (150 OME (75-500) vs. 90 OME (15-200); p<0.01). In New Zealand and Australia, 42.1% (285 OME (150-584) vs. 120 OME (6-210); p<0.01) and 63.3% (150 OME (86-503) vs. 95 OME (28-221); p<0.01) of prescribed opioids were consumed at 7-days, respectively. OPERAS will provide the first high-quality global data on opioid prescription and consumption patterns with patient perspectives. These data can inform prescribing practice and inform guidelines. The growing interest in New Zealand and Australia in student- and trainee-led orthopaedic collaborative research, as evidenced by this study should be actively encouraged and fostered

The gold standard treatment of hip dysplasia is a peri-acetabular osteotomy (PAO). Labral tears are seen in the majority of patients presenting with hip dysplasia and diagnosed using Magnetic Resonance Imaging (MRI). The goal was to (1) evaluate utility/value of MRI in patients undergoing hip arthroscopy at time of PAO, and (2) determine whether MRI findings of labral pathology can predict outcome. A prospective randomized controlled trial was conducted at tertiary institutions, comparing patients with hip dysplasia treated with isolated PAO versus PAO with adjunct hip arthroscopy. This study was a subgroup analysis on 74 patients allocated to PAO and adjunct hip arthroscopy (age 26±8 years; 89.2% females). All patients underwent radiographic and MRI assessment using a 1.5-Tesla with or 3-Tesla MRI without arthrography to detect labral or cartilage pathology. Clinical outcome was assessed using international Hip Outcome Tool-33 (iHOT). 74% of patients (55/74) were pre-operatively diagnosed with a labral tear on MRI. Among these, 41 underwent labral treatment (74%); whilst among those without a labral tear on MRI, 42% underwent labral treatment (8/19). MRI had a high sensitivity (84%), but a low specificity (56%) for labral pathology (p=0.053). There was no difference in pre-operative (31.3±16.0 vs. 37.3±14.9; p=0.123) and post-operative iHOT (77.7±22.2 vs. 75.2±23.5; p=0.676) between patients with and without labral pathology on MRI. Value of MRI in the diagnostic work-up of a patient with hip dysplasia is limited. MRI had a high sensitivity (84%), but low specificity (44%) to identify labral pathology in patients with hip dysplasia. Consequently, standard clinical MRI had little value as a predictor of outcome with no differences in PROM scores between patients with and without a labral tear on MRI. Treatment of labral pathology in patients with hip dysplasia remains controversial. The results of this subgroup analysis of a prospective, multi-centre RCT do not show improved outcome among patients with dysplasia treated with labral repair

Arthroscopic management of femoroacetabular impingement (FAI) has become the mainstay of treatment. However, chondral lesions are frequently encountered and have become a determinant of less favourable outcomes following arthroscopic intervention. The aim of this systematic review and meta-analysis was to assess the outcomes of hip arthroscopy (HA) in patients with FAI and concomitant chondral lesions classified as per Outerbridge. A systematic search was performed using the PRISMA guidelines on four databases including MEDLINE, EMBASE, Cochrane Library and Web of Science. Studies which included HA as the primary intervention for management of FAI and classified chondral lesions according to the Outerbridge classification were included. Patients treated with open procedures, for osteonecrosis, Legg-Calve-Perthes disease, and previous ipsilateral hip fractures were excluded. From a total of 863 articles, twenty-four were included for final analysis. Demographic data, PROMs, and radiological outcomes and rates of conversion to total hip arthroplasty (THA) were collected. Risk of bias was assessed using ROBINS-I. Improved post-operative PROMs included mHHS (mean difference:-2.42; 95%CI:-2.99 to −1.85; p<0.001), NAHS (mean difference:-1.73; 95%CI: −2.23 to −1.23; p<0.001), VAS (mean difference: 2.03; 95%CI: 0.93-3.13; p<0.001). Pooled rate of revision surgery was 10% (95%CI: 7%-14%). Most of this included conversion to THA, with a 7% pooled rate (95%CI: 4%-11%). Patients had worse PROMs if they underwent HA with labral debridement (p=0.015), had Outerbridge 3 and 4 lesions (p=0.012), concomitant lesions of the femoral head and acetabulum lesions (p=0.029). Reconstructive cartilage techniques were superior to microfracture (p=0.042). Even in concomitant lesions of the femoral head and acetabulum, employing either microfracture or cartilage repair/reconstruction provided a benefit in PROMs (p=0.027). Acceptable post-operative outcomes following HA with labral repair/reconstruction and cartilage repair in patients with FAI and concomitant moderate-to-severe chondral lesions, can be achieved. Patients suffering from Outerbridge 3 and 4 lesions, concomitant acetabular rim and femoral head chondral lesions that underwent HA with labral debridement, had worse PROMs. Reconstructive cartilage techniques were superior to microfracture. Even in concomitant acetabular and femoral head chondral lesions, employing either microfracture or cartilage repair/reconstruction was deemed to provide a benefit in PROMs

Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon's visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is a safe alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. One hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p < 0 .001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p < 0 .001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone

Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon's visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is a safe alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. One hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p < 0 .001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p < 0 .001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone