Background: The minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) are valuable clinical thresholds used to provide clinical relevance to patient outcome scores. In hip arthroscopy (HA) for femoroacetabular impingement (FAI) syndrome, these values have been defined for the short- and midterm postoperative period, but meaningful long-term thresholds have not been established. Purpose: To define the MCID, PASS, and SCB for the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at a minimum follow-up of 10 years for patients who underwent HA for FAI syndrome. Study Design: Case series; Level of evidence, 4. Methods: A retrospective cohort study including all patients who underwent primary HA for FAI with a single surgeon from February 2010 to December 2013 was performed. Patient outcomes were assessed with an anchor question, mHHS, and NAHS at baseline and at 1, 5, and 10 years of follow-up. MCID was calculated using the distribution-based method at all time points, using 0.5 standard deviations as the threshold. The anchor-based MCID, PASS, and SCB were calculated at 10 years using thresholds representing the optimal cutoff on a receiver operating characteristic curve. Correlations between baseline characteristics and achievement of the MCID, PASS, and SCB were assessed with binomial logistic regressions. Results: The 154 patients included in the study had a mean age of 38.8 ± 13.0 years, a mean body mass index of 24.6 ± 3.9 kg/m ² , and 63.6% were female. The distribution-based MCID values for 1-year, 5-year, and 10-year scores were 7.8, 8.3, and 9.5 for mHHS and 9.5, 10.4, and 10.2 for NAHS, respectively. The anchor-based MCID was 20.3 for mHHS and 24.4 for NAHS. The PASS was 81.9 for mHHS and 83.1 for NAHS. The SCB values were 34.0 and 41.9 for mHHS and NAHS, respectively. Increased body mass index was associated with decreased achievement of SCB for mHHS ( P = .03) and NAHS ( P = .04), as well as NAHS PASS ( P = .01) and anchor-based MCID ( P = .01). Conclusion: The establishment of the MCID, SCB, and PASS for the NAHS and mHHS provides a valuable clinical context for improvements in outcome scores after HA. Anchor-based calculations were consistently higher than distribution-based calculations.

Background: Operative treatment of chronic exertional compartment syndrome (CECS) with fasciotomy is effective for symptomatic resolution, but outcomes at medium- to long-term follow-up are unclear. Hypothesis: Patients will have favorable satisfaction at medium- to long-term follow-up and a high return to sport (RTS) rate after fasciotomy for treatment of CECS. Study Design: Cross-sectional. Level of Evidence: Level 3. Methods: Retrospective review of patients who underwent fasciotomy for treatment of CECS from 2010 to 2021. Outcomes were assessed using Tegner Activity Scale, symptom resolution, patient satisfaction, return to activities, and EQ-5D-5L survey. Results: Fifty patients (23 male and 27 female) were included. Mean age at time of surgery was 29.0 ± 11.6 years with mean follow-up 6.0 ± 2.3 years (range, 2.6-10.9). Tegner activity scores at final follow-up were improved compared with symptom onset (mean, 5.2 vs 3.3; P < 0.01). Increased preoperative symptom duration correlated with decreased RTS (β = -0.447; P = 0.01) and return to work (RTW) (β = -0.572; P = 0.01). Patients with a previous psychiatric diagnosis (n = 15) had lower rates of RTS (β = -0.358; P = 0.03) and RTW (β = -0.471, P = 0.02). Mean time to RTS was 5.5 ± 6.1 months. Mean visual analogue scale satisfaction rate was 74.4; 36 (72.0%) patients would be willing to have their fasciotomy again. Patients with fasciotomy of 1 to 2 compartments had higher Tegner score at final follow-up ( P = 0.02) than those who had fasciotomy of >3 compartments; 19 (38.0%) patients reported experiencing paresthesia after their operation. No patients experienced major complications. Conclusion: Medium- to long-term outcomes of patients with CECS treated with fasciotomy demonstrated high satisfaction levels and high RTS rate. However, rate of minor complications including paresthesia, swelling, and cramping was high.

Background: The knee’s inflammatory response to ligamentous, meniscal, and cartilage injuries is complex and incompletely understood, particularly in the setting of concomitant injuries. Recent research has highlighted the potential utility of synovial fluid biomarker analysis in identifying factors involved in the progression of posttraumatic osteoarthritis. Purpose: To investigate if unique patterns of knee injury are associated with distinct synovial fluid biomarker profiles at the time of surgical intervention. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients undergoing arthroscopic knee surgery were prospectively enrolled and asked to complete the Lysholm Knee Scoring Scale and visual analog scale for pain preoperatively. Synovial fluid was aspirated from the operative knee before surgical incision, and the concentrations of 10 biomarkers of interest were quantified. Patients with intraoperative evidence of articular cartilage, meniscal, and/or anterior cruciate ligament (ACL) injury were identified and included for subsequent analysis. Biomarker concentrations were log-normalized and standardized. Principal component analysis (PCA) was performed using biomarker variables to reduce dimensionality and extract key patterns. Multivariable linear regression for each retained principal component (PC) was performed with the predictors of age, sex, body mass index, symptom duration, ACL injury, meniscal injury, and Outerbridge grade. A separate regression analysis was performed to assess relationships between PCs and patient-reported outcomes controlling for the same variables. Results: A total of 387 patients were included in the analysis, of whom 176 (45.5%) had ACL rupture, 327 (84.5%) had meniscal injury, and 225 (58.1%) had cartilage injury. PCA yielded 3 PCs (PC1, PC2, and PC3) that explained 66.9% of variance in biomarker data. PC1 was found with significant loadings of VEGF, IL-6, MMP-3, MIP-1β, and MCP-1; PC2 with TIMP-1 and TIMP-2; and PC3 with RANTES, bFGF, and IL-1RA. Multivariable linear regression found ACL injury ( P = .014; β = .164) and meniscal injury ( P = .029; β = .118) to be positively associated with PC1, Outerbridge grade to be negatively associated with PC2 ( P = .041; β = –.132), and ACL injury to be positively associated with PC3 ( P = .035; β = .141). PC1 was associated with a worse preoperative Lysholm score ( P = .001; β = –.199). Conclusion: Cartilage lesions exhibited a synovial fluid inflammatory profile distinct from ACL and meniscal injury at the time of knee arthroscopy. While ACL and meniscal injuries displayed a pro-inflammatory phenotype, more severe cartilage lesions were associated with a reduced presence of anti-inflammatory markers. The pro-inflammatory phenotype also independently correlated with worse baseline knee function. These findings contribute to the understanding of the pathophysiology of ligamentous, meniscal, and cartilage injuries and may aid in the identification of pathology-specific treatments to help alter the natural history of disease.