Andrew J. Curley’s research while affiliated with Georgetown University Medical Center and other places

Introduction: Previous studies have shown good mid-term outcomes of hip labral tear treatment with arthroscopy. However, long-term results are limited within the young adult population. The purpose of this study was to report survivorship and patient-reported outcome measures (PROMs) at minimum 10-year follow-up in young adult patients following primary hip arthroscopy with labral repair or debridement. Methods: Data were prospectively collected and retrospectively reviewed on all patients who underwent primary hip arthroscopy between June 2008 and August 2012. Young adult patients aged greater than 19 and less than 40 years who underwent labral repair were included. Preoperative and minimum 10-year follow-up for multiple patients reported outcomes (PROs) were collected. Rates of achieving the minimal clinically important difference (MCID) and the patient acceptable symptomatic state (PASS), as well as hip joint survival from conversion to total hip arthroplasty (THA) and progression to subsequent ipsilateral revision hip arthroscopy were reported. Results: Of the 241 hips eligible for analysis, 194 hips (80.5%) had minimum 10-year follow-up. There were 122 females (62.9%) and 72 males (37.1%) included in the present analysis with a mean age and BMI of 28.9 years and 24.8 kg/m2, respectively. The 10-year survivorship for young adult patients was 91.8%, and 12.9% of patients progressed to a subsequent ipsilateral revision arthroscopy at mean 36.8 months. There was significant improvement in all PROMs from baseline to minimum 10-year follow-up, including mHHS, NAHS, HOS-SSS, VAS, iHOT-12, and Patient Satisfaction (P<0.05). All patients aged 19-40 years achieved high rates of MCID, for mHHS, NAHS, and VAS, as well as high rates of PASS for mHHS. Conclusion: Young adults who underwent primary hip arthroscopy with labral treatment demonstrated overall 10-year survivorship of 91.8%, significant improvement in PROMs, and high rates of achievement of PASS for mHHS and MCID for mHHS, NAHS, and VAS.

Background The purpose of this study was to (1) evaluate preoperative pelvic tilt utilizing the sacro-femoral-pubic (SFP) angle on standing pelvic x-rays, and (2) determine if the SFP angle changes after a unilateral or bilateral PAO. Methods A retrospective review was conducted of PAOs performed by a single hip preservation surgeon from November 2018 to November 2023. Standing x-rays were reviewed at 4 time points: preoperative, subacute postoperative, 6-month follow-up, and 12-month follow-up. Data collected included demographics, lateral center-edge angle (LCEA), Tönnis angle, and sacro-femoral-pubic (SFP) angle (a surrogate metric for pelvic tilt). Linear mixed models and Wilcoxon signed-rank tests were used to evaluate preoperative to postoperative differences in pelvic tilt for the unilateral and bilateral PAO groups, respectively. Results Seventy-four patients met inclusion criteria, consisting of 53 unilateral and 21 bilateral PAO patients (18.5±4.1 vs. 21.3±5.1 y, 90.6% vs. 95.2% female, LCEA 17.5 deg±6.5 deg vs. 18.0 deg±5.5 deg and 18.0 deg±6.3 deg, respectively). The Average preoperative pelvic tilt, calculated from the SFP angle, for the unilateral and bilateral PAO patients were 9.1 degrees±5.5 degrees and 8.1 degrees±5.6 degrees, respectively. These values increased postoperatively at average 7-week (−0.3 deg±3.4 deg and 1.3 deg±3.7 deg), 6-month (1.1 deg±3.8 deg and 2.7 deg±3.4 deg), and 12-month (1.0 deg±4.1 deg and 2.7 deg±3.0 deg) follow-up. Significant differences in pelvic tilt were observed from preoperative x-rays to 6 months ( P =0.002) and 12 months ( P =0.001) for the bilateral PAO patients, whereas the unilateral group demonstrated similar pelvic tilt at all time points ( P =0.09). Conclusion Patients undergoing bilateral PAO demonstrated an average increase in pelvic tilt of 2.7 degrees as measured by SFP angle at 6 months and 12 months postoperatively, suggesting a compensatory adaptation after surgery that may have implications in rehabilitation regimens and planned surgical corrections. Level of Evidence Level III—therapeutic study.

Background Despite a growing body of literature regarding anterior cruciate ligament reconstruction (ACLR), there remains a wide diversity in surgical technique and clinical practice across providers. Purpose To (1) describe current ACLR practice preferences among members of the Herodicus society and (2) determine whether these preferences are influenced by years in practice and overall surgical volume. Study Design Cross-sectional study. Methods A 24-question survey investigating surgeons’ practices and preferred ACLR surgical techniques was sent via email to all active Herodicus Society members. Survey responses were subdivided by years of experience and overall ACLR annual case volume. Descriptive statistics were compiled and chi-square testing was utilized to determine the significance of experience and case volume on survey responses. Results Of the 113 invited Herodicus Society members who perform ACLR, 69 (61%) completed the survey. Respondents had a mean ± SD of 30.9 ± 9.8 years of experience in clinical practice and performed a mean of 96.0 ± 50.7 primary and 21.6 ± 16.9 revision ACLR annually. Of revision cases, 72.1% were performed using a single-stage technique. Mean frequency of graft usage by surgeon was bone–patellar tendon–bone autograft (58.6%), quadriceps autograft (14.6%), hamstring tendon autograft (14.0%), and allograft (11.8%). The plurality of surgeons responded that they used anterolateral augmentation “rarely” in primary ACLR (39.1%) and “sometimes” in revision ACLR (31.9%), with the majority performing lateral extra-articular tenodesis (66.7%) rather than anterolateral ligament reconstruction (14.5%). Most surgeons would not allow a 20-year-old football player to return before 7 months after ACLR (71.0%) but highly valued return-to-sports testing to determine readiness (94.2%). Higher volume surgeons performed single-stage revision ACLR at a significantly higher rate (79.8% vs 62.9%, P = .02) and significantly differed in return-to-sports criteria, with a greater proportion relying primarily on biometric testing ( P = .01). Conclusion The survey demonstrated that, in the Herodicus Society, a wide range of preferences exist regarding ACLR surgical technique. Bone–patellar tendon–bone autograft is the most frequent primary ACLR graft choice. Most participants have not embraced newer techniques such as anterolateral or suture tape augmentation. Return to sports is generally not allowed before 7 months and heavily factors-in return-to-sports testing metrics, suggesting that purely time-based criteria for return to sports is not modern practice among elite sports medicine surgeons.

Purpose The aim of this study was to examine demographic and surgical factors that influence patient‐reported knee function in patients who undergo anterior crucial ligament reconstruction (ACLR) with concurrent bucket‐handle meniscal tear (BHMT) procedures. We hypothesized that repair of BHMT in the setting of concomitant ACLR and shorter time from injury to surgery would lead to improved patient‐reported outcomes. Methods Forty‐one patients (mean age: 28.0 ± 9.8 years, 72% male) with BHMT at the time of ACLR completed the International Knee Documentation Committee Subjective Knee Form (IKDC‐SKF) via online survey at an average of 15.2 months postop. Patient demographics and surgical characteristics, including time from injury to surgery, were compared between repair (n = 22) and meniscectomy (n = 19) groups using one‐way analysis of variances; distributions of sex, graft source, BHMT compartment and zone were compared between groups using χ² tests. The association between IKDC‐SKF score, demographics and surgical characteristics was evaluated using multivariable linear regression. A priori alpha level was p < 0.05. Results Meniscal repair and meniscectomy groups differed based on graft source and BHMT zone but not IKDC‐SKF score (p = 0.085). Patients undergoing ACLR with autograft (p = 0.003) and with red–red zone BHMT (p < 0.001) more often underwent meniscal repair. The regression model demonstrated longer time from injury to surgery (p = 0.049), red–red tear zone (p = 0.04) and meniscectomy (p = 0.008); these were predictive of poorer IKDC‐SKF scores. Conclusion BHMT repair was more likely performed in ACL autograft and on red–red zone tears. Longer time from injury to surgery is an indicator of poorer IKDC‐SKF score, as this may increase the risk of concomitant pathologies. White–white zone BHMTs are associated with better IKDC‐SKF scores than red–red zone BHMTs, which may be due to the smaller volume of tissue removed during meniscectomy of white–white zone tears and the avoidance of iatrogenic complications of meniscal repair. Level of Evidence Level III, therapeutic study.

Background Lower socioeconomic status and public insurance lead to a longer delay to surgery and a higher likelihood of concomitant pathology before undergoing anterior cruciate ligament reconstruction (ACLR). However, few studies have examined the influence of community deprivation on ACLR timing and outcomes. Purpose/Hypothesis The primary aim of this study was to define the effect of the area deprivation index (ADI) and insurance classification on access to orthopaedic care after an ACL rupture, and the secondary aim was to determine whether these variables were associated with a second ACL injury after primary ACLR. It was hypothesized that patients with a greater national ADI percentile and Medicaid insurance would experience longer delays to care and an increased risk of reinjury after ACLR. Study Design Cohort study; Level of evidence, 3. Methods A retrospective study was performed to evaluate patients undergoing primary ACLR between 2016 and 2019. The national ADI percentile was obtained utilizing the Neighborhood Atlas website. The relationship between national ADI percentile and care characteristics (eg, time to specialized care) was investigated using the Spearman rho correlation coefficient ( r). The association between patient and care characteristics and second ACL injury after the index procedure (ie, graft rerupture or contralateral ACL rupture) was investigated using binary logistic regression. Results A total of 197 patients met the inclusion criteria. Longer times from injury to surgery ( r = 0.238; P < .001) and from specialized care to surgery ( r = 0.217; P = .002) were associated with a greater national ADI percentile. The second injury group reported significantly greater national ADI ( P = .026) and included a greater percentage of patients with Medicaid insurance (31.3%) compared with the no second injury group. Patients experienced 5.1% greater odds of a second ACL injury for each additional month between evaluation and surgery. Conclusion Greater national ADI percentile and Medicaid insurance status were associated with adverse ACLR timing and outcomes. Patients with a greater national ADI percentile took significantly longer to obtain surgery after ACL injury. Those who sustained a second ACL injury after ACLR had an overall higher mean national ADI percentile and included a greater proportion of patients with Medicaid compared with those who did not sustain a second ACL injury. Future studies should critically investigate the underlying factors of these associations to reach equity in orthopaedic care.

Background The Patient Acceptable Symptom State (PASS) after primary hip arthroscopy has been determined; nonetheless, the PASS still needs to be defined for revision hip arthroscopy. Purpose To define minimum 2-year follow-up PASS thresholds for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and International Hip Outcome Tool-12 (iHOT-12) after revision hip arthroscopy, and to identify predictors of achieving the PASS. Study Design Case-control study; Level of evidence, 3. Methods Data were prospectively collected and retrospectively reviewed for all patients who underwent revision hip arthroscopy between April 2017 and July 2020. Patients were included if they had baseline and minimum 2-year follow-up scores for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12. PASS was calculated using the anchor-based method. Receiver operating characteristic curve analysis was used to determine the thresholds for the PASS. A multivariate logistic regression was used to identify predictors for achieving the PASS. Results A total of 318 patients who underwent revision hip arthroscopy met the inclusion criteria. Of those patients, 292 (91.8%) had baseline and minimum 2-year follow-up. Of this group, 68 patients (72.1% female and 27.9% male; mean age, 32.9 years) answered the PASS anchor question. Achievement PASS rates were 58.8%, 41.2%, 52.9%, 60.3%, and 52.9% for the mHHS, NAHS, HOS-SSS, VAS, and iHOT-12, respectively. The area under the curve (AUC) values for the PASS for mHHS, NAHS, HOS-SSS, VAS, and iHOT-12 were 0.912, 0.888, 0.857, 0.903, and 0.871, respectively, indicating excellent discrimination. The PASS for the mHHS was 76 (sensitivity, 0.809; specificity, 0.905), for the NAHS was 86.3 (sensitivity, 0.660; specificity, 1), for the HOS-SSS was 64.3 (sensitivity, 0.745; specificity, 0.905), for the VAS was 3 (sensitivity, 0.830; specificity, 0.905), and for the iHOT-12 was 64.3 (sensitivity, 0.745; specificity, 0.905). Body mass index (BMI) was identified as a significant predictor of achieving PASS for the NAHS (OR, 0.967; 95% CI, 0.940-0.996; P = .027), as patients with a BMI ≤25.4 had 1.03 times higher odds ratio of achieving PASS for the NAHS. Conclusion After revision hip arthroscopy, the minimum 2-year follow-up PASS thresholds for the mHHS, NAHS, HOS-SSS, VAS for pain, and iHOT-12 were 76, 86.3, 64.3, 3, and 64.3, respectively. The odds ratio of achieving PASS for the NAHS was 1.03 times higher for patients with a BMI ≤25.4.

Background The transtendinous technique has been used to treat partial-thickness gluteus medius tears in the setting of concomitant arthroscopy for labral tears. The tendon compression bridge technique for gluteus medius repair has been developed as an alternative method, providing several advantages; however, comparative studies between the 2 techniques are lacking in the literature. Purpose (1) To evaluate the short-term patient-reported outcomes (PROs) of the tendon compression bridge technique and (2) to compare these findings with short-term PROs of the transtendinous technique. Study Design Cohort study; Level of evidence, 3. Methods Data were prospectively collected on patients who were followed for a minimum of 2 years after an endoscopic tendon compression bridge procedure for gluteus medius repair in the setting of concomitant hip arthroscopy for labral tears. The following PROs were collected preoperatively and postoperatively: modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, visual analog scale score for pain, and the International Hip Outcome Tool. Clinical outcomes were assessed using the Patient Acceptable Symptom State, minimal clinically important difference, and maximum outcome improvement satisfaction threshold. Patients were propensity matched 1:1 to a cohort that underwent gluteus medius repair using the endoscopic transtendinous technique with concomitant hip arthroscopy. Results A total of 48 hips (48 patients) that met inclusion criteria (age, 53.3 ± 9.8 years; 92% female; body mass index, 26.7 ± 4.6), with a mean follow-up of 38.5 ± 15.7 months, were matched to 48 hips (46 patients) that underwent gluteus medius repair using the transtendinous technique. Both groups demonstrated significant improvement from preoperative scores to latest follow-up ( P < .05). Mean magnitude of improvement and latest follow-up scores were not significantly different between the tendon compression bridge group and the transtendinous group, and the groups demonstrated similar favorable rates of achieving Minimal Clinically Important Difference (79% vs 79%, respectively), Patient Acceptable Symptom State (73% vs 73%, respectively), and Maximum Outcome Improvement Satisfaction threshold (65% vs 58%, respectively) for modified Harris Hip Score ( P > .05). Patient satisfaction between groups was similar (8.1 ± 2.2 vs 7.7 ± 2.7, respectively) ( P = .475). Conclusion At minimum 2-year follow-up, the endoscopic tendon compression bridge technique for partial-thickness gluteus medius tears, when performed with concomitant hip arthroscopy, was associated with significant improvement in functional outcomes. These postoperative results were comparable with those of a matched cohort that underwent the endoscopic transtendinous technique for partial-thickness gluteus medius tears, suggesting that the tendon compression bridge technique for gluteus medius repair is an effective treatment option for partial-thickness gluteus medius tears.